TUG/DUG Flap Breast Reconstruction

The TUG/DUG (transverse upper gracilis/diagonal upper gracilis) procedures are two similar types of breast reconstruction surgery that use a patient’s own tissue from the inner thigh to create a new breast after a mastectomy. Along with the PAP procedure, the TUG/DUG procedures are preferred types of natural reconstruction for slim women who lack sufficient donor tissue in their abdomen or for women who already have had abdominal surgery.

These are two of several autologous (own tissue) breast reconstruction procedures offered at Brigham and Women’s Hospital as an alternative to reconstruction with artificial implants. Like many other forms of autologous reconstruction, the TUG/DUG procedures involve the transfer of a complete flap of tissue – including skin, fat, and its accompanying blood supply – to the chest, where the surgeon re-establishes blood flow to the flap through the guidance of a microscope. The flap is then shaped by the surgeon to achieve a very natural appearance and feel to the reconstruction.

Both procedures involve the sacrifice of a small piece of muscle from the inner aspect of the patient’s leg, but do not result in any long-term functional issues, as the muscle is redundant (not needed). The two procedures differ slightly in the orientation of their scars – the TUG being across the thigh and the DUG being angled down the thigh.

TUG/DUG flaps are typically reserved for patients who do not have enough tissue in their abdomen for reconstruction, or for those who have already had abdominal surgery. The amount of tissue available for transfer in TUG/DUG flaps is typically modest – meaning that it is most ideal for patients with smaller breasts (A or B cup).

What Are the Potential Benefits of This Procedure?

• Provides a natural look and feel
• Less post-surgical care as compared to artificial implant surgery
• Viable option for slender women who don’t have sufficient tissue to take from their abdomen or for women who have had previous surgery of the abdomen
• Inner-thigh scar is well hidden
• Doesn’t sacrifice important musculature

Who Is a Good Candidate for This Procedure?

You should consider TUG/DUG reconstruction if you:

• Desire reconstruction using your own tissue
• Do not have sufficient abdominal tissue to create a breast mound
• Have a slender body shape
• Have had previous surgery of the abdomen
• Have had failure of a previous abdominal flap
• Have had failure of a previous implant

More Information

If you have further questions, please contact us.  

Breast Reconstruction Words to Know

• Areola: Pigmented skin surrounding the nipple.
• Breast augmentation: Also known as augmentation mammaplasty; breast enlargement by surgery.
• Breast lift: Also known as mastopexy; surgery to lift the breasts.
• Breast reduction: Reduction of breast size and breast lift by surgery.
• Capsular contracture: A complication of breast implant surgery which occurs when scar tissue that normally forms around the implant tightens and squeezes the implant and becomes firm.
• DIEP flap: Deep Inferior Epigastric perforator flap which takes tissue from the abdomen.
• Donor site: An area of your body where the surgeon harvests skin, muscle and fat to reconstruct your breast – commonly located in less exposed areas of the body such as the back, abdomen or buttocks.
• Flap techniques: Surgical techniques used to reposition your own skin, muscle and fat to reconstruct or cover your breast.
• General anesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness.
• Grafting: A surgical technique to recreate your nipple and areola.
• Intravenous sedation: Sedatives administered by injection into a vein to help you relax.
• Latissimus dorsi flap technique: A surgical technique that uses muscle, fat and skin tunneled under the skin and tissue of a woman’s back to the reconstructed breast and remains attached to its donor site, leaving blood supply intact.
• Local anesthesia: A drug injected directly to the site of an incision during an operation to relieve pain.
• Mastectomy: The removal of the whole breast, typically to rid the body of cancer.
• SGAP flap: Superior Gluteal Artery perforator flap which takes tissue from the buttock.
• Tissue expansion: A surgical technique to stretch your own healthy tissue and create new skin to provide coverage for a breast implant.
• TRAM flap: Also known as transverse rectus abdominus myocutaneous flap, a surgical technique that uses muscle, fat and skin from your own abdomen to reconstruct the breast.
• Transaxillary incision: An incision made in the underarm area.
• TUG/DUG flap: Also known as transverse upper gracilis/diagonal upper gracilis, two similar types of breast reconstruction procedures that use a patient’s own tissue from the inner thigh to create a new breast after a mastectomy.