This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.
Question: I am having mastectomy in January; I would like to know about the TUG procedure – if it can be performed following a mastectomy or does it have to be done at the time. I should not be receiving chemo or radiation. My surgery is in Houston ( MD Anderson ). I live in the Nashville area.
Answer: We do not recommend the TUG flap under most circumstances. A significant incidence of lower extremity lymphedema has been reported following its use, and it is often not large enough to provide a satisfactory breast mound by itself. In addition, the donor site is prone to wound healing problems, and the donor site scars can be difficult to conceal.
Our first choice for autogenous breast reconstruction is the DIEP flap from the abdomen, which is a tried-and-true technique. If this donor site is not available, we recommend the SGAP donor site from the upper buttock. The sGAP can produce arguably the best breast reconstruction of any donor site, but is difficult to perform, which usually means the patient needs to travel to get the necessary surgical expertise.
The PAP (profunda artery perforator) flap, which comes from the “banana roll” of the posterior thigh, is our choice if neither the DIEP nor sGAP are available or adequate. It provides about as much volume as the TUG, but has far less risk of lymphedema, and a dramatically better donor site scar.
Any of these flaps can be done at the time of mastectomy or later, with the caveat that you never want to let a flap get radiated, as it can “shrivel up” dramatically. There are advantages to doing the flap at the same time, and advantages to waiting, but probably most of the time it is better to do it at the same time, if possible.
For completeness’ sake, it bears mentioning that if you are not receiving radiation, you may be able to get a satisfactory reconstruction with implants. However, even the best implant reconstruction does not approach the “naturalness’ of a reconstruction using your own tissue.
Thanks for your question, and good luck!
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