Summary
Autologous tissue microsurgical breast reconstruction is increasingly requested by
women following mastectomy. While the abdomen is the most frequently used donor site,
not all women have enough abdominal tissue excess for a unilateral or bilateral breast
reconstruction. A secondary choice in such women may be the transverse upper gracilis
(TUG) myocutaneous flap. This study reviews our experience with TUG flap breast reconstruction
looking specifically at reconstructive success rate and the requirement for secondary
surgery. A total of 16 free TUG flaps were performed to reconstruct 15 breasts in
eight patients over a period of five years. Data were collected retrospectively by
chart review. Follow up ranged from 14 to 41 months. During the follow up period,
there was one (6.3%) complete flap loss in an immediate breast reconstruction patient.
Four further flaps (25%) failed in their primary aim of breast reconstruction, as
they required additional significant reconstruction with either deep inferior epigastric
perforator (DIEP) flaps (two flaps (12.5%), one patient) or augmentation with silicone
breast implants (two flaps (12.5%), one patient), giving a successful breast reconstruction
rate with the TUG flap of only 66.7%. In all of the remaining reconstructed breasts,
deficient flap volume or breast contour was seen. Eight flaps were augmented by lipofilling.
A total of 62.5% of the donor sites had complications, namely sensory disturbance
of the medial thigh (25%) and poor scar (37.5%) requiring revision. This series demonstrates
a high rate of reconstructive failure and unsatisfactory outcomes from TUG flap breast
reconstruction. We feel this reinforces the necessity of adequate pre-operative patient
assessment and counselling, including discussion regarding the likelihood of subsequent
revisional surgery, before embarking on this form of autologous breast reconstruction.
Keywords
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Article info
Publication history
Published online: March 14, 2012
Accepted:
February 19,
2012
Received:
November 2,
2011
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
