DIEP vs TUG autologous flap breast reconstruction.

Question

Following mastectomy and implant, I've had CT scans to establish whether I'm a suitable candidate for DIEP reconstruction. I had keyhole abdominal surgery in the past but scans show good blood supply. My surgeon is offering bilateral TUG flap to create a new breast instead of DIEP. I am reluctant to have this procedure and wonder whether anyone can advise why this procedure is being considered over the DIEP. Any advice is very much appreciated.

Benjamin Baker, BMBS MBA FRCS(Plast) · Answer

Thanks for your question. Although DIEP flap reconstruction is considered the gold standard and is suitable for the majority of patients seeking total autologous reconstruction, there are a number of reasons why your surgeon may have offered a thigh flap as an alternative: 
- your abdomen is not of sufficient volume to create a breast of the size that you wish to have, or your abdominal tissues are tight and this will leave you with a high scar following closure. - you have abdominal scarring that prevents use of a DIEP flap (this will not be the case for you if you have had keyhole surgery only in the past)- you do not wish to have abdominal scars and prefer to have scars on your thigh(s)
If you are unsure, I would advise contacting the surgeon or a member of their team to discuss this with them before undergoing your reconstructive surgery. All the best!

Charles K. Lee, MD, FACS · Answer

....but your anatomy will reveal which is the better option.  The DIEP is the first choice for the autologous breast reconstruction; however, I would assume your surgeon is concerned about the abdominal surgery despite the CT angiograms.   The TUG flap is also a good choice and is usually a good second choice if the DIEP is less than optimal.  The donor sites are quite nice for both.

Dean Trotter, MBBS, FRACS · Answer

Both the DIEP and TUG flaps are excellent methods of breast reconstruction.  The DIEP is a more commonly utilised method because it tends to provide a large amount of tissue from an excellent donor site and is supplied by longer and larger blood vessels.  The TUG flap tends to be a second-line method of reconstruction because there is usually less tissue available in the thigh and the vessels that supply the tissue are shorter and smaller in size.  The thigh donor site tends to have more healing problems such as seroma (fluid collection) and the scar is not quite as easy to conceal.  In addition, the TUG flap removes a muscle whereas the DIEP does not.I'm unclear if you are having bilateral breast reconstruction or if you have been advised to have bilateral TUG flaps to reconstruct one breast.  If you are using both thighs to create one breast, that suggests to me that you must have quite a slim physique and it may simply be that you have inadequate abdominal tissue available to allow a DIEP flap to be performed.I think you'd benefit from another consultation with your surgeon to clarify the decision making process.Kind regards,Dean

DIEP vs TUG autologous flap breast reconstruction.

Answers (3)

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