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An Alternative to DIEP: Breast Reconstruction with Tissue from Your Thighs

If you want to have breast reconstruction with your own tissue but aren’t a candidate for a DIEP flap (or you prefer not to have that procedure), your thighs may be a possible resource for your new breast(s). Although thigh flaps aren’t used as frequently as implants or abdominal flaps for breast reconstruction, they produce very good reconstructive results and also slim the thigh. While the thighs don’t usually provide the same amount of fat as the abdomen, the available soft fat is usually enough to create small- to moderate-sized breasts.

 

New breasts from thigh tissue

Thigh flap procedures are done in the same way a DIEP flap is taken from the abdomen: A microsurgeon carefully removes a segment of skin, fat, and blood vessels, transfers it to the chest, reattaches the small blood vessels to blood vessels in the chest, and then shapes the tissue into a breast. Fatty tissue from one thigh is used for unilateral breast reconstruction; tissue from both thighs is needed to reconstruct both breasts.

 

The crescent shape of thigh flaps offers unique advantages over other autologous tissue flaps: Bringing the ends together creates a natural breast shape with good projection and allows for nipple reconstruction during the initial procedure. Because thigh skin tends to be slightly darker than breast skin, later tattooing of the nipple and areola after a skin-sparing mastectomy may be unnecessary unless you want a deeper pigment. The procedure also slims the thigh, similar to the result of a cosmetic thigh lift.


The PAP flap uses tissue from the upper back of the thigh (left); the TUG flap (center) uses tissue from the inner thigh. The crescent-shaped flap is folded over and the ends joined (center) and relocated to the chest (right).


© 2023 The Complete Guide to Breast Reconstruction, Johns Hopkins University Press

 


Breast Reconstruction with PAP and TUG Flaps

The muscle-sparing profunda artery perforator (PAP) flap removes skin and fat from the upper thigh through a vertical incision down the back of the thigh or a horizontal incision just below the buttock. The underlying muscle is preserved. This procedure is usually a viable option even for women who are thin and lack sufficient tissue elsewhere for breast reconstruction.


The transverse upper gracilis (TUG) flap also uses skin and fat from the upper inner thigh. However, unlike the PAP flap, it includes a portion of the gracilis muscle, a minor muscle that helps flex the knees inward. Losing part of the gracilis doesn’t affect long-term functionality because other muscles pick up the slack. The remaining scar on the upper thigh is usually well disguised and is typically hidden in underwear and swimsuits.

 

Recovery

Breast reconstruction with thigh flaps requires two to three days in the hospital. Recovery can be awkward and restrictive because you’ll need to refrain from flexing your hips or spreading your legs for a couple of weeks to avoid putting tension on the incision. Initial soreness from the surgery lasts about two weeks. Tightness where the tissue was removed gradually improves over several weeks. Wearing a compression garment on your thighs for several weeks will minimize swelling. Your thigh muscles may be weak before your strength eventually returns. You’ll need four to six weeks before resuming most normal activities, and about eight to 12 weeks before returning to strenuous activities or exercise.

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