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Reconstruction with Tissue from the Inner Thigh (TMG/TUG or PAP-flap)

As some patients are not suitable candidates for flaps from the lower abdomen tissue can be taken from the inner thigh. This operation is particularly suitable for slender patients with small breasts. The TMG-flap is nourished from a vessels from the gracilis muscle. Therefore it is called 'Transverse Myocutanoeus Gracilis Flap, or sometimes TUG-flap (Transverse upper Gracilis). Another vessel in that area is a perforator vessel from the profund femoral artery; If this supplies the tissue, then it is called PAP-flap.

The scar is placed on the inner thigh. An initially described "tight feeling" at the thigh ceases after 2 to 3 weeks. Persistent hypesthesia of the dorsal thigh is rarely noted. This operation is an excellent alternative to DIEP-flap reconstruction.  


The operation is carried out under general anaesthesia. The inner thigh fat flap is transplanted to the breast together with its vessels and is connected to new vessels in the region of the ribcage or the armpits. The thigh from which the tissue has been taken is closed again by means of an upper thigh lift.

Risks and Possible Complications

In rare cases it may happen that the body does not accept the new tissue. The risk of this happening is below 2%. Here we can try to remove a possible existing thrombosis in the sutured vessels by re-operating immediately. Further risks are problems in healing of the inner thigh. An initially described "tight feeling" at the thigh ceases after 2 to 3 weeks. Persistent hypesthesia of the dorsal thigh is rarely noted. A major asymmetry of the thigh in unilateral transplantations occurs only in rare cases.

Follow-up Treatment

The follow-up treatment is initially more thorough. Patients wear a garment and a support bra for 6 weeks to protect the tissue and to improve the look of the scars. Strenuous activities should be avoided for 6 weeks.

We recommend operations for correction after 6 months at the earliest, that is after the inner scars have healed off completely. Included in the correcting operations are adjusting the lifting or reduction of the other breast and, of course, the remodelling of the nipple. However, all assimilating procedures should have been finished before this last operation.