TUG and PAP Flap

Utilizing the Inner Thigh to Reconstruct the Breast

TUG/PAP Flap Breast Reconstruction

The most common types of natural tissue breast reconstruction involve the transfer of skin and fat from the abdominal wall to the chest wall. However, for some women, these techniques are ill suited to their needs. Women with slender body types or those who have previously undergone abdominal surgery may consider an alternative – transverse upper gracilis flap (TUG) or profunda artery perforator flap (PAP) breast reconstruction. To learn more about this technique and discover whether you are a candidate for such a procedure, please feel free to contact our reconstructive surgeons today.

TUG or PAP Flap Procedure

During either the TUG flap or PAP flap breast reconstruction procedure, which can be performed immediately following mastectomy or as a delayed surgery, the flap is harvested from one or both inner thighs (for unilateral or bilateral reconstruction). The approach we most commonly utilize involves elevating this flap with a fleur-de-lis pattern through a vertical incision running down the inner thigh as well as a transverse incision just below the groin and buttock crease. With this procedure, the soft, fatty tissue of the inner thigh is transferred as a free flap to the chest. For the TUG flap, this tissue is transferred along with the gracilis muscle (a small adductor muscle) which carries the flap blood vessels. For the PAP flap, the blood vessels are taken without the need to remove any muscle. The choice of flap frequently depends on the patient's anatomy. The blood supply to the flap is then attached microsurgically to vessels on the chest wall. The tissue is used to create a breast shape, and because of the soft, pliable nature of the skin and fat on the inner thigh, this flap provides results that look and feel very natural.

Once the TUG or PAP flap has been transferred, the incisions on the inner thigh are closed. The overall effect is similar to that of a thigh lift; the incisions are typically hidden and the procedure usually has a slimming effect on the donor thigh. In comparison to other non-abdominal breast reconstruction procedures, such as GAP flap reconstruction, the TUG or PAP flap technique tends to be more efficient as the procedure does not require the body position to be changed during surgery.

Illustration © BRO Development, LLC. All Rights Reserved. www.breastreconstruction.org

Risks and Benefits

The specific risks associated with TUG flap or PAP flap surgery relate to the thigh donor site and to the fact that this reconstruction involves a free flap transfer. With experience and skill, these risks can be mitigated. Our team of plastic surgeons specializes in reconstructive microsurgery and is among a small handful in the country that routinely performs TUG flap and PAP flap breast reconstruction. Any potential problems with healing at the thigh donor site are minimized by the use of a vacuum assisted closure dressing on the intact skin repair during the post-operative hospital stay. In addition, lower extremity compression garments should be worn after surgery. Since this is a microsurgical free flap, flap viability is closely monitored in the hospital after surgery. The benefits of TUG flap and PAP flap breast reconstruction clearly outweigh the risks since the outcome provides for a natural, soft breast reconstruction with a typically favorable improvement in appearance at the thigh donor site.


The TUG flap and PAP flap breast reconstruction technique is ideal for patients with slim or athletic bodies, who are lacking excess skin and fat on the abdomen and who may otherwise not be ideal candidates for implant reconstruction. Additionally, patients who have previously undergone abdominal surgery may find that the TUG or PAP flap technique is an attractive alternative to other techniques. Since the size of the breast that can be reconstructed with a TUG or PAP flap is limited by the volume of tissue available on the inner thigh, this technique is usually best suited for women looking to restore small to medium volume breasts.

Contact the Plastic Surgeons of the
New York Breast Reconstruction Associates at Aesthetic Plastic Surgery, PC

Please feel free to contact Aesthetic Plastic Surgery, PC today to arrange a consultation regarding post-mastectomy breast reconstruction. We are among a small group of practices nationwide that routinely performs TUG flap and PAP flap breast reconstruction, a highly effective technique that produces consistent and natural results.


Aesthetic Plastic Surgery, PC Great Neck Office 833 Northern Blvd
Ste 160

Great Neck, NY 11021
(516) 498-8400

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