Transverse Upper Gracilis Flap with Implant In Postmastectomy Breast Reconstruction: a Case Report

Abstract

Autologous flaps can be used in combination with prosthesis in postmastectomy breast reconstruction. The deep inferior epigastric perforator (DIEP) flap is considered the preferred choice among autologous tissue transfer techniques. However, in patients with a peculiar figure (moderately large breasts and large thighs with flat stomach), who cannot use their abdominal tissue, the transverse upper gracilis (TUG) flap with implant is investigated as a further option for breast reconstruction. This report presents a patient who underwent the TUG flap plus implant reconstruction. A bilateral skin-sparing mastectomy was performed removing 340 g for each breast. The volume of the TUG flaps was 225 g (left) and 250 g (right). Preoperative volumes were restored by placing under the TUG muscle a round textured implant. No complications occurred during the postoperative period both in the recipient and donor site and the outcomes of the procedure were good. In cases where the use of the DIEP flap is not possible because of past laparotomies or inadequate abdominal volume, the TUG flap plus implant may be considered as a valid alternative.

The transverse musculo‐cutaneous gracilis flap for breast reconstruction: How to avoid complications

“…In case of inadequate breast volume with TMG flap reconstruction, several autologous options are available to prevent the adjunction of the breast implant . An easy way to safely increase TMG flap volume is through lipomodelling .…”

The use of the Alexis® device in breast augmentation to improve outcomes: a comparative randomized case-control survey

“…The choice of breast augmentation procedure is determined almost entirely by three variables: the selection of incision location, the pocket plane for implant placement (subpectoral, dual plane or subglandular), and the appropriate implant type (6,18).…”

Modern Perforator Flap Imaging with High-Resolution Blood Pool MR Angiography

“…The transverse upper gracilis flap has been used most commonly as an alternative donor site to the abdomen for breast reconstruction in patients with smaller breasts who do not have available abdominal tissue or who prefer to avoid an abdominal or buttock donor site (38)(39)(40)(41). The transverse upper gracilis flap may be harvested with or without the gracilis muscle but includes the overlying subcutaneous fat and skin of the upper inner portion of the thigh (Fig 8).…”