Reconstruction TUG using 1 02 thighs

[Tricks24]

Afternoon Ladies

i am only 2 weeks diagnosed and yesterday had plastics consult to confirm viability of TUG reconstruction.  I have HRE- ER+ in left side with MX only option so decision has been on recon type - initially own tissue had been ruled out but thankfully plastic specialist has given a ‘green for go’ altho it is a double TUG which is daunting!!  Implant simply wasn’t sitting comfortably with me.

Your stories here I read yesterday after clinic and again today and I truly feel this is the best decision for me personally long term.  I will be starting my list for shopping against your recommendations 😁 Any other helpful hints & tips welcome......I was dreaming of She Wees last night 🤣

Hope to hear from you soon

Best Wishes

xx

[Jmg314]

Hello! I wish you the best of luck with your surgery. The best recommendation I can give you is to take your pain meds as prescribed - the right combination of prescribed and over the counter meds will make your ride home much better. The drains are disgusting but they aren’t in very long! I would suggest a pillow for under your thighs - they will be very uncomfortable but get better in time. I used the mastectomy pillow for the car, for sleeping, and for relaxing. It kept my arms comfortable and gave me something to rest my arms on. Remember everyone’s experiences are different and yours may be better than mine. I don’t regret the procedure at all. It was difficult but I was feeling better each week; after 2 months I’m very active again. Using the bathroom was initially horrible because of the weight put on your stitches. My doctor didn’t fully explain that! I would strongly suggest a soft toilet seat or even a funnel from amazon until your comfort level improves. It takes a few weeks but it gets much better. Good luck and hang in there! 

[lomalley10]

I am scheduled to have Tug flap surgery in 7 days.  Both breast/thighs.  I'm getting a bit anxious as it is getting closer.  I had reconstruction after my bilateral but it has not done well and now the implants are recalled so this is my decision.  I have questions about recovery and what to expect for mobility.  I am also traveling up to the doctor of my choosing so I will be traveling day 7 post op 3 1/2 hours to return home.  Any advice for car comfort and travel?

[Jmg314]

Thank you so much for the encouragement. I’ve tried to wrap my head around the entire process and in the end I know surgery is the best mental and physical option for me! I’m sorry you’ve had to go through this as well. This forum is great for those of us who silently fret but put on the brace face to friends and family how “fine” we are. Many times I haven’t been fine but stressed beyond belief.  But it will get better! So many brave women before me have gone through much worse so I try to remember that. I also read your blog - I’m sorry everything hit you at once. Thanks again for the note! TUG is not that common but I’m thankful it’s an option. Take care and good luck with you’re healing! 💚

[Mai7]

I had a TUG Flag reconstruction just over 4 weeks ago.  I left the hospital shuffling very slowly but have now built up my limp to a faster pace and I'm starting to walk a bit more normal.  Some sitting positions are still a bit difficult but I'm doing well and really glad I had the operation.  I have a plastic stool in the shower as it's hard to balance with the leg surgery and also need wash hair bent over forwards as I dont have enough stretch in my armpit yet to wash hair standing with head tilted back.  The stool also makes it easier to keep the stitches (glue) dryer.  The TUG Flap breast itelf is healing nicely and the bruising is getting better all the time.  I've written a blog about my experience which you can read here:

http://lifeafterlola.blogspot.com/p/delayed-reconstruction.html

Best wishes for your surgery and feel free to ask any questions. x

[TVGirl]

See my post dated 4 December 2018 in this thread - just keep scrolling till you reach it. TUG activities plan highlighted in lilac. Good luck!

[Jmg314]

Correction - forward, not firearm!, of activities chart :cathappy:

[Jmg314]

Hi I’m new to site and missed your post about activities chart. Would you mind giving me title or a firearm? Thx much 

[TVGirl]

They gave me I/v painkiller at the end of the op. I didn’t need any painkillers at all after that, though they did give me ibuprofen & cocodamol to take home, but I didn’t need to take them. The thigh was only sore if I overstretched and pulled on the stitches. There was no pain at all in the breast area.
My thigh drains were removed in the evening of the day after the op. So I was then in normal clothes (including pants!) and strolling around the hospital in my gym wear at a cautiously normal pace. At home I went for a walk every day, going a bit further each day to build it up. I did get a bit out of puff for the first week but it was back to normal after that. I had plenty of energy after 3 weeks so I had to force myself not to overdo it and to stick to the weekly activities chart (see previous post) so as not to risk opening the thigh wound. 
I imagine that having both sides done at once will be more demanding and I hope that it all goes smoothly for you. Best of luck.

[Jmg314]

Hello - having TUG both thighs later this month. I bought flannel shirt dress and Velcro straps for thigh drains. Sounds like pants were an option about a week after surgery. What did you do for pain management? Also, how long before you felt energy return? Thanks so much! I’m sorry you’ve had to go through BC as well. No fun at all but you certainly count your blessings! Regards, Janice 

[amp257]

Not got experience of this but hope it goes well .. sounds an impressive plan and significant change .. all the areas seem to have different expertise .. this option wasn’t offered to me .. but good luck .. will be interested to hear how you get on and good you have a date ! x

[kc72]

Hi Livy

So sorry to hear you have to go through this but hope the info is of some help re TUG expectations and recovery. I’m a year on now, and remain delighted with results/outcome.

If you did have any specific questions feel free to PM me, otherwise best wishes for your op and treatment plan. 

KC72

[Livy]

Oh thank god, you are the only one I've found so far who's had a TUG flap. This may be my only option apart from implant which I don't want so thank you for such a positive outlook. Feeling much happier now.

[kc72]

Hi nicpic. Just wanted to add my experience if of help as make right decision for you.

I was offered immediate recon when diagnosed. A meeting was set up with a plastic surgeon who talked me through my options, advantages and disadvantages of each surgery. He had lots of info, and was able to show lots of pictures of his results which helped me visualise what work was involved, the process and what happens over time to the recon and scars. They need you to be realistic about what’s achievable and how long it takes - it’s a process. My husband came to all appointments with me so he could hear first hand the info and ask his questions too.

I’m 46, size 8-10, B/C cup. DIEP or shoulder were not options for me as I have no spare fat in those places. My options were TUG or implant. I felt I wanted something that was natural and part of me. It will grow and shrink as my body changes over my lifetime. Given my age I was concerned that if I had an implant I’d need further ops when the implant reached its shelf life. Seemed the bigger up front op was better long term to save on future ops for replacements.

I had about 3 meetings with surgeon before op to talk through the surgery in detail and risks. I went to a show and tell event which was invaluable with practical info from nurses and seeing results in the flesh from those who’d had surgery was good to see, hear and understand what’s involved. The event gave me confidence in my decision.

I’ve been very lucky. I had no infections and surgery went to plan. My op was about 7 hrs (single mx, recon and anc). I was rested, physically fit and healthy before my op which helped with recovery. I was in hospital 3 nights. up and walking day after surgery, including stairs. I had my jeans back on 6 days after surgery, dusting and light chores after a week, walking outside within the week, driving at 4 weeks, and ready to go back to work after 6 weeks or so. I went to a dance class again about week 8 - to help regain some of my fitness. You’ll need to do exercises daily to regain flexibility but it all helps you feel your body is making progress.

I’m lucky I had the support of my husband. We don’t have children, so I knew we could both concentrate 100% on my recovery and manage our commitments to suit me. He helped with chores and worked from home for a bit so he was on hand if needed. You need to be selfish to give yourself the best chance possible to get over the op ASAP. I found it helped to have small achievable daily goals to help mentally with feeling every day I was recovering - e.g. today’s the day I’ll cook dinner, have a bath for first time, go outside. Listen to your body - it will tell you when you can move and stretch and when you just need rest.

10 weeks on I’m in a great place physically. My boob has settled, fantastic shape, it’s soft, it wobbles and feels 100% me. I’ll need further 1 or 2 small ops later - to create a nipple plus bit of lipo to make it a bit bigger so I have a matching pair!

For me the tug was the best decision. But it’s a personal choice. Good luck with whatever you choose to do.

[millymop]

Hi Nicpic,

i am 4 weeks post bilateral TUG reconstruction of one breast.  My husband was also very worried about me having this surgery.  He'd been online and read some negative things that worried him.  Many of the posts are quite old and surgery has advanced a lot in the past few years thankfully.

I have other issues which make me more at risk if I pick up an infection so an implant wasn't a realistic option as infection risks are greater with this ( not huge though, just too much for me).  I also felt that even if I didn't get an infection, implants do need replacing as TVgirl says and mean more surgery as I get older (55 now).  The first surgeon I saw ultimately seemed to feel that all she could offer me was a reduction of the healthy breast so that I would need a smaller and lighter prosthesis - not the answer I was looking for.  She did however offer to refer me to a colleague for a second opinion as they had more experience with TUGs.  He has been amazing!  Discussed potential risks and his history of doing op, infection rate etc ( almost non-existent over hundreds of ops).  My husband as reassured by coming to these appointments with me.  

I think all my family were very worried, but eventually when we properly spoke about it, told me that I had to do what I needed to do/ whatever felt right.  

Scars don't worry me too much.  I already had a few big ones!  The scar from my mastectomy was huge and being concave on one side of my chest bothered me much more.  I couldn't have a DIEP because of a large abdominal scar  although if I wasn't vulnerable to infection it could have been used with a mesh for support.  Because I am a D cup and quite slim tissue was taken from both thighs and the scars are quite long.  They are to the inner area of my thigh going down the back of my leg ( slightly different angle to usual to provide more tissue and they are also healing more quickly than usual because that aren't under the buttocks).    I believe that a good surgeon will work with you for the best results.

My expectations of the end result were low - surgeon said it would look fine in a bra but might feel like two rolls of flesh - as 2 flaps used.  But the results really exceed my hopes.  The shape is lovely and looks like a nice pert rounded breast.  It feels warm and looks natural, excepting the scars.  A small area did not take unfortunately,( I am told this is not a frequent problem) but i am assured it will heal naturally.  Might require a small skin graft under local anaesthetic or possibly a small operation to join the edges.  It has not put me off and I would still make the same decision.

To summarise the reasons why I had a reconstruction with my own tissue were partly medical (infection risks), for a more natural end result and no need once nipple etc constructed and breast reduction on other side completed for further surgery in the future.  (Implant is still likely to need nipple construction and symetricisation of other breast from what I have read).  There is certainly more scarring, but my other scars have all faded over time to thin white lines and as I don't go around topless aren't a worry for me aesthetically.

Recovery has been a lot better than I expected!  It is tough, but I am resting lots and my husband is doing a lot around the house.  I believe this is the hardest part, but I am going for short walks and am now driving our automatic car.  Every day feels easier. I could possibly do more, but don't want to risk causing any problems by doing more than I am supposed to.  ( I ignored some of the advice post mastectomy and caused a huge seroma - lesson learnt!).  On the plus side I don't have to consider recovering from more surgery in the years to come.  You will be advised about healthy eating etc before the surgery to increase recovery.  

Sometimes having a choice makes it more difficult!  Ideally you will be advised by doctors who know what they are talking about.  Ask lots of questions and take your husband with you if you can.  Ultimately you need to choose what seems best for you.  Everyone will have different opinions and make different decisions.  I go to a breast cancer support group and people there have chosen to have no reconstruction, implants or various types of own tissue reconstructions and they all seem happy with their own decisions.

Good luck with your decision making.

[TVGirl]

I initially wanted to have a silicone reconstruction as it’s a quicker op and faster recovery. However my plastic surgeon advised me of all the drawbacks of it, eg capsular contracture is common and the contraction can force the implant out of position. Also it needs to be replaced every 10 years I think. Or even removed permanently if your body keeps reacting to it with scar tissue/ contracture. And it’s cold. And it doesn’t feel like it’s part of you or move like it’s part of you.

He told me that the “Gold Standard “ reconstruction op was the DIEP (tummy) reconstruction from own flesh. A much bigger operation, but with  better long-term satisfaction. The new breast is warm and feels like it’s part of you, it moves naturally, no capsular contracture. The main drawbacks are a longer recovery and a scar on the bikini line. Plus all the usual risks of major surgery.

I couldn’t  have a DIEP as I didn’t have enough tummy flesh so I had the second-best  op which is the TUG using thigh flesh. You can see my thigh scars on this thread. I was told that it will be a couple of years before the scars go white, so the pics below are not the final result.

My partner didn’t want me to have the TUG as he was worried about such big surgery. So I talked it through several times with my surgeon, who put me at ease about my many anxieties. I felt fully informed and empowered to make my own decision to go ahead.

I  was also put in touch with a woman who had had the TUG op who showed me her results in detail -  breast & thigh - and spent time explaining everything and answering all my questions. Added to this I went to the Show and Tell evening and saw and heard approx 10 more women talk about their DIEP and TUG ops. I took my partner although obviously he could only attend the Tell part and not the Show part!

In addition 2 close members of my family had DIEP ops 3 years ago and I have a friend who has had a TUG. All are fine and are pleased that they chose that option. In fact we all feel lucky that we were offered this option and had specialist DIEP/TUG surgeons  available locally.

So if there is a difference of opinion about what the best choice is, my suggestion would be to get as much face time with relevant consultants and women, and take the family with you to these meetings.

Does your surgeon do the DIEP and TUG ops?  Or is he/she a silicone specialist? Not all reconstructive surgeons are trained to do both, I think the issue is the specialist extra training in microsurgery needed to connect up the blood supply for DIEP/TUG. Plus the op theatre team needed is bigger - at least 2 surgeons- and the op theatre is needed for much longer, and the post op needs specialist reconstruction nurses on a one to one basis for the first 12-24 hours to check every 15 mins that the blood supply to the transplant is good. All this costs the NHS more  time and more money compared to the silicone option.

It seems to be a matter of luck whether you are referred to a consultant  who specialises in DiEP/TUG  and does it all the time. Maybe a good idea to ask for a consultation with a DIEP & TUG specialist if you haven’t done this already, plus go to Show &Tell plus meet people who’ve had the ops  to help you make up your mind?

[Nicpic]

Hi

New here as recently diagnosed 42years old with smallish breasts , only having mastectomy one side

why did people choose tissue from thigh reconstruction over implant ?

i am very confused

my husband mum and sister want me to have implant for speedier recovery and quicker op, but I don’t want to br left looking odd

my husband is also worried I will hate the scar on my thigh

Any comments greatly appreciated 

thank you

[millymop]

Thank you so much.  This is really helpful!  

Yes, the surgeon is quite relaxed about the unhealed area and says if it doesn't heal he can do more surgery to pull some of the tissue around ????  It just looks yuk!  But still so much better than having nothing there at all.

Thigh wounds are healing well apparently.  

It is great that you can share your experience and reassure others.  Thank you again.

[TVGirl]

Here is the chart that I was given and followed carefully. Please note the asterisked sections re TUG. Also I should add a word of caution that this plan was suitable for me and may not be suitable for everyone. And that recovery from a bilateral TUG is likely to be more demanding than from a one-sided TUG.

Nevertheless it may be a useful guide for you. But don't stress too much about it if things take a little longer for you, we are all so individual.

Sorry to hear that you have an area that isn't healing, this is probably fairly common. I was lucky in that respect. I just kept using the brown tape for 6 months and it all knitted together well.

[TVGirl]

[millymop]

Hi TVGirl,

Thanks so much!  That's very helpful!  I hate feeling so useless and lazy!  But it is very important to make sure I heal properly.  Have a dead area which hasn't taken, so doing dressings and want to make sure it heals asap.  Husband is being very helpful! 

Don't feel I can walk that far yet, but am managing more every day. 

The plan the hospital gave you would be really helpful if you are able to post it   I was only told i could make the odd cup of tea!

[TVGirl]

I am now 2 weeks post lipofill to fill a small dent at the top centre of the new breast. The op took an hour under GA and I was a day case, I spent 5 hours in toto at the hospital.
I am pleased with the results but I am expecting that the op will need to be repeated at least once more, in maybe 6 months’ time, as some of the transplanted fat will inevitably die off.
They took fat from rear thigh and hips. The resultant bruising was just under the skin and my rear thigh did look very black and blue. But it looked much worse than it was, it didn’t hurt at all, maybe just a bit uncomfortable to sit on a hard kitchen chair. No pills needed, not even paracetamol.
The top of the reconstructed breast is now filled out nicely and matches the other one very well. I had a bit of minor bruising at the top of the breast, nothing Technicolor there though.
I came out of hospital with 4 tiny plasters on my legs/hips; these were then swathed in thick cotton wadding around the entire thigh from top to knee and held in place by tight crepe bandages, with my own tight cycle shorts over the top. The wadding/crepe fell apart after 5 days. Its purpose was to prevent further bruising. Legs like tree trunks so I could only get loose yoga pants over the top.
At the breast I had 2 tiny plasters over incisions which each had one stitch in, and for 11 days I had to wear a tight chest binder 24/7 which the hospital gave me, to keep the breast still whilst the fat tried to form a new blood supply. It’s important not to allow movement of the breast which could damage this delicate process. I also had to wear firm-hold Spanx power shorts for 11 days to stop further subcutaneous bleeding and to minimise the dents where the fat was removed. These were very effective and I can’t see any dents now.
I am now wearing a very firm hold sports bra 24/7 for 2 more weeks to keep intact as much of the new blood supply as possible and not to shear the blood vessels by movement at all.
For 11 days it was flannel wash only, I wasn’t allowed to get the plasters wet, also I didn’t take the chest binder off as it would hab been impossible to get it back on without help and I didn’t want to allow the breast to move if not absolutely necessary.
Following the 11 day milestone, I could also dump the compression shorts and drive again, but I have to wait a further 2 weeks before going back to normal activities including sports/gym etc and before I can lose the sports bra 24/7.
At 3 months post op I’ll see the surgeon to decide if the op needs to be repeated in 6 months’ time.
Hope this helps!

[TVGirl]

At 2 weeks I was walking maybe a mile or two with no problem. In fact walking was fine from day one but I was sternly warned not to forget and accidentally step out sideways so as not to open/pull on the scar. I was very careful about lifting for 6 weeks so I made my own meals (sandwich, cups of tea etc) but I didn’t do any family meals involving heavy pots & pans full of water. My partner got everything I needed out of low kitchen cupboards before work and when he got home he picked up anything I’d dropped during the day. He did all the cleaning too. I had to shower in the evening so my partner could put my socks on on the morning before he left for work. I remember it as a fairly quiet 6 weeks full of friends visiting or taking me out to their homes for a lunch standing up in their kitchens.
Did your hospital give you a week-by - week chart of what was permitted? If not I’ll see if I can find mine and post it here.
I was told 6 weeks is the magic time when I can start to get back to normal - driving, sitting etc. And it was correct - at 5 weeks I still could not reach to put socks on and at 6 weeks I could do it.
Hope that is helpful, just take it easy till 6 weeks and walk a bit more every day.

[millymop]

Hi Girls,

you seem to have made amazing progress with your reconstructions.

I'm 11 days post op from bilateral TUG for delayed reconstruction.  Feeling sore (of course!) but improving every day.  Just wondering about when I can start getting back to normal activity wise.  Husband back at work next week and he's been making every meal , drink etc.  I want to be completely independent but was told to do nothing for a couple of months, get a cleaner, dog walker etc.  

How / what were you doing at various stages?  I'm doing very short walks at the moment, but even havinga shower , drying off and getting dressed is quite hard work.

Thanks for any advice you can give 

[TVGirl]

At 6 weeks exactly post-op I sat on a hard kitchen chair for a meal and it felt odd at first but it was easy to do, I was just a bit apprehensive about it. Within a couple of days later, sitting was completely back to normal.

I would say don't push yourself: I was told to avoid sitting whenever possible. Lie down on a couch like the Romans to eat!

I also started driving again at 6 weeks, which was liberating.

I wouldn't have wanted to go back to work at 6 weeks, I would take an extra week to do all those things I'd not been able to do whilst recovering.

Yes, I'm at QVH, what an awesome place that is!  We are so lucky to have a specialist plastics hospital in our region.

I'll let you know how the next stage goes.

[LozC28]

Thank you, I can’t tell you how relieved I am that the worst is over! I’m sure you feel like that too.

It’s comforting to know that you didn’t sit down for 6 weeks, I’ve been trying to push myself to keep trying (thinking that I should be able to do it) but I just find it so uncomfortable and it makes me feel nervous that I might be opening up the scars. Did you find after 6 weeks this was then easy to do? I’m due to go back to work after 6 weeks (from discharge) but may need to extend that. 

Ohh excellent news, you will have to let me know how you get on with the fat transfer operation, if I remember correctly we’re both under Queen Victoria in East Grinstead.

It sounds like your recovery went well, so you should congratulate yourself too 😊

[TVGirl]

Well done, the worst is definitely over!

I’ve got my first fat transfer op next month, they are taking it by liposuction from my non-operated thigh to even up the 2 thighs’ shape. They will do a small lift on the other breast at the same time. 90 mins in total in the operating theatre for these procedures.

Then 2 more fat transfers are planned down the line followed by nipple creation, tattooing and then it’s all done.

I didn’t sit down at all for 6 weeks except when I had to travel by car to the hospital. I was told that sitting on the wound reduces blood supply to it and could slow healing process. Also I didn’t want to stretch the scar at all. The sugeon told me that if I did ever have to sit down, it should always be on a soft cushion/pillow to reduce pressure on the wound.

i didn’t have any problems getting into the shower, maybe this is because I led with my “good” leg for this, I’m not sure.

You are doing very well considering that you have had much more surgery in one go than I did - you should congratulate yourself! And you will never have to worry about getting breast cancer again!!!

[LozC28]

I forgot to add, a front fastening bra and night shirt is also something I would recommend taking into hospital with you.

[LozC28]

Hi

I'm so sorry for the delay in getting back to you, I wanted to thank you for all the really helpful information you have provided. I am now 4 weeks post surgery and often refer back to your post to see what you were able to do at each stage!

I also wanted to comment on my experience just so there is a bit more information out there for others who decide to have the TUG flap reconstruction. 

The operation:

I had a bilateral mastectomy and immediate bilateral TUG flap reconstruction, for me it was preventative surgery as I carry the BRCA 1 gene.

The operation took between 9 and 10 hours in total. Im very pleased with the results, I have a good shape and the size of my boobs are very similar to the size I was before. I was also very lucky in that the surgeon also managed to make some nipples at the same time (but I understand this doesn’t always work). One boob is slightly larger than the other, but it is not that noticeable and my surgeon mentioned this could be rectified with some fat grafting in the future. 

My operation was on a Tuesday and I was home by Friday afternoon. When you get picked up to go home, I would recommend sitting on a pillow in the car and placing a small pillow between the seatbelt and your chest.

The recovery:

I have to say that I found the first 7-10 days quite difficult, mainly because it’s quite an effort moving in general. Going to the toilet is also quite difficult and I found I was holding on to the sink so that I didn’t put all my weight down.  I needed help with pretty much everything, including putting my own knickers and clothes on. Unfortunately, I do not have a walk in shower at home so initially I was having sink washes or going round to my aunties to use their showers! After about 10 days - 2 weeks I started to use steps (a gym box one side and then another step in the shower) to get into the shower (and still do), this was something I hadn’t really considered before the operation. 

I am still struggling to sit upright in a chair and as TV girl pointed out it is not particularly comfortable given the position of the scars on the back of my legs. I still can’t put my own shoes either. I would recommend buying a V pillow, I use this during the day and when I sleep. I found, at first, that I couldn’t lie too flat as it made my chest feel very heavy. I also sit and sleep on a blanket to provide a softer surface for the scars.

I have tried to make myself go out for short walks each day, you are told to keep your knees together for at least 4 weeks so my walking resembled that of a penguin! To be honest, in the early days it is hard to walk normally anyway. I would say that I am now walking normally, albeit still quite slowly. 

A week after I was discharged I went back for a dressing change, but after this  you are required to do it yourself at home. I change my dressings every 5/7 days.

I was very focused on getting to the operation and getting that part over with that I hadn’t given the recovery process much thought. Initially I found it frustrating but once I gave into the fact that it was going to take time I felt much better. You will definitely need someone at home for the first 2 weeks after you are discharged. 

I have a follow up appointment with the surgeon next week so I will post again if he gives me any more information or tips. Please feel free to ask any questions 🙂 

[TVGirl]

Hi!

I also had problems getting enough specific info which is why I've posted on here to help others.

Please bear in mind that I had the mastectomy done seperately a couple of years before the reconstruction.

Mastectomy:

Whilst in hospital after the mastectomy I just wore the hospital gown as I had leaky drains in for 12 hours. Then they sent me home with no drains and I wore a baggy button-up shirt like this one for about two weeks. It made it easy to change clothes as my armpit was sore where they took a few lymph nodes to check them. The breast area wasn't sore at all. I did get a small seroma but it didn't affect the bra size in any way. I wore the same bra for the mastectomy and for the delayed reconstruction.

I had the mastectomy at 8pm and I went home at 10 the next morning. I was up and about pottering at home thereafter although I did watch a lot of tv as I didn't want to hold much more than a cup of tea for the first few days. It got easier every day and I could do more and more.

Reconstruction:

After the delayed reconstruction this year, day and night, I wore a bra like this full cup sumptuously soft one with padding. I wore my usual size, I didn't have any significant swelling at all. The consultant really liked the shape of the soft light padding which helped to maintain/mould the shape of the new breast whilst it healed. It was very comfortable to sleep in. I'd suggest you buy one bra in your size, one in the next cup size up, and one bra back expander. Then after the op get someone to return the ones you don't need and get a few more in the correct size.

On top of the bra, whilst I had drains in for 24 hours in hospital, I wore the hospital gown. Thereafter I wore a sleveless yoga top like this one. Combined with just the cycle shorts it looked like I was alwys on my way to the gym!

For cycle shorts I wore expensive power shorts like these for 6 weeks, to compress the scar and to mould the thigh into a decent shape whilst it healed. Well worth the money. I was on the cusp between 2 sizes and so I got the bigger one. The lycra was very strong and it was the right choice.

For trousers I wore cotton joggers like these over my cycle shorts. They were very cheap, and quick and easy to wash if the leg wound oozed at all.

I had the delayed reconstruction on day one and I went home on day 3.  I was up and about immediately but I was told not to sit down for I think 6 weeks unless unavoidable e.g. for the car journey home from hospital. Standing, walking, & stairs were no problem. Getting to sit eg on the loo was very difficult for a week or even two as I was very worried about tearing my stitches out or opening the wound.

My legs were very restricted in the amount the skin at the rear would stretch and they took exactly 6 weeks to fully recover. So do expect to eat standing up at the kitchen counter and to be very cautious lowering yourself onto the loo in the early days. Plus you may have read my whinges elsewhere on this site about not being able to reach my feet to put on my socks or cut my toenails. All these recovered well, it just needed patience, plus a bit of care and luck with the wound healing.

It's nearly 6 months after my reconstruction now and I am thrilled with the result. My surgeon is going to do a small breast lift on the unoperated breast, then 3 lots of lipo fat transfer over the next few months so the 2 breasts are as identical as possible, and also nipple construction and tattooing. Apparently you usually need 3 lots of lipo as 50% of the fat transfered gets reabsorbed each time. So in maybe a year from now I will have finished all the reconstruction work.

I hope this covers everything you wanted to know and do ask if you need any more info. I guess that a double reconstruction will be more demanding on you  in the recovery period than a single one and I wish you all the best.

[LozC28]

Hi

Firstly, thank you so much for posting on the site, I have been really struggling to find other people who have had theTUG flap, and the information you have provided has been so helpful. Also the results of your TUG flap are amazing!

 I’m due to have this done in 4 weeks time (preventive surgery as I’m a BRCA 1 carrier). I have a few questions about what I should expect post surgery.  For example, what did you wear? At the moment, I’m thinking loose, baggy trousers and tops which button down the front? And how long was it before you were up and walking about? Did you have much swelling? I’m just tying to work what size post operative bras to buy!

Any information would be greatly appreciated.

Thank you.

[TVGirl]

Hi 

No, I don’t have any internal nerve pain, I never had any at all right from the start. My thigh is completely pain-free. I was given paracetamol and neurofen to take home but to be honest I didn’t need these. Both op sites were just a bit sore/tender if you touched them.  A lot of the tiny nerves in the skin are cut and the breast and thigh skins are permanently numb for maybe an inch all around the wounds.

You could ask your consultant about this and any other concerns as they arise, as far as I know the Specialist Breast Reconstruction Plastic Surgeons know about the risks and are very careful to avoid damaging the main internal nerve in the area. Definitely discuss this with your surgeon and he should be able to reassure you. Maybe something along the lines of “Have you ever had a TUG patient who has had a problem with this?”

I took a list with me to see my surgeon every visit and we spent 20mins going through it so he could reassure me on every point. This happened on maybe 3 separate visits as I thought of new questions such as  ”how many TUGs do you personally do per year and has anyone ever had any problems?”

Wound healing /opening / infection is a known potential problem for everyone in the thigh area and I had to go on a “Prehabilitate” programme run by the anaesthetists to ensure optimum physical condition going into the op. This involved  a month of ultra-healthy diet with no treats - plenty of protein and vitamins instead! -, no coffee, no alcohol, no smoking, plus 30 mins of vigorous exercise daily and 30 mins of relaxation /meditation daily. And no flights pre-op.

I met a woman whose thigh wound just wouldn’t knit together post-op and it took maybe 9 months for new skin to grow across. But she was still happy 3 years later that she had had the op.

My hospital monitors you every 15 mins for 12 hours after the op, then every 30 mins for another 12 hours, then hourly, to make sure that the transplant isn’t failing (losing its blood supply). They have a full theatre team on standby in the hospital all night  post-op and an empty theatre always ready so they can rush you back into theatre and quickly restore the blood supply if it seems to be developing any problems. I think that they have 9 or 10 specialist consultants in reconstruction. I would imagine that your hospital follows the same protocol but it may not have the luxury of an empty theatre if it’s not a specialist hospital for  reconstruction only. So it’s worth asking what happens if the transplant needs fixing in the hours after the op.

Do you have a specialist Breast Reconstruction Nurse that you can call at your hospital and chat through any worries or concerns you may have during your wait for surgery? Maybe she can put you in touch with another  person who has had a TUG who you can speak to in detail about it?

Hearing about your wait,  I feel very lucky that I only waited 4 months once I’d made my mind up, but I could have had my op within a month if I’d been willing to have it at short notice in December.

I wasn’t psychologically bothered when I was flat on one side, although I know many people understandably are. My main reason for having the op was that I was fed up with all the clothing and neckline issues that being flat brings. It’s such a relief not to have to think about that any more.

I hope that this helps you and I think that an occasional chat with your surgeon and/or reconstruction nurse may help you as worries / concerns inevitably arise during your wait.

Best of luck.

[Janco]

Hi

i have only just picked up this reply and phot, thank you so much for taking the time to do this, it’s very helpful.  I am feeling positive now and more willing to give this a shot.  I’m on a long waiting list so it may be April 2019 when it’s scheduled, so I have time to prepare and think about it.  

After the problems I’ve had with previous surgeries, I am most concerned about nerve pain and ongoing problems in the donor site.  How are you now, still pain free?   No I am told that having soft tissue again in the  breast area is psychologically a big step forward. 

Thank you. 

[TVGirl]

I’ve added another pic, standing up this time. You can see the differing contours of the thighs and also the scar without the tape.

Very best of luck with your decision.

[TVGirl]

[Janco]

Wow, I can’t thank you enough for such a comprehensive reply.  When I saw the photo I wondered why you had posted a ‘before’ photo, then realised my mistake, no one would ever know that there was a difference, you are so right.  And the fact that you can do Pilates and sport, amazing, this has inspired me.  I am currently under the Royal Victoria Infirmary at Newcastle for this proposed operation.  Waiting list is 1 year. When I had my failed surgery at York and realised that they couldn’t offer me a corrective solution, I had consults in London with what my husband and I researched to be the best people.  They raised my hopes and suggested various options, it was obviously difficult to imagine how it would work logistically with me living in York and having surgery in London, when you need so many checks and visits both before and after, so we asked who was the best in the North and somewhere along the line my current consultant at the RVI was mentioned. I was referred there. He immediately advised me that previous options discussed would not work and has built my confidence in him, advising that only the TUG is viable. How on earth do you know if a consultant is as good as those at QVH, I don’t know.  Thank you for your message, it has inspired me and made me realise that this could actually give me a solution. 

[TVGirl]

I’ve just posted a pic of my thighs taken today, I’m dress size 12, you can see that the difference between the 2 sides is minimal. You can also see the micropore tape covering the scar. The scar itself is approx 3mm wide now.

Hope this helps.

[TVGirl]

[TVGirl]

I am now 4 months post delayed -TUG and I am now very very pleased that I went ahead with it. I was very unsure if I wanted to do it.

I had it done at QVH East Grinstead which is a specialist plastics reconstruction centre for this op, 40 miles from my home. Their failure rate is exceptionally low. I would suggest that you get a consultation at a specialist plastics reconstruction centre like that in your region, if there is one, especially as you have already had 2 failures.  There was a woman at the ‘Show and Tell’ evening at East Grinstead who had had multiple failures before she went there and her surgeon worked miracles for her. I think that you are entitled to be referred to QVH from anywhere in the UK if you feel up to travelling. I had 4 consultations with my surgeon whilst I was making my mind up to go ahead (minimum would be 1 or 2), plus the Show and Tell evening, plus 1 pre-op visit. Post op I visited at 1 week, 6 weeks and 3 months.

My left thigh is now approx 1-2cm smaller in circumference just at the very top. No one would ever notice this except you!  I have a flat thin scar approx 1-2cm below the bikini line at the front and it’s hidden in the bum-cheek crease at the rear. The scars are very neat and will fade to white over time. I have 2 horizontal scars on the breast, both thin flat lines, sited above and below the transplanted skin from the thigh. These are below the top of a balcony bra and I don’t have to wear the hated full-cup bras any more. I have to wear micropore tape over the scars to keep them flat as they heal. The inner thigh skin is darker than the natural breast skin and there isn’t anything you can do about this, but the colour difference  is hidden by a bra.  It’s also a good idea to have laser hair removal  on the bikini line before the op, to stop hairs appearing on the new boob - although you can always get this done afterwards.

I don’t have any pain at all now. At 6 weeks my surgeon told me to go to some yoga and Pilates classes to stretch the scars (no chance of me opening my wounds by that stage). The yoga and Pilates were miraculous and within a week I could reach my feet etc. I then gingerly went back to tennis and it took a couple of weeks to get my thigh muscles back to strength again. The operated thigh does still twinge the morning after I do squats and lunges in the gym but it is not a big issue. My thigh is not tight at all now.

I am now planning to have my other boob lifted to match after the summer and the surgeon will also do some liposuction at the same time from the “good” thigh to fill in the slight hollow at the top of the new boob. This hollow is normal and I am told it needs 2-3 lipo sessions (local anaesthetic) to fill it over the course of a year or so. I will also have a nipple created and tattooed in exactly the right position to match once everything has settled down.

I hope this answers all your questions and do get in touch if I can help any more. Best of luck with your decision.

[Janco]

Hi. I am currently on the waiting list for TUG, which is my last chance. I had a mastectomy and LD back muscle transfer which was unsuccessful.  It’s been a terrible experience.  I also had an inplant but it had to be removed as I had an infection.  Because of this I am very wary of having more surgery but what I am left with isn’t standard, it’s pretty grotesque. Please can you tell me if your thigh is really obviously smaller than the other, if you have any pain and how neat the scars are.  Has the tightness got better at all?  I still have this in my back from where the muscle was taken and to be honest I don’t relish having 2 areas. Many thanks. 

[TVGirl]

Today I am 4 weeks post delayed unIlateral TUG op, the op took 4.5 hours. My left thigh was used to make a new right breast, B cup to match the existing one. I spent 2 nights in hospital. I only took paracetamol & nurofen for a few days afterwards.

I am delighted with the new breast size and shape - pert and youthful, warm and soft - and it feels like me. I have a couple of small mildly tender points near the sternum where there are big internal stitches yet to dissolve; otherwise it is pain-free.

My left breast will not be lifted to match until a much later date when any swelling in the new breast has disappeared. The surgeon is hopeful of visually getting a really good match in this way. The new nipple will then be created a few weeks later, followed by tattooing when the nipple has healed.

The thigh healing has been uneventful so far.  BUT I have an incredibly tightly stretched feeling all the way down the centre rear of my thigh to just above the knee. At the moment I literally can’t reach to put on my left shoe and sock without help, nor reach my left foot to wash it or cut my toenails, and I can’t pick things up from the floor. I can sit for short periods (10 mins) but my surgeon isn’t keen on me sitting as the pressure can delay the wound healing. It’s also uncomfortable anyway. I certainly wouldn’t want to drive yet. However I can easily walk 10,000 steps a day with no problem, uphill, downhill and briskly.

 I think that all this is probably very normal at 4 weeks post-op. I don’t want to put you off, just to explain that, if you are like me, you will not be able to do certain things for a considerable period and you need patience. Before the op I was a very sporty person so it is very frustrating not to be able to get back to my sports at the moment.

Before the op I had a prosthesis for 18 months, then had 3 very long consultations with my onco-plastic surgeon before I finally decided to go ahead with the TUG; I was trying to persuade him to give me a silicone implant or a DIEP but he refused as he strongly felt he wouldn’t get the best possible result with these.  It took about a year from the first time I saw him to the TUG op happening.

The op you are considering is obviously bigger and more complex than I have had, and my only advice is not to expect to be able to do very much for many weeks afterwards.

Happy to answer any questions. Good luck with your surgery.

[HelenaR_BCC]

Hi brenda.edge,
I’m sorry you haven’t yet received a response to your question - hopefully one of our lovely forum members will be along to offer advice soon. I did find the following discussion which might be of interest https://forum.breastcancercare.org.uk/t5/Surgery/Delayed-reconstruction-using-thigh-flap-TUG-has-any...
All the best, Helena

[brenda.edge]

Hi am on list for TUG reconstruction after left breast mastectomy using 1 or 2 thighs, depending on breast reduction on other side( involving removing implant and then uplift), Surgeon proposes to do lot in 1 op and even make a new nipple - 9/10 hours surgery. At moment DD will be B?Any one had TUG flap can tell me their experiences. Very apprehensive! Thanks