What does TMG mean?
Transverse myocutaneous gracilis flap.
It is also commonly called a transverse upper gracilis, or TUG, flap. It includes upper inner-thigh skin, fat, and part or all of the gracilis muscle.
Breast & Chest • Reconstruction
TMG Flap Breast Reconstruction
TMG flap breast reconstruction uses skin, fat, and gracilis muscle from the upper inner thigh to rebuild a breast after mastectomy.
Who might consider it?
Someone who wants their own tissue and has suitable inner-thigh tissue.
It may be considered when abdominal tissue is limited or unsuitable. Breast size, thigh anatomy, health, and treatment plans all affect suitability.
Is it a major operation?
Yes. It involves microsurgery and recovery at both the chest and thigh.
The tissue is fully detached, and its blood vessels are connected to vessels in the chest. Hospital monitoring helps the team check its blood supply.
01 · Overview
Rebuilding a breast with inner-thigh tissue
A TMG flap creates a breast mound using living tissue from the upper inner thigh. The surgeon transfers skin, fat, and gracilis muscle to the chest, reconnects tiny blood vessels, and shapes the tissue. This approach is also commonly called a TUG flap. [1]
The inner thigh usually provides less tissue than the abdomen, so this approach often fits smaller breast-volume goals. It may be an option when abdominal tissue is not available or when you prefer a thigh donor site. The surgeon must assess whether there is enough tissue and a suitable blood supply. [1]
Reconstruction can sometimes start during mastectomy or take place later. Radiation, other cancer treatment, previous surgery, and your health can affect that timing. A breast mound does not replace normal breast tissue, restore normal sensation, or remove the need for cancer follow-up. [2]
- Tissue source
- Upper inner thigh
- Flap type
- Free flap containing skin, fat, and muscle
- Anesthesia
- General anesthesia
- Care setting
- Hospital surgery with inpatient monitoring
How is TMG different from a PAP or DIEP flap?
TMG includes gracilis muscle from the inner thigh. A PAP flap uses thigh skin and fat while preserving that muscle. A DIEP flap uses abdominal skin and fat while preserving abdominal muscle. Each has different tissue-volume, blood-vessel, scar, and recovery considerations.
Will removing gracilis muscle affect walking?
Other muscles help perform similar movements, so many people retain good everyday leg function. Temporary weakness, tightness, or discomfort can occur, and lasting changes are possible. Discuss sports, physical work, and any existing leg problems before surgery.
02 · Concerns & Goals
What you may want to discuss
Choosing reconstruction means considering your chest, the tissue donor area, and the recovery that fits your life. Your priorities help guide the discussion.
Restoring a breast mound
You may want a breast shape after mastectomy that feels like part of your body. The amount of available thigh tissue sets limits on size and projection.
Avoiding an abdominal donor site
A thigh flap may be worth discussing if you have limited abdominal tissue, previous abdominal surgery, or a preference to avoid an abdominal scar.
Breast balance
Matching the opposite breast may involve a later adjustment to the reconstructed breast, the other breast, or both. Exact symmetry is not realistic.
Thigh appearance and comfort
The donor thigh can look and feel different afterward. Scar position, contour changes, sitting comfort, and leg movement deserve as much discussion as the breast result.
03 · Options
How the approaches differ
These are planning choices within TMG flap reconstruction, not options that suit everyone. Your microsurgeon and cancer-care team can explain which are reasonable for you.
Immediate TMG reconstruction
Reconstruction begins during the mastectomy operation.
How it worksThe flap is transferred after breast tissue is removed, when the cancer and surgical plans allow.
May suitPeople whose health, anatomy, and treatment plan support a combined operation.
Main tradeoffIt combines procedures into a longer operation, and later treatment can affect the reconstruction.
Delayed TMG reconstruction
Reconstruction takes place after mastectomy recovery or cancer treatment.
How it worksThe surgeon rebuilds the breast mound at a separate operation.
May suitPeople who need or prefer more time before reconstruction.
Main tradeoffIt requires another major operation, and scarring or radiation changes may make planning more complex.
One-sided TMG reconstruction
Thigh tissue is used to rebuild one breast.
How it worksA flap is usually taken from one inner thigh and shaped to suit the chest and opposite breast.
May suitPeople needing one breast reconstructed with a suitable tissue-volume match.
Main tradeoffThere may be differences between the thighs and breasts; balancing procedures may be discussed.
Two-sided TMG reconstruction
Tissue from both inner thighs may be used to rebuild both breasts.
How it worksA separate flap from each thigh is transferred to each side of the chest.
May suitPeople needing both breasts reconstructed who have suitable tissue and can safely undergo the operation.
Main tradeoffBoth thighs need to heal, surgery is more extensive, and available volume may still limit breast size.
Flap selection and timing depend on donor tissue, circulation, overall health, prior treatment, and the surgeon's microsurgical assessment. [1] [2].
What if one thigh does not provide enough volume?
A different donor site, later fat grafting, or another reconstruction strategy may better fit your goals. Some specialized plans combine flaps or use an implant, but these add complexity and are not necessary or appropriate for everyone.
Does TMG reconstruction include a nipple?
Not automatically. Whether your nipple can be preserved depends on the mastectomy plan. Nipple reconstruction or tattooing may be discussed after the breast mound heals.
04 · Results
What may improve and what may remain
Breast shape and feel
Your own tissue can create a breast mound, but it will not be identical to the original breast.
- Available thigh tissue influences breast size and projection.
- Sensation is usually reduced or altered, and normal sensation may not return.
- Swelling and tissue settling change the appearance over time.
Changes at the thigh
The donor site is part of the long-term result.
- A scar usually lies near the upper inner-thigh crease, though its position and length vary.
- Contour differences, tightness, numbness, or weakness can remain.
- Using one thigh may leave more noticeable differences between the legs.
A staged process
The first operation may not be the final step.
- Later fat grafting, scar revision, or breast balancing may be considered.
- Weight changes, aging, and radiation can change the reconstructed breast.
- Nipple reconstruction or tattooing is usually a separate decision.
Reconstruction results develop over months. Scars remain, and additional procedures may be needed to address shape, symmetry, or complications. [2]
05 · Recovery
Planning your recovery
Recovery at a glance
- Stay after surgery
- Determined by Your Surgeon
- Initial recovery at home
- Varies by Individual
- Return to desk work
- Varies by Procedure and Work Activity
- Light daily activities
- Based on Individual Recovery
- Strenuous exercise
- Based on Surgeon Clearance
Returning to work does not mean fully healed. Follow your surgeon’s instructions; strenuous activity requires clearance.
Recovery involves both the chest and inner thigh. Your surgical team will tailor movement, wound care, and activity limits to your flap, donor-site closure, and healing.
Step 1 · Day of surgery
Treatment day
After general anesthesia, the team monitors the transferred tissue's circulation and manages pain. You may have drains at the chest and thigh.
Step 2 · First several days
Hospital recovery
Staff continue flap checks and help you begin movement safely. Discharge depends on flap health, comfort, mobility, and whether you have the support needed at home.
Step 3 · First few weeks
Early home recovery
Fatigue, swelling, and tightness can limit daily tasks. Visits allow the team to assess wounds, remove drains when appropriate, and adjust restrictions.
Step 4 · Following weeks to months
Gradual return
Work and exercise resume in stages with clearance. Returning to work is not the same as complete healing; deeper tissue recovery and scar changes continue.
Planning everyday activities
ActivityGeneral planning contextWhat affects the plan
Walking and stairsPlanning context: Assisted movement usually begins in the hospital. [3]What affects it: Thigh discomfort and balance may affect pace, stride, and stair use. Ask how to progress safely.
Sitting and drivingPlanning context: Inner-thigh closure can make sitting uncomfortable.What affects it: Driving requires safe movement, emergency braking, and being off impairing medicines, as well as surgical clearance.
Work and household tasksPlanning context: Plan for several weeks away, with timing adjusted to your job and healing.What affects it: Physical work, long commutes, lifting, and prolonged sitting may require more time or modified duties.
Exercise and liftingPlanning context: Resume in stages rather than by a fixed calendar. [3]What affects it: Chest strain and wide leg movements can stress healing areas. Ask for specific limits and a rehabilitation plan.
Follow your surgical team's instructions even if you feel ready sooner. Ask before applying pressure, heat, or cold to areas with altered sensation.
Before your procedure
- Review cancer treatment and reconstruction timing with both surgical teams.
- Discuss previous operations, blood clots, leg swelling, and any walking or strength concerns.
- Provide a full medication and supplement list; ask which changes are needed rather than stopping medicines yourself.
- Discuss smoking, vaping, and all nicotine use, including the team's requirements before and after surgery.
- Arrange transportation and help with meals, household tasks, children, or pets.
- Ask about expected scars, hospital stay, drain care, follow-up visits, and an after-hours contact number.
Will I need special garments?
Your surgeon may recommend a particular bra or donor-site garment, or may want pressure avoided in certain areas. Ask what to wear, how it should fit, and when to start; do not assume a tight garment is helpful.
What if I live far from the surgical hospital?
Discuss how long to stay nearby, where follow-up will occur, and where to go for urgent flap concerns. Long travel also needs planning around mobility and blood-clot risk.
06 · Safety
Risks and what your clinician assesses
Temporary swelling, bruising, soreness, fatigue, and altered sensation can occur at both sites. These should be monitored through follow-up; a sudden or worsening change should not be assumed to be routine recovery.
Blood-supply problems and flap loss
A clot or circulation problem can threaten the transferred tissue and require urgent surgery. Part or all of the flap may be lost despite treatment.
Bleeding or fluid buildup
Blood or fluid can collect at the chest or thigh. Drainage, another procedure, or occasionally transfusion may be needed.
Infection and delayed healing
Wounds may become infected or open, including at the inner-thigh closure. Treatment may involve dressings, antibiotics, or surgery.
Fat necrosis and contour changes
Areas of fat can become firm when their blood supply is inadequate. Lumps, unevenness, or volume loss may require assessment or treatment.
Donor-site and sensation changes
Thigh scarring, contour differences, persistent pain, numbness, weakness, or leg swelling can occur. Breast sensation may remain reduced.
Anesthesia and blood clots
Major surgery carries anesthesia risks and the risk of clots in the legs or lungs. Your team assesses risk and plans prevention.
Discuss these risks and your individual health history with your surgeon. [4]
What your clinician assesses
- Inner-thigh tissue volume, skin quality, blood-vessel anatomy, and desired breast size
- Chest skin, prior mastectomy or radiation, scars, and ongoing cancer treatment
- Heart and lung health, diabetes, nicotine use, medications, and clotting history
- Baseline leg function, home support, recovery demands, and expectations
07 · Costs
What makes up the Total Procedure & Care Cost
Compare written estimates for the same planned scope: one or both breasts, timing with mastectomy, hospital care, and any planned later procedures. Ask the insurer and surgical team about coverage and authorization.
Surgeon
Surgical care
Surgeon services for flap transfer, microsurgery, and breast shaping.
Ask your surgeonAsk whether mastectomy, assistant surgeons, balancing surgery, or later revisions are billed separately.
Facility
Anesthesia and facility
Anesthesia, operating room services, inpatient care, and flap monitoring.
Ask your surgeonConfirm network status and how a longer stay or unplanned return to surgery would be handled.
Supplies
Supplies and follow-up
Potential charges for dressings, garments, medicines, follow-up, and rehabilitation.
Ask your surgeonAsk which items and visits are included, and for how long.
TRC
Patient Services
Any separately listed care-coordination or administrative services.
Ask TRCAsk whether these services apply, what they include, and whether they are optional or covered by insurance.
Your written estimate should explain the services included, any separate charges, and payment terms.
08 · Questions
Common questions
Are TMG and TUG the same procedure?
The names are commonly used for the same upper inner-thigh gracilis flap approach. Ask your surgeon which skin pattern and amount of muscle they plan to use.
Can I have TMG reconstruction after radiation?
It may be possible, and healthy transferred tissue can be useful in a previously treated chest. Radiation changes can also increase complexity. Timing and suitability require a joint discussion with your reconstruction and cancer-care teams.
Will I need an implant?
Not necessarily. TMG reconstruction uses your own tissue, but the amount available may not achieve your desired size. Your surgeon can discuss accepting a smaller size, later fat grafting, or another approach.
Will reconstruction affect cancer follow-up?
You will still need a follow-up plan based on your cancer history and remaining breast tissue. Tell your care team about any new lump, skin change, or persistent pain rather than assuming it comes from reconstruction.
0 consultation questions in your plan
View in My TRC workspaceMy Aesthetic Plan
Prepare for your consultation
Bring these to help your consultation:
- Confirm the flap choice, donor thigh or thighs, breast-size goals, and reconstruction timing.
- Get a personalized recovery plan, home-support plan, and urgent-contact instructions.
- Review written costs, coverage, and which later procedures are separate.
View My Aesthetic Plan
Choices stay in this visit until saving to your account completes. Nothing is sent to a clinician.
Sources
- [1]American Society of Plastic Surgeons: Breast Reconstruction TechniquesTissue-based reconstruction, thigh-based TUG flaps, donor-site selection, and microsurgical transfer.
- [2]American Society of Plastic Surgeons: Breast ReconstructionReconstruction choices, immediate versus delayed planning, limitations in sensation and symmetry, and staged reconstruction.
- [3]American Society of Plastic Surgeons: Breast Reconstruction RecoveryIndividualized recovery instructions, drains, follow-up, activity guidance, and seeking immediate care for shortness of breath or chest pain.
- [4]American Society of Plastic Surgeons: Breast Reconstruction Risks and SafetyBleeding, infection, delayed healing, anesthesia risks, blood clots, sensation changes, donor-site concerns, and partial or complete flap loss.
Photographs are illustrative scenes, not patients, staff, facilities or outcomes. This information does not replace a personal assessment by your treating clinician.