TMG flap
Implant based breast reconstruction
Autologous breast reconstruction
A proportion of women requesting autologous (without an implant) breast reconstruction, are slim and do not have enough fat tissue in the lower abdomen to perform a DIEP flap. Others may have had surgical procedures in the past to the abdomen, which because of the position of the position of the scars means that this is not possible. In addition to an SGAP (superior gluteal artery perforator) flap a TMG (Transverse Myocutaneous Gracilis) flap may be considered as an option.
This technique utilises fat and a redundant muscle from the upper inner thigh, which is then transferred to the chest. Microsurgery techniques are then used to connect the blood vessels in the flap to ones in the chest.
A TMG is a relatively new method used for breast reconstruction. Its use depends on the patient's breast size and body habitus, but in suitably chosen patients this technique can give an excellent autologous reconstruction in those wishing to avoid an implant-based reconstruction. The donor scar is hidden in the groin crease and leaves no residual functional deformity.
Further information
Anaesthetic
The operation is performed under general anaesthesia. The operation takes 4-6 hours.
Length of stay
4-5 nights following the operation.
Risks/Possible complications
Early (1-2 days):
Frequent
- Bruising
- Swelling
- Discomfort
Infrequent
- Bleeding (haematoma)
- Infection
- Failure of the flap (approx 1%)
- Partial failure of flap
- Re-operation (approx 1%)
- Wound breakdown
- Necrosis of the mastectomy skin flaps
Later (after one week):
Frequent
- Reduced or no sensation of reconstructed breast
Infrequent
- Scars - abdominal, umbilicus, breast unsightly, lumpy, stretch
- Asymmetry of inner thigh
- Seroma
- Fat necrosis
General anaesthetic
- Deep vein thrombosis
- Chest infection
- Allergic reaction to drugs or tape
Recovery
Immediately after the operation
- You will feel bruised and sore and there will be some swelling
- Pain is usually moderate and controlled with standard painkillers
- There will be drains in the chest and thigh, which will be removed between 2-5 days later
- A urinary catheter will be left in for 2 days until you are mobile
- You will be out of bed the next day and over the next few days you will increase the amount of walking that you do
After return home
- Socialising with friends 1-2 weeks
- Return to work at 4 weeks
- Driving at 4 weeks
- Swelling and bruising 6-8 weeks
- Wear buttock compression garment for 5 weeks
- Return gym and strenuous activity after 3 months
- Final result at 4-6 months
Permanence of results
Permanent.