About breast reconstruction using tissue from your thigh

This is a free flap operation. It uses tissue from the upper inner thigh. It may be an option when the tummy area cannot be used. The plastic surgeon removes tissue from the thigh and attaches it to the chest using microsurgery. Microsurgery uses high magnification microscopes to operate on areas that are too small to be seen. There are two different operations that use tissue from the thigh.

A TMG flap

A transverse myocutaneous gracilis flap (TMG) or transverse upper gracilis flap (TUG flap) uses skin, fat, and usually muscle from the thigh.

A PAP flap

A profunda artery perforator flap (PAP) uses skin and fat from the thigh.

Who is it suitable for?

This type of reconstruction may be suitable for women who:

  • have small to medium size breasts
  • have previous scarring on the tummy area
  • have upper thighs that touch
  • are slim.

It may not be suitable for women who want large breasts reconstructed.

What are the limitations?

  • You will have a scar on your breast(s) and a scar on your upper inner thigh.
  • If you want a larger breast(s), you may need an implant as well.
  • Your upper thigh may become numb or lose some feeling.
  • If you are having one breast reconstructed, you may need to have surgery to lift or reduce the size of your natural breast. This is to make both breasts a good match.
  • One thigh may be slightly smaller than the other after surgery.

What are the risks?

With any operation, there are risks, such as infection. There are also some specific risks with this type of reconstruction.

Build-up of fluid (seroma) under the wound on the thigh

Sometimes after wound drains are taken out, fluid builds up under the wound. This is called a seroma. This sometimes happens after the operation, but usually gets better within a few weeks. We have more information about seroma.

Swelling of the leg

You may be asked to wear supportive clothing, such as cycling shorts and support (TED) stockings, for up to 6 weeks after the operation. These will reduce the risk of swelling in the leg and groin area after the operation.

Long term swelling in the leg is rare. Your surgeon will take care to prevent this. There are fine tubes, called lymph vessels, in the legs. They drain fluid from the tissues. If some of these tubes are damaged during the operation, fluid may build up in the lower leg. This fluid build-up is called lymphoedema. Although lymphoedema can be treated, it never goes away completely.

Tightness in the upper inner thigh

The area around the scar may be flatter than normal and can feel tight. This is because skin, muscle and fat are removed from the upper inner thigh during a TUG flap.

About our information

  • References

    Below is a sample of the sources used in our breast cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    European Society for Medical Oncology. Primary breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of oncology 26 (supplement 5): v8–v30. 2015.

    Morrow M, et al. Chapter 79: malignant tumors of the breast. DeVita, Hellman and Rosenberg’s cancer: principals and practice of oncology (10th edition). Lippincott Williams and Wilkins. 2014.

    National Institute for Health and Care Excellence (NICE). Early and locally advanced breast cancer: diagnosis and management. July 2018.

    Scottish Intercollegiate Guidelines Network. SIGN 134. Treatment of primary breast cancer: a national clinical guideline. September 2013.


  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Rebecca Roylance, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.