A Personal Account of the TUG Reconstruction

When I asked for stories about reconstruction, I never thought I would hear from anybody who had the TUG flap operation (where skin and fat is used to recreate breasts) as there doesn't seem to be much information about it and it wasn't really mentioned to me at any of my consultations.  However, I have to admit, after reading Carley's story and seeing her photos, this reconstruction is definitely back on the radar for consideration for me. 

This is Carley's story:

On 20th December 2015 I found a lump in my left breast.  The following day I went to the Doctors. I was 34 years old. My doctor referred me to the hospital and 2 weeks later I had my appointment. As you can imagine, I spent Christmas and New Year worrying.

At the appointment I was examined by a Doctor and given an ultrasound scan and had a 2 biopsies taken and was told it looked clinically benign and the next time they see me I would hopefully be given the all clear! I wasn’t given a mammogram as they told me that I was too young. A letter that the hospital wrote to my Doctor said “Ultrasound showed 1.5cm hypoechoic oval lesion with a slightly lobulated border and is likely to represent a fibroadeonoma” and confirmed that core biopsies were taken.

I had an appointment for 2 weeks later on a day that I was supposed to be at work so I asked if they could change it to a few days later as in my head I was going to be ok! On the day of my appointment, I told my husband to go to work but my friend insisted she came with me so I wasn’t on my own. When we got to the hospital, I told my friend I was ok and she could wait in the waiting room and I walked into the room. The Doctor said “have you anyone with you?” and that’s when I knew it was bad news. I burst into tears and they told me I had cancer and the Macmillan nurse got my friend. I didn't take anything in at that point and my friend rang my husband who came home.

The next day I had a mammogram, another biopsy but this time from my lymph nodes and a CAT scan. When the results came back it confirmed that I had “left breast intraductal carcinoma 1.5cm in diameter, grade 3, triple negative, lymph node positive”. I then had to have an MRI and also a bone scan but thankfully those were both clear.

However, because of my age, it was decided that I should have genetic testing, even though there was no family history. The Doctors wanted to get the results from the testing back before surgery so the decision was that I should have chemotherapy first. I have a real fear of needles so I had a portacath inserted the day before my first chemo. My chemo regime was 3 x FEC and 3 x Docetaxel with a zoladex injection every month to protect my ovaries whilst on chemo. Half way through chemo I was given another ultrasound that showed the lump had shrunk by a third and had responded really well.

The genetic results came back and confirmed I was BRCA2 positive. At that point, I decided I wanted to have a double mastectomy and so started to investigate reconstruction options. I didn’t have enough fat on my tummy for a DIEP and also didn’t want implants, so my surgeon suggested I have the TUG procedure (where fat/skin is taken from the inner thigh).

On 21st June 2016 I had my operation (that included full node clearance on my left hand side – the side that had breast cancer). The operation was about 10 hours and all the cancer was removed with good margins (so my surgeon later told me that I wouldn’t need radiotherapy). During recovery I was put under a heating blanket to keep the new breast tissue warm. I also had 2 drains in each breast to drain away the excess fluid and 1 drain to each thigh (which were the last ones to come out). I was in hospital for 6 days and the pain to the thigh area was definitely more painful than the breast area. The cut on the thigh extends around and under my bottom at the back and then up into the inner groin area so is extensive and the photo was taken a week after surgery. However, I was only home for 2 days when they split open and I got an infection. I was re-admitted for 4 days and put on intravenous antibiotics. My thighs were horrendous and I had to have my dressings changed every other day due to them leaking excess fluid. They definitely took much longer to heal than my breasts. At the time of writing, my thighs have only just healed and it’s now the beginning of October (so it’s taken about 3 or 4 months to fully heal).

By contrast, the photo of my breasts was taken 6 weeks after the operation and they healed beautifully. They feel very natural and soft, and exactly like my breasts felt before surgery and I’m thrilled with them. I decided not to have nipple reconstruction as I didn’t want any tissue to remain from my breasts. In the photo, you’ll see that there are circles where my nipples would be. During the operation, the skin covering the breasts is saved and the tissue from the thighs is put under to make the breast. However, the surgeons need a way to check how the tissue under the breast is responding and therefore a small area is left that exposes the thigh tissue underneath. Any changes in colour etc., may indicate a problem but I didn’t have any of that.  They also checked the tissue was OK by using a Doppler every 15 minutes for the first 24hrs then every 30 minutes and then every hour etc so there was lots of checking!

Where the circles are on the breast area is where I will have tattoos as soon as I’m fully healed. However, in the meantime I have found some temporary nipple tattoos that you put on and they last for about a week before you need to replace them. A link to the American online store is in the tab “Links” if you want more information.

I am now 15 weeks post surgery and am still wearing a soft bra, day and night. I will soon be having a follow up appointment to check how everything is going. What I will have to have (at some point) is a bilateral oophorectomy (ie taking my ovaries out) as with BRCA2 there is an increased risk of ovarian cancer but I’ve delayed this as we would like to try for another baby.

I am delighted with my reconstruction option but, like all reconstructions, it was tough going but worth it in the long run.