TUG and PAP Flap Breast Reconstruction

If you are considering autologous breast reconstruction but do not qualify for DIEP flap surgery, you may be a candidate for TUG or PAP flap surgery, which harvests tissue from one or both inner thighs. With extensive training and experience in microvascular and flap surgery, Dr. Oren Lerman provides both TUG and PAP flap procedures at his Manhattan, New York, practice.

TUG and PAP Flap versus DIEP Flap

The most common type of autologous tissue reconstruction is the DIEP flap procedure, which harvests tissue from the abdomen. However, patients who are slender or who have undergone abdominal surgery before typically do not have enough fat tissue to harvest. In such cases, TUG and PAP flap surgeries may be recommended. The major difference between the TUG and PAP flap procedures is the type of tissue harvested. While the PAP harvests only fatty tissue, TUG harvests both fatty and muscle tissue. 

TUG and TAP flap surgery
TUG and TAP flap surgery harvest tissue from one or both inner thighs to reconstruct the breast mound.


Like all autologous tissue reconstructions, TUG and PAP flap surgeries minimize the risk of graft rejection and post-surgical complications. Furthermore, the tissue is soft enough to provide an alternative to saline or silicone implants that looks and feels natural. Both surgeries can also essentially provide a thigh lift, leaving patients with slimmer upper legs.

Dr. Oren Lerman’s advanced training in microvascular surgery and flap procedures allows him to lay the foundation for a safe recovery and natural-looking reconstruction results. 

However, like any surgical procedures, TUG and PAP flaps involve some risks, such as infection, lumps in the harvested tissue, and tissue breakdown. Choosing a credentialed surgeon with many years of experience in breast reconstruction surgery can minimize these risks.

Surgery and Recovery

TUG and PAP flap surgeries can be performed immediately after a mastectomy, or they can be delayed. They are both performed under general anesthesia.

To extract the tissue, Dr. Lerman creates a vertical incision along the inside of the thigh, crossed with a horizontal incision that runs just below the groin and buttock crease. The tissue is completely extracted from the thigh and transferred to the breast. Once placed, Dr. Lerman will individually attach the blood vessels in the flap to those in the surrounding tissue so that it is properly nourished. At this point, the incisions in the thighs and the breasts can be closed, and the patient is moved to the recovery room.

Once you have been released from the hospital, it will take six to eight weeks to heal. While you will have scars on the thigh and breast from the incisions, they will fade over time, and will be placed in a way that allows them to be easily concealed.

Reach Out Today

Dr. Oren Lerman’s advanced training in microvascular surgery and flap procedures gives him the experience necessary to lay the foundation for a safe recovery and natural-looking reconstruction results. If you require a mastectomy and would like to learn more about your breast reconstruction options, contact our practice today and schedule a consultation.

Dr. Oren Lerman

Oren Z. Lerman, MD

Dr. Oren Lerman performs a variety of cosmetic and reconstructive procedures with a specialty in reconstructive breast surgery. In fact, he is the director of breast reconstruction at Lenox Hill Hospital's Institute for Comprehensive Breast Care as well as the Microvascular and Cosmetic Breast Fellowship. In addition to the hospital, Dr. Lerman is affiliated with:

  • The New York Regional Society of Plastic Surgeons (Past President)
  • The American Board of Plastic Surgery (Diplomate)
  • The American College of Surgeons (Fellow)
  • The American Society of Plastic Surgeons
  • The American Society of Reconstructive Microsurgery

You can schedule a consultation with Dr. Lerman by filling out our online form or calling (212) 434-6980.

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"The one thing that is most important when we're doing cosmetic surgery and aesthetic surgery of the face or the body is to make sure that the patient is happy afterwards..." Dr. Oren Lerman

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