All visitors are required to wear masks.

For COVID-19 safety, all visitors to ChristianaCare facilities and services are required to wear masks. This includes visitors who are vaccinated. Please read our visitor guidelines before arrival.

Masks required at outpatient locations; visitors and support persons limited

All visitors at outpatient locations must be masked in alignment with the masking guidelines on our visitation policy page here. Patients at ChristianaCare’s outpatient services are advised to come to their appointments alone unless a support person is absolutely needed. If a support person is needed, such as a parent, guardian or spokesperson, we highly encourage that the support person be vaccinated. Outpatient practices are not requiring vaccination or a negative COVID test for visitors at this time.

All hospital visitors required to be vaccinated or have a negative COVID-19 test.

  • Inpatients in our Christiana, Wilmington and Union hospitals may have one visitor daily between 10 a.m. and 8 p.m. The visitor must be 16 or older.
  • Patients having outpatient surgery may have one support person accompany them. Support persons must be 16 or older.
  • All visitors and surgical support people must show proof of vaccination OR a negative COVID-19 test within the prior 72 hours.

Before visiting, click here for more details about visitation.

Visit or for local vaccination and testing sites.

Plastic Surgery


In this type of breast reconstruction surgery, the skin and fat of the upper thigh are used to create the breast mound. With the PAP (profunda artery perforator) flap, the tissue remains attached to a single perforator blood vessel and is a muscle-sparing procedure. With the TUG (transverse upper gracilis) flap, the skin and fat are attached to the gracilis muscle.

Image provided by the
Canadian Breast Cancer Network.

Both the PAP and TUG flaps are free flaps that requires your surgeon to detach the tissue from your thigh and reattach it to blood vessels in your chest. The procedure requires a longer surgery and recovery time than some other reconstructive procedures.

The scars of the PAP/TUG flaps are hidden inside the upper thigh and lower buttock. This may be a good choice for a woman who has small breasts with little abdominal tissue. Your surgeon can assess your body shape to guide your flap options.

Who can have this procedure?

PAP/TUG may be right for you if you:

  • Prefer a breast reconstruction without an implant and do not have enough tissue in other areas of your body to consider other flap procedures.
  • Have had radiation to the chest wall in the past.

Things to Consider

  • Not all breast reconstructive surgeons have the expertise to perform this complex procedure. ChristianaCare’s Stephanie Caterson, M.D. is very experienced in flap procedures and has performed more than 50 PAP or TUG flaps.
  • Both PAP and TUG procedures require a lengthy hospital stay and recovery time.
  • For more information, please visit the American Society of Plastic Surgeons website.

For more information or to schedule an appointment, call our office at 302-623-3605.