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Center for Breast Reconstruction


The skin & fat of the upper thighs are used to create the breast mound.

What is PAP/TUG Flap?

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.

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.

Digram of pap flap procedure

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.

Contact Us

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