• Lucy W

My TUG Flap Breast Reconstruction Surgery



When I was younger I often thought about having breast implants due to not being overly gifted in the chest area. This idea faded quickly when a friend of mine had this surgery and the results were shocking.

Never did I think I would be 30 and having a breast reconstruction using the muscle, tissue and blood vessels from my inner thigh to form a breast where I had previously had a masectomy (left side).



When I sat with my plastic surgeon last February he provided me with the option of a TUG flap (Transverse Upper Gracilis) reconstruction. I was aware of this procedure after speaking with my Macmillan nurse before my treatment started and the thought of it did make me wince. I explored the option of implants but due to my chest area being exposed to radiation (15 rounds of radiotherapy) my surgeon was not willing to use implants as an option because my skin is too damaged and will not stretch to the desired size.

Another reconstruction they can do is using the muscle from your upper back or fat from your stomach. I don't have any fat around my midriff, therefore, my surgeon wasnt happy to move forward with this option.


I looked over a few photos of women who had this procedure and to be honest their breasts and thighs looked brilliant considering, however, the scars did put me off a little. Here is a diagram of what the procedure consists of



Although I was very apprehensive, I decided this was the only procedure for me. I had been waiting over 19 months for this surgery and out of the blue I got a call from my surgeon to say he could do my reconstruction within a week.


I want to share my experience of this surgery (with some funnys) and give some insight into what it involves and also my current journey to recovery.


Pre op - 14 Sept 2018


I will not bore you with the ins and outs of this as many know why this process was introduced before surgery but I am a pretty niave person and I thought I would be out within an hour. Well, 4 and half hours later I was finally done. I believe I stripped in every room I was seen in, not by choice, although some would argue.


Day/night before surgery - 16 Sept 2018


The hospital where I was having the surgery needed me in the night before so I could be admitted and prepare me for the surgery the next day. We rocked up at 4 after being told my bed was ready on the plastic/trauma ward. My husband and my daughter stayed for a bit but then got off to let me get ready to be seen by my surgeon. He came around to visit me about 8 o'clock where he wanted to mark all the areas for the surgery. The drawings resembled one of those pictures on a menu in a restaurant where they show what meat comes from which part of the cow.


This picture shows the drawing on my right inner thigh and this goes all the way to the top of my thigh at the back (under my bum cheek). I have not shown the full breast area as although I am brave, Its a personal decision to not present my mastectomy but I do applaud the women who do.


I had to sign all the relevant risk paperwork and consent to the surgery. I then had the night to reflect on my decision and the day ahead of me. This was not helped by a women who was in the bed opposite me as she kept sitting up every minute and staring at me, then throwing herself on the bed. It was amusing but I also feared I would wake up with her next to me.



Surgery day - 17 Sept 2018


I didn't sleep well at all which was to be expected because of the ordeal ahead but I was also quietly fearing for my life from the women across the way.

When I did manage to have an hour, I dreamt the reconstruction was a balloon under my top and it burst everywhere. Was this my state of mind or just another lucyism, who knows.


The hardest part about waiting for the surgery was the nil by mouth. I wanted to eat everything and anything in sight and to make it worse they put me on the ward with other women eating. I ended up walking about the hospital for 30 minutes at a time just to suppress my cravings for a McDonalds.


They came to collect me at 3pm which I was dressed for the occasion. I had a beautiful long patterned gown and stunning dark green surgical stockings. I must not forget the see through cotton hair piece which completed the stylish surgical look. Hair did not disappoint either, they could have mistaken me for Marv from the film Home Alone.





I have a very positive outlook but walking down the corridor to the surgical ward sent my mind into overdrive and I just started crying. Was this because I knew what was coming or just because I was finally on my way to completing another part of my journey?


The anaesthetist was beautiful and made me feel at ease, although when they hooked the heart monitor up my heart rate was through the roof. Im not going to lie, it was mainly because of the surgery and the unknown but maybe was raised a little because of a girl crush.

I was given some drugs to relax me and I will say now, I have never felt so free in my life. It was a combination of happy drunk and that feeling when you peel your fake eyelashes off after a night out.

She put the oxygen mask on and leant over me and said " we will see you the other side Lucy". I immediately started to panic thinking why is she saying that, I'm not going to die and then the next thing I knew I was waking up to nurses around me shouting my name.


As predicted, I started throwing up from the effects of the anaesthetic whilst shouting "I think I have wet myself" over and over again (this accident was not predicted). Fortunately, I hadn't because I had a catheter in but the recovery nurse still checked and reassured me.

The surgery was a success and I was loaded with morphine which again is another highlight for me.


I looked to the clock and the time was 9:45pm. I had been in surgery for over 5 and a half hours which is a very long time to be under the knife. They wheeled me back to my own isolated room on the plastic/trauma ward and I immediately felt the warmth. You know that feeling when you get off the plane in a hot country except I was drugged up, tied to a hospital bed with drains attached and genuinely looking like death warmed up. The reason for the high temperature in the room is to ensure there is good circulation around my body because of the procedure of removing the blood vessel from my thigh and placing it in my chest - basically plugging it in.

A plus side to me being in my own room, I didn't have the fear of some women crawling into bed with me.


Recovery


The procedures the staff and hospitals have in place are very intense with this type of surgery as they need to ensure the "Flap"(yes I laughed when they first used this term) was not going to die and fail. The reason its called a flap is because it's a flap of skin and tissue removed from my thigh and placed on my chest.

They did also remove cartilage from my breast bone and placed it under my new breast. This could potentially be used to form a nipple at a later date.


Day 1 - Recovery


I was monitored every hour (no sleep for Lucy) which consisted of the following:

  • Blood pressure

  • Heart rate

  • Temperature

  • Doppler scan to flap This was used every hour to ensure there was good blood flow to where they connected the blood vessel.

  • Stitching and wound checks. The surgery on my thigh was very invasive and in a very awkward place. I guess most nurses have seen lady parts and fitted women with catheters so not much fuss given.

  • Drain levels checked. The reason for drains is so any built up of fluid can be vacuumed from the wound. I had two drains in the breast and one in my thigh.

  • Morphine drip check. A line was inserted into my thigh to give me a very slight injection of morphine over the next couple of days.

  • Injection once a day into my stomach. This was to prevent blood clots as I was not very mobile. I also had to wear the surgical stockings the entire time.

  • Flowtron Boots. The boots were worn over the stockings and tighten slightly on your calves to ensure blood flow is reaching my heart and prevent blood cots and DVT

  • Emptying the catheter. I don't envy the nurses doing this job but it must be done and it's so uncomfortable as anyone who has had the pleasure of having one will know.














On the first day the physiotherapists graced me with their presence and helped me stand for a couple of seconds and then got me back into bed. This was very daunting as I have never had drains or such intense surgery like this before in two separate places.


Every day I had visitors and my husband and daughter were certainly there to cheer me up and nearly cause me to split a stitch.


I did take a look at my new boob (which is now named Betty Boob and I can't take the credit for this but a beautiful soul can).


My surgeon is amazing! Betty looks like a real boob although the scars do resemble the shape of an eye or as Nevaeh would say "a pair of lips". The scars will be barely visable as they used glue instead of stitches on my breast.

I was given pain relief of Paracetamol, ibuprofen and on occasions oral morphine.


Day 2 - Recovery


I was now only being monitored every 4 hours with all the above checks mentioned on day one. The breast nurse asked me to ensure I had cycling shorts for the physotherapists to put on me before I started walking. Well here is what they had to put up with.



At least I made their day and the surgeon came to visit whilst these were being put on and he isn't a man of many words so his eyebrows did the talking. I also had to provide a sports bra with padding and a zip up the front for easy access.


I managed to walk to the bathroom and back and also the recliner chair they ordered.


They checked the drains often and if not much fluid was being vacuumed they take them out. I did have one drain taken out on day two of my recovery which was a small relief because you feel so restricted. Every time I got up or walked the help had to hold the drains whilst I moved about.


Day 3 - Recovery

This was a day for milestones. I had the dreaded catheter out which meant I could go to the toilet but I still had the drains attached to me.


I was only being monitored every 6 hours by now which meant I could have some sleep, although I didn't.


My breast looked very swollen and a lot bigger compared to my other "good" breast but this is due to the swelling and bruising.


I did not imagine it to look this good, so I am one happy girly.


Day 4 - Recovery/discharged


I had the drain from the thigh and morphine drip removed along with the other breast drain and I could eventually have a proper shower instead of positoning my body like I'm flaunting my moves on the just dance arcade game. I also roped my husband into washing my hair in the room sink as the en suite sink was as useless as tits on fish.


My breast nurse came to see me and I was informed they were discharging me.

I had exercises to do for my left arm and also my right leg.

I was delighted to find out that I needed to wear the stockings and lycra shorts for 4 weeks once discharged, along with the sports bra.


The terms for discharge were:

- Plenty of rest

- Light walking

- No driving for 4-6 weeks

- Possibly able to return to work after 6-12 weeks (after a week I am bored)

- No heavy lifting etc for 4 weeks


I am so grateful to my surgeon, nurses and all the hospital staff as I would not of had an experience like this without them. I do not have any negative comments to say about the NHS, they are brilliant.


I have not really suffered any side effects just fatigue, loss of appetite (not always a bad thing) and ulcers on my tounge.


Future


Believe it or not this is only the first stage of my reconstruction. I have opted to have my other breast off and reconstruct that in the same way as this one. More invasive surgery but prevention is an ongoing part of my journey.


I am very much looking forward to just purchasing a dress or top without having to be conscious of how my chest will look. No more fake boob - cloth or silicon and overall having two boobs.


Much love

Lucy x







Life or Just Lucyisms

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