Doctors performing PAP or TUG flap?

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ashell
ashell Member Posts: 108
edited August 2017 in Breast Reconstruction

Hey everyone!

I've had my implants following umx for a little over 4 years now, and I'm really not happy with the effect they have had on my upper body strength. Really getting serious about getting rid of them and going with an autologous reconstruction, ideally from the thigh. I'm hoping to get some feedback from people who have had either of these procedures. Who was your doctor? Location? Their experience with the procedure? Your happiness with the outcome? Did your insurance cover it? And if you considered this option but ended up going with another flap such as DIEP, are you happy with your decision?

I would like to stay in California for it but I want the best possible outcome and it seems that the most experienced/specialized surgeons are located out of state.

Thank you for any info!

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  • Honeybadger
    Honeybadger Member Posts: 64
    edited July 2017
    Hello Ashell, I just had a bilateral TUG Flap 7/17/17. I had TEs three years ago and had capsular contracture on radiated side. Swapped it out and then developed either an infection or Red breast syndrome. Whatever it was, that TE failed. It was removed and a round implant was placed on prophy side. I remained flat on my left while I healed emotionally and physically. I always felt the iron bra feeling even on the,left after the te was removed. My pecs had been lifted and even as I regained strength I felt like I was going to hurt myself performing any pec exercises. Ihad been so srrong before. It was x very upsetting and uncomfortable. I considered many options. With my pear shape, DIEP wasn't a good match. I was going to have the PAP flapwith Dr. Korn in NY, but he has done comparatively MANY more TUGs than PAPs. With my track record, I became more comfortable with the TUG. It will be 2 weeks in a couple of days. The pain has been minimal. Was in hospital 3 nights. Stopped narcotics by 5th day. They helped, but I hate the side effects. My upper body is just a bit tight. No pain. But it's also been pretty numb for years. My legs are very tight, and tingle at the incisions. The left leg swelled a lot the 3rd & 4th day. Less so now. But they ace wrapped both legs in the hospital and then that caused really bad bruising. Doc wasn't too concerned, but I confess I don't keep them wrapped constantly. It's difficult not to go too tight. If its too loose they fall when I walk. I had 6 drains to start. Now I have 2 (1 in each upper thigh). Once they're out I'll wear Spanx type compression. That would tug the drains too much at this point. Sorry for the novel. And no paragraphs! My breasts look promising. I'm optimistic round 2 will even them out. I have extensive scaring b/c I needed skin island to radiated side. I was prepared for that reality. I was a small A to start and looks like I'll be a B maybe full B if the radiated side can get there with fat grafting. My thighs are nice & slim now. Good thigh gap :) If I can get through this without complications I'll be delighted. I wasn't an easy case. I hope this helps you and whoever else is out there dealing with this awful disease and the difficult decisions. I felt there was no perfect answer, just the decision you can live with, take the plunge with and then hope and pray for the best. I hope you get many more responses. Good health and good luck. HB
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  • Lula73
    Lula73 Member Posts: 1,824
    edited July 2017

    hi ashell- welcome to the discussion on autologous recon! I had bmx with immediate DIEP recon in New Orleans at the center for breast restoration surgery. Wasn't a candidate for implants due to prior full mantle radiation when I was 13. Autologous tissue recon was my only recon option. DIEP worked out great as I had a little tummy after having 2 babies but my shape would be classified as pear. My breasts turned out great-soft and warm and they move and look like my originals.

    Why did I travel to New Orleans for the surgery? The docs at The Center for Restorative Breast Surgery do more autologous flap surgeries in a year than any other group in the world. This is all they do-no facelifts, laser hair removal, etc. Their flap failure rate (1%) is well below the national average (10%) and their infection rate is less than 2%. They are the ones pioneering the newer procedures as well. And they have 2 micro surgeons working on you at the same time to reduce the amount of time you are under anesthesia. They are also the guys who fix other doctors' mess ups. You can check out their before and after pics for each of the procedures on their website: www.breastcenter.com

    Dr Dellacroce did my surgery. He has extensive publications to his name and also speaks internationally on autologous breast recon. He did a talk at a medical meeting where he discusses APEX flap (a twist in DIEP flap that allows better outcomes in appearance, recovery and less fat necrosis) and stacked flap extensively. He also briefly discusses TUG and PAP flaps. I've posted the link to the YouTube video of the talk. If you want to skip to the part about TUG and PAP it begins at roughly the 13 minute mark. Definitely something to think about especially if you're a candidate for DIEP, APEX or SGAP.



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  • cwink
    cwink Member Posts: 5
    edited August 2017

    lulu - I wish I would have seen your post a couple of months ago. I did the PAP flap surgery last monthand I have major regret. The breast looks okay but I am so disappointed in the donor site. Although they say muscle sparing, there is clearly a divot in my inner thigh lacking muscle structure. They said my butt cheek would not drop but it did. Now I have to do revision and hope that i get the same results. The same bad results? I thought it was so important for me to have autologous but I'm realizing now that I should have just done the implant.

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  • Lula73
    Lula73 Member Posts: 1,824
    edited August 2017

    cwink- so sorry things didn't go as planned. Are you planning to go back to the same surgeon for revision? The docs at the center for restorative breast surgery (NOLA) also do revisions where other surgeons botched the job....

    www.breastcenter.co

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  • ashell
    ashell Member Posts: 108
    edited August 2017

    HB-

    Thanks for the reply! No need to apologise. I'm glad things are going well for you! I hope everything is healing nicely. When are you planning on going in for round 2?

    Lula-

    Thanks for the info! I'm glad you're happy with diep. I've been considering it, as well as going to Nola since they seem to be the gold standard. But I'd prefer not to travel too far. But there are definitely worse places to be than Nola haha.

    My fear with diep is that I don't have much abdominal fat and was initially told I'm not a candidate, though I might be able to do stacked. I just wouldn't want it to feel too tight, and I am planning to have children and wouldn't want that to interfere either. And that huge scar is a bit intimidating. But I do know of so many people who have done it and are very happy with it. I carry my weight in my lower body, so when I heard about the thigh as a donor site I thought- that's perfect for me!

    Cwink-

    Thanks for sharing, I'm so sorry you are feeling regret. I have been doing research and like the idea of PAP not using muscle, but I have been unsure since I don't really know anyone who has had it done. I hope that you get wonderful revision results and are ultimately happy with your decision. Unfortunately it seems there are risks of being unhappy no matter what recon you choose, I hate my implants even thought they originally seemed like the best, and only, option.

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  • cwink
    cwink Member Posts: 5
    edited August 2017

    Lulu,

    Thank you and thank you for the recommendation. I don't see PAP on their website. I did send inquiry. I think what I really need is someone specializing in thigh lift now. That is what they'll do to match other leg.

    Ashell,

    thank you as well. I completely agree, we do what we think is best at the time and hope for good outcome. My caution to others would be try implant first if you think it could be a liveable situation. If it doesn't work, you can always go autologous later. It doesn't work the other way around. That's what I wish I would have done. I thought I was minimizing procedures by doing it this way, it would just be one revision and done. I am still hopeful for a good outcome, butit seems like there could be multiple touch ups in store down the road.

    Cwink

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  • TwoHobbies
    TwoHobbies Member Posts: 2,118
    edited August 2017

    Ashell, I can't help you with the California part, but surely someone in California is doing this. When I was looking 6 years ago, I believe there was a female doctor doing it in California. I had mine done by Dr. Song at University of Chicago Hospital. I had a TUG, but it was a vertical incision rather than the transverse near the top of the leg. This was because he thought he could get better volume. The "breasts" look very good. Everyone who sees them compliments them. LOL that is referring to doctors. The only man who has seen them is my husband.

    I would say the only downside to this surgery is you have one additional numb area (thigh where the incision is) than with implants. The shape of the legs looks pretty normal. I can wear shorts without issue. The first couple of years I wore the skirt type swimsuit until the scars turned white. Now I'll wear a normal swimsuit. People always ask if I notice any difference in the strength of the leg and I don't. I ride bikes, I walk, run, kick a ball. I can't tell a bit of difference.

    Here is a thread on TUG. https://community.breastcancer.org/forum/44/topics/753990?page=8#post_3729902

    I know there was a person who ended up having a TUG on one side and a PAP on the other and we joked that she was the perfect advisor. You might search pap vs tug and see if you can find it. As I recall, she didn't have a huge preference for either, maybe one had a slight advantage. Edited : Found what I was looking for: See Amac: https://community.breastcancer.org/forum/44/topics/784881?page=2

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  • Honeybadger
    Honeybadger Member Posts: 64
    edited August 2017

    Hello Ashel, Lula, Cwink and Two Hobbies. So glad to see some responses here. All the choices we have are difficult and unfortunately have their down sides even when all goes as well as possible. I hope that doesn't sound too negative. I am, so far, happy with my results and am able to do more each day. Two Hobbies you are a big inspiration!

    I knew I would have extra scarring because I needed skin "paddles" due to radiation damage. I knew I couldn't get significantly larger sized breasts. Luckily B is large compared to my original >A. I expect strange numbness around the scars. BUT I was miserable when I was flat on one side. And I am SO pleased at how I am healing. Having thinner thighs makes me very happy. The other options would not have given me that pleasure. I don't know the timeline for FG, scar revision & nips but I'm hoping to do it before March when insurance year ends b/c of deductible. Will discuss it with PS on Monday.

    Ashell, you've made me wonder. Could a woman have a DIEP a carry a pregnancy after? I wouldn't think so, but I'm no expert on that. You may be a candidate for prepectoral (over the muscle) implants. I'm not sure if you had radiation which can complicate things. But the woman who started that thread here did and I understand she and most of the women there are much more comfortable with their results. They also have a list of PSs in N America who do that technique. I didn't pursue that route because of my radiation damage, small size, possible issue with dermal matrix and my track record made me more risk averse. Plus I wanted the bonus of thigh gap, but that's me.

    Cwink, I sincerely hope you get the results you want and deserve.

    Lula, thank you also for the information, though I have to admit I'm glad I watched it after my TUG surgery. The points the doctor makes are valid. Doctors absolutely should be striving to achieve consistent results, minimal scarring and mastering muscle sparing techniques. For me I took the risk of losing the gracilous(sp?) since my doc had more experience with that than the PAP. It may sound strange, I just couldn't bring myself AND my loving family & friends who drive me to, once again, schlep me to the city every week. This cancer "journey" has been exhausting in every way and I know I've had it easier than many.

    Good health and good luck to you all.

    HB

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  • ashell
    ashell Member Posts: 108
    edited August 2017

    Two hobbies- thanks for the reply and info. I know of at least one doctor in California who does them and have spoken to one of his patients and seen that she has beautiful results. I do plan to get in touch with him and am considering having him do mine, but I want to make sure I'm considering all my options this time rather than going with the first PS I find. I will look at the things you posted, that's very helpful.

    HB- thanks for your insight. I'm sure it's possible, I think I've read about some women who have had children following that procedure, but I imagine it would create risks/possible complications. I have also considered prepec implants, it would solve my strength problem, but I feel like I still wouldn't be happy with the look and feel. But since my main motivator is getting my upper body strength back, it definitely is something to consider.

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