Breast reconstruction surgery

TMG Flaps

Transverse Myocutaneus Gracilis Flaps (TMG Flaps) refers to an alternative way of approaching breast reconstruction for patients who have undergone a mastectomy. This approach uses living skin, tissue, fat and muscle that is taken from a donor site on the upper, inner thigh.

Suitability for this operation also relies upon women having enough spare tissue on their upper, inner thighs to make a suitable flap (new breast). Typically, this is the second choice of donor area after the abdomen (DIEP flap) as it slightly more challenging as a donor site in terms of potential complication such as fluid collection. However, it is a good second choice for women who may have undergone stomach surgery in the past and have a degree of scar tissue in the abdomen.

The operation involves isolating and extracting skin, tissue, fat and a small section of muscle from the inner thigh and transplanting it in place of the original breast. It is shaped to resemble the original breast, and then, through an intricate microsurgical process, blood vessels are then connected between the chest and the flap, allowing blood flow to be reconnected to the newly reconstructed breast.

My specialty is microsurgery and I have done a year’s fellowship in microsurgical reconstruction at Charing Cross, followed by cosmetic and reconstructive surgery fellowships at leading reconstructive centres in Australia and North America.

Recovery after a TMG Flaps procedure

The operation itself takes around five hours and patients should expect to remain in hospital for around one week afterwards. Every breast reconstruction procedure I perform is carefully planned beforehand with scans if necessary, as this reduces recovery time. The aim is to have the patient fully mobilised and discharged as quickly as possible as clinical evidence supports enhanced recovery in terms of potential complications.

During the days and weeks following the operation, any bruising, swelling and pain will gradually subside, and you’ll be prescribed painkillers to help mitigate this. Once you are home, recovery tends to be between four to six weeks.

At the donor site on your thigh, the wound will also need time to heal fully and should be covered with a sterile dressing until it has closed. It is sometimes recommended to wear compression shorts during the recovery period to minimise the risk of fluid building up inside the wound. Occasionally, some women report a loss of senstivity at the donor site once the incision has healed, although this side effect rarely outweighs the benefit of being able to naturally reconstruct the breast from the patient’s own tissue cells.

I often combine this procedure with lipofilling or fat transfer to smooth out the newly-reshaped breasts.

What my patients say about me

Having had the upset of being diagnosed with breast cancer and having opted to have a skin and nipple sparing double mastectomy, I was very keen to ensure that the cosmetic result that would be achieved when replacing the expander implants for permanent ones was as good as humanly possible.

I am a very fussy individual and after much research, I narrowed down my search to three top plastic surgeons. Two in the UK and one in the US. Mr Ramsey was the last of the surgeons I saw. His approach was very different to the others: he did not seem to think that I had ‘to make do’ with the result I had because I was a cancer patient who had had a double mastectomy.

I had two consultations, and he was incredibly thorough, patient and kind. He explained everything in great detail and never made me feel that I was asking too many questions (I always do!).

He was careful to manage my expectations. Frankly, there was no need. The result is near perfection, and this is not a qualified statement. Even if I had elected to have breast surgery for aesthetic rather than medical reasons, I would be completely delighted with the result. Mr Ramsey is a genius!

Mrs A BrakeBreast Reconstruction After Double Mastectomy