Natural Breast Reconstruction Using Thigh Tissue

What Are Thigh Flaps?

For women seeking natural breast reconstruction who may not be candidates for abdominal tissue options like the DIEP flap, thigh flap procedures offer an empowering alternative. These surgeries use tissue from the upper inner thigh or buttock area to create a soft, natural breast shape—without the need for implants.

At PRMA, our expert microsurgeons offer several types of thigh flaps, including the PAP flap (Profunda Artery Perforator), TUG flap (Transverse Upper Gracilis), LTP flap (Lateral Thigh Perforator), and VUG flap (Vertical Upper Gracilis).

Unlike abdominal flaps such as the DIEP, thigh flaps are ideal for women who may not have enough abdominal tissue or prefer a different donor site. They can also be a solution for those who have had prior abdominal surgeries.

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Key Information

No implants needed: Natural tissue from the inner or outer thigh creates a soft, natural breast without the need for implants.

Ideal alternative to DIEP flap: Great for women without enough abdominal tissue or with prior abdominal surgeries.

Improved recovery: Minimally impacts muscle strength and function for a smoother recovery.

Minimal scarring: Provides subtle thigh contouring with discreetly placed scars.
Dual-surgeon precision: Performed with PRMA’s dual-surgeon microsurgical expertise for enhanced safety and results.

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Understanding Your Options

PAP Thigh Flap

The PAP flap uses skin and fat from the inner upper thigh, deep below the surface, without taking any muscle. The tissue is carefully transplanted to recreate a soft, natural breast. Scars are hidden along the groin crease for minimal visibility. Compared to other thigh flap options, the PAP flap typically provides a larger volume of tissue, making it a great choice for women who desire more fullness without affecting leg strength.

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TUG Thigh Flap

The TUG flap also uses skin and fat from the inner thigh but includes a small portion of the gracilis muscle to help support blood flow to the new breast. Like the PAP, the scar is hidden in the groin crease, but because it uses some muscle, it’s better suited for patients who need a moderate amount of tissue and aren't concerned about very minor muscle loss. It’s an excellent option for women who have less thigh volume or who may benefit from the added structural support the muscle provides.

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VUG Thigh Flap

The VUG flap is a variation of the TUG flap, but the tissue is harvested vertically along the inner thigh rather than horizontally. This technique allows surgeons to create a longer, thinner flap of tissue, which can be especially useful for shaping smaller or more slender breast reconstructions. Like the TUG, it uses a small part of the gracilis muscle, but its vertical design can offer different scar placement and cosmetic benefits depending on body shape and surgical goals.

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LTP Thigh Flap

The LTP flap harvests skin and fat from the outer (lateral) thigh, completely sparing the muscle. This option is ideal for women who have more fullness on the outer thigh rather than the inner thigh. The LTP flap leaves a scar hidden along the side of the upper thigh and preserves full muscle strength. Compared to the PAP, TUG, and VUG, the LTP flap offers a different donor site option and is especially appealing for women who want to avoid inner thigh scars or optimize outer thigh contouring.

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What to Expect During Surgery

During thigh flap reconstruction—whether PAP, TUG, VUG, or LTP—tissue from your inner or outer thigh is carefully transplanted to recreate a soft, natural breast. Using advanced microsurgical techniques, PRMA’s dual-surgeon team connects tiny blood vessels under a microscope to ensure healthy blood flow to the new breast.

Depending on the flap type, some procedures (like TUG and VUG) may use a small portion of muscle, while others (like PAP and LTP) spare muscle entirely. Surgeries are performed under general anesthesia, with most patients spending 2–3 days in the hospital afterward for recovery and monitoring.

Every step of the way, PRMA is committed to providing expert surgical care, compassionate support, and the safest path to reclaiming your confidence and well-being.

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Before & After

See real results from women who’ve trusted PRMA with their reconstruction journey.

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Before

Before

Procedure: Bilateral Mastectomy with Immediate High Definition DIEP Flap Breast Reconstruction

Before

Before

Procedure: Bilateral Mastectomy with Immediate High Definition DIEP Flap Breast Reconstruction

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Recovery Timeline

Week 1:

You'll spend the first few days in the hospital for close monitoring. During this time, expect swelling, bruising, and soreness at both the chest and thigh donor sites. Movement will be limited, but gentle walking is encouraged to promote circulation.
Week 2:

During the second week, discomfort begins to ease, although tenderness and fatigue are still common. Light walking around the house is encouraged, but you’ll need to avoid bending, squatting, and lifting anything heavy.
Week 3-4:

Swelling and bruising continue to fade into weeks three and four, and your range of motion improves. Many patients start to feel stronger and more independent, though strenuous activities are still off-limits.
Week 5-6:

Energy levels are noticeably better, and many patients return to desk work and light daily routines. Gentle stretching may be introduced if approved by your surgeon, but heavy lifting and vigorous exercise should still be avoided.

Am I a Candidate for Thigh Flap Surgery?

While thigh flap reconstruction offers an excellent, natural option for many women, it’s not the best fit for everyone. Factors like body shape, tissue availability, previous surgeries, and personal goals all play an important role in determining the right approach.

Ideal candidates for thigh flap include:

Individuals without sufficient abdominal tissue for a DIEP or other abdominal-based flap.
Women who have had previous abdominal surgeries (like a tummy tuck) that limit abdominal donor tissue options.
Patients seeking an implant-free, natural reconstruction option.
Women with adequate soft tissue available on the inner or outer thighs.
Patients willing to accept scars on the thigh in exchange for natural breast results.
Women who are in overall good health and nonsmokers (or willing to stop smoking before surgery) to promote safe healing.
Patients looking for a long-lasting solution with minimal long-term maintenance compared to implants.

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Find Your Surgeon

PRMA is the only center in San Antonio, Texas, and one of only a handful of centers worldwide to provide breast reconstruction on such a large scale. Our surgeons treat patients from across Texas and the US, as well as routinely welcome international patients. We are proud to have a tremendous global reputation for breast reconstruction excellence.

Dr. Minas Chrysopoulo

Championing Advanced Breast Reconstruction Access Nationwide

Dr. Gary Arishita

Dedicated to Restoring Confidence Through Expert Reconstruction

Dr. Oscar Ochoa

Board-Certified Plastic Surgeon & Fellow of the American College of Surgeons (FACS)

Dr. Gary Arishita

Dedicated to Restoring Confidence Through Expert Reconstruction

Dr. Oscar Ochoa

Board-Certified Plastic Surgeon & Fellow of the American College of Surgeons (FACS)

Will Insurance Cover Thigh Flap Surgery?

Most insurance plans are required by law to cover breast reconstruction after mastectomy, including natural tissue options like thigh flap procedures. At PRMA, we work closely with patients and their insurance providers to help navigate the approval process and make reconstruction as accessible and stress-free as possible.

For more information, visit our Insurance FAQs in the patient resource center.

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Preparing for Surgery

Whether you’re local or traveling in, we’re here to make your experience as smooth and stress-free as possible. Explore what to expect before surgery and how to plan your trip to PRMA.

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Preparing for Surgery

Travel Accomodations

Frequently Asked Questions

Will my thighs look different after tissue is removed?

Yes, many patients notice a slimmer contour at the donor site, similar to the effect of a cosmetic thigh lift.

How long will it take for thigh scars to heal and fade?

Early on, scars may look red or raised, but they typically soften, flatten, and fade significantly over 12–18 months.

Can I have a thigh flap if I’ve already had a thigh lift or liposuction?

While prior thigh surgeries like lifts or liposuction can impact your eligibility, every case is unique. PRMA’s surgeons will assess your needs and surgical history to determine if a PAP, TUG, VUG, or LTP flap is still a safe and effective choice.

How does recovery from a thigh donor site compare to abdominal donor sites like the DIEP flap?

Thigh donor site recovery typically involves different movement restrictions compared to abdominal flaps. Patients often find it a little easier to stand upright earlier, but activities that strain the legs—like squatting or stretching—may take longer.

Is it possible to combine thigh flaps with other techniques for better results?

Yes! In some cases, PRMA surgeons may combine smaller thigh flaps with additional techniques to achieve the desired breast size or shape.

DIEP Flap Breast Reconstruction

Thigh Flaps (PAP, TUG, VUG, LTP)

What Are Thigh Flaps?

Key Information