ePlasty: Vol. 18
Dividing the Pedicle: Subpectoral Breast Augmentation Beneath Bilateral Transverse Upper Gracilis Myocutaneous Free Flaps
Kevin T. Jubbal, MD,a Dmitry Zavlin, MD,b Jessica F. Rose, DO,b and Anthony Echo, MDb

aDepartment of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, Calif; and bInstitute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Tex

Correspondence: research@zavlin.com
Keywords: breast, free tissue flaps, breast implantation, microsurgery, mammaplasty


A 45-year-old female patient with left-sided lobular carcinoma in situ (Fig 1) underwent bilateral mastectomies with immediate free transverse upper gracilis (TUG) flap breast reconstructions (Fig 2). Desiring augmentation and improvements in symmetry 6 months postoperatively, she received 205-mL implants in each subpectoral plane after bilateral pedicle division. No complications occurred, and the flaps remained soft and viable without fat necrosis (Fig 3).

Figure 1. Preoperative frontal (a) and lateral (b) views of the torso. The relative size of the left breast is smaller than that of the right side, with asymmetri .......