Thigh-based Breast Reconstruction: A Decade of Experience With the Diagonal Upper Gracilis Flap

The thigh is an alternative donor site for autologous breast reconstruction when abdominal flaps are unsuitable, though limited tissue and donor-site complications pose challenges. To improve volume and reduce morbidity, thigh flaps evolved from the transverse upper gracilis to the diagonal upper gracilis (DUG) designs. This study presented the largest DUG flap review, evaluating outcomes and donor-site morbidity.

A retrospective review of patients undergoing DUG flap breast reconstruction was performed between 2012 and 2022. Demographics, surgical details, and complications were analyzed. Odds ratios assessed the association between unilateral versus bilateral donor-site harvest and revision surgery rates.

During a 10-year period, 109 flaps (70 patients, mean body mass index 24.3 kg/m²) were performed. Of these, 100 flaps were used for mastectomy reconstruction, 13 of which were stacked, and 9 were used for partial oncoplastic reconstruction. No flap failures occurred. The complication rate was 13.6%, of which 9.1% was related to the donor site, primarily cellulitis. No donor-site wound dehiscence, labial spreading, contour irregularity, or lymphedema was observed. Revisions occurred in 20% (breast) and 25.7% (donor site) of patients. Unilateral thigh flap harvest reduced the odds of donor-site revision and symmetrization procedures.

The DUG flap's diagonal design maximizes tissue harvest while minimizing donor-site morbidity. Unilateral harvest often achieves aesthetic results, curtailing the need for contralateral symmetrization. The DUG flap avoids concerns with thigh-based flaps, such as genital/gluteal distortion and lymphedema. Moreover, it offers a reliable learning curve, with bailout options via profunda artery perforator flaps.