DUG, PAP, LTP (Thigh), and GAP (Buttocks) Free-Flap Reconstruction Surgery

DUG, PAP, LTP (Thigh), and GAP (Buttocks) Free-Flap Reconstruction Surgery


DUG (Diagonal Upper Gracilis), PAP (Profunda Artery Perforator), and LTP (Lateral Thigh Perforator) are types of free-flap reconstruction that use tissue from your upper inner or outer thigh. Your plastic surgeon the takes tissue and its blood supply from the area and then transplants it to your chest to sculpt a new breast. The scar is located on the inner or outer thigh area or on the upper thigh just below the buttock crease, depending on the donor site. Thigh flap reconstruction is generally used when tissue can’t be taken from the abdomen.

GAP (Gluteal Artery Perforator) free-flap reconstruction uses skin and fat from your upper or lower buttocks to sculpt a new breast. As with the DIEP abdominal flap, microsurgery is used to connect this tissue to a new blood supply in the chest. Also, like the DIEP abdominal flap, a GAP buttocks flap reconstruction spares the buttock muscle. This type of reconstruction is generally used if you do not have enough tissue in your abdomen or have had previous surgeries that prevent the use of abdominal tissue.


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  • Reconstructed breast looks natural
  • Reconstructed breast ages naturally
  • Reconstructed breast adjusts to weight gain and loss
Things to Consider

Not everyone is a candidate for this type of surgery. These are some of the factors that could prevent you from getting thigh or buttocks flap reconstruction:

  • Some medical co-morbidities where a longer surgery is not safe
  • History of clotting disorders
  • Active smoking

Who Should Get DUG, PAP, LTP, or GAP Flap Surgery?

Thigh or buttocks free-flap procedures are best for people who:

  • Cannot have tissue taken from the abdomen
  • Do not want a foreign body in them (an implant)
  • Want to avoid lifelong imaging for implant surveillance   
  • Are willing to accept a longer initial recovery

What to Expect with DUG, PAP, LTP, or GAP Flap Reconstruction

In general, the timeline for surgery and recovery is similar among all types of autologous breast reconstruction.

Tissue Transfer

  • Hospital stay: 2 to 3 Days
  • Recovery: 4 to 6 Weeks

Nipple Reconstruction

  • Hospital Stay: None (outpatient)
  • Recovery: Minimal

FAQs: Preparing for Surgery

Tips and advice to prepare for all types of reconstruction surgery – like what to expect the day of surgery, what to bring, and how to prepare.

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FAQs: Life After Surgery

More information and resources about life after reconstruction surgery – like what to expect and how to prepare for life after surgery.

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Get the Support you need at MSK

MSK offers compassionate care from a team of experts offering the latest breast reconstruction techniques. We’re here for you every step of the way, before, during, and after surgery.

Financial Services at MSK
Managing the cost of your cancer treatment can be stressful and difficult. To speak with someone about your options, contact your Patient Access Coordinator (PAC).

Support & Helpful Resources
Your mental health is important, too. We offer many resources to help you through the emotional aspects of breast reconstruction.