TUG/DUG (transverse upper gracilis/diagonal upper gracilis) flap techniques are used to reconstruct the breast using the patient’s own tissue. The two techniques take tissue from the inner thigh, as opposed to the abdominal area like other techniques. These techniques are also muscle sparing, using only skin, fat, and their blood-supply during the transfer. Breast reconstruction patients from Washington, DC; Chevy Chase and Bethesda, MD; Arlington and Fairfax, VA; and beyond visit the experienced team at Center for Plastic Surgery for these and many other advanced techniques.
The TUG/DUG flap techniques offer an alternative to tissue expanders and implant use for a natural looking and feeling breast. Important muscles are spared during this technique, sacrificing only a small part of the muscle from the inner thigh, reducing the risk of muscle weakness after surgery. The incisions during this technique are on the inner thigh where they are well hidden.
Who Is a Candidate?
Candidates for TUG/DUG flap reconstruction are typically those who do not have enough abdominal tissue to have a DIEP or SIEA flap procedure. Patients who have already had a DIEP or SIEA flap or other abdominal procedure in the past can benefit from the TUG/DUG technique for their reconstruction. To be a successful candidate, patients must have enough tissue in the upper thighs for the transfer. These techniques are ideal for patients with small to medium sized breasts, as only a moderate amount of tissue will be taken.
A Reputation Built on Results
Dr Fleury is a great doctor. My wife just had breast cancer surgery with his help. Everything is perfect!
KKevin Fan
I cannot say enough wonderful things about Dr. Albino and his entire team. After going through cancer treatment and everything that comes with it, having a surgeon you can completely trust makes an enormous difference. Dr. Albino has been exceptional every step of the way.
From placing my tissue expanders after cancer to preparing for my upcoming reconstruction, his attention to detail is truly beyond measure. He is incredibly knowledgeable, professional, meticulous, and clearly takes tremendous pride in his work. But what makes him truly stand out is the way he treats his patients. His bedside manner is exceptional—he is compassionate, patient, attentive, and genuinely listens. He takes the time to explain everything thoroughly, answer every question, and make sure you feel comfortable and informed throughout the process.
And his team is just as exceptional. Every member of his staff has been kind, caring, professional, responsive, and incredibly supportive. They consistently go above and beyond to make what can be an overwhelming and emotional experience feel easier and more manageable. You can tell that the compassion and excellence Dr. Albino brings to his patients is reflected throughout his entire team.
During an experience that can be physically and emotionally overwhelming, Dr. Albino and his team have given me confidence and reassurance at every stage. I never feel rushed or like just another patient. I feel heard, cared for, and completely confident that I am in the best possible hands.
His combination of surgical expertise, precision, professionalism, compassion, and an outstanding team is truly rare. I am incredibly grateful to have Dr. Albino as my surgeon and am looking forward to having him complete my reconstruction. I would recommend him and his team without hesitation to anyone looking for exceptional care.
Dr. Albino and his team are, quite simply, exceptional beyond measure.
PPetra Horne
I saw Dr Fleury for a consultation for breast reconstruction and he was very kind, patient, supportive, and thorough in his explanations.
DDaphne Williams
I came to Dr. Albino from another local surgeon, hoping to get a more encouraging second opinion after a double mastectomy and breast cancer treatment. Not only did I get an encouraging second opinion, my results are far greater than anything I expected. My reconstruction journey started with expanders, and for months I heard "you won't love your results but you'll be ok with them one day," and this was hard to grasp. I couldn't imagine looking in the mirror and seeing the remnants of cancer for the rest of my life. Dr. Albino gave me so much hope and optimism that I could be happy with my results. I had an implant and fat grafting revision with Dr. Albino almost 3 weeks ago, and I am thrilled with everything! Not only am I ok, I love the way I look. I feel like me again. I have recommended him to everyone I know, and cannot sing his praises enough. He is meticulous and professional, but has amazing bedside manner and true compassion for this difficult journey. The office staff is pleasant, and Heather has responded to about 80 emails from me without a single complaint. I am so grateful for this practice that gave me my confidence and my body back. If you have the opportunity to work with Dr. Albino I highly recommend him!
LLindsey Shaver
Center For Plastic Surgery has the most amazing, courteous staff and THE most amazing doctors. I love Dr. Albino. He always takes time to answer any questions. He is funny, kind and always upbeat..but most importantly, he is the best, especially for breast reconstruction surgery. I recommend him hands down.
LLois Mei-Mei Watts Venners
Dr. Fleury and all his team at CPS are truly wonderful. He performed reconstruction after a double mastectomy due to breast cancer and he is an amazing micro surgeon keeping all the transplanted sections alive and healthy even though I have diabetes. He worked with my insurance and helped fight them when they canceled coverage for the nerve graft the night before surgery. Erin, Cameron, Nina and really the whole office have always been so kind, sympathetic and knowledgeable. I have a new lease on life thanks to Dr Fleury and CPS.
MMartha Forster
Choosing Dr. Christopher Fleury as my plastic surgeon was one of the best decisions I made after my breast cancer diagnosis.
From the very first appointment, he made me feel comfortable, and honestly, that mattered more than I could have imagined given everything else I was dealing with. He listens. Really listens. He took the time to understand what I wanted my reconstruction to look like instead of assuming he knew what was best for me. I wanted a natural result that stayed close to my original size, and every decision along the way reflected those conversations. Although I'm still in the middle of reconstruction, I already feel completely confident in where we're headed together.
None of that would matter if he weren't exceptionally gifted technically, but he is. He performed my reconstruction after my double mastectomy, including tissue expander placement, ADM placement, and a nerve allograft. One of the biggest surprises was learning he could perform the nerve allograft. I hadn't even known that preserving the possibility of sensation was an option, and he took the time to explain both the potential benefits and the limitations honestly. Knowing I have a real chance of regaining sensation down the road is something I'll always be grateful for.
What stood out just as much was how well he understood the cancer side of this, not just the plastic surgery side. When I asked about direct-to-implant reconstruction, he walked me through why it wasn't the right fit for me and why he recommended the expander approach instead. Rather than giving me a one-size-fits-all answer, he explained the reasoning behind every recommendation. That told me he was thinking about my long-term outcome, not just what was easiest.
He also worked seamlessly with my breast surgeon, Dr. Bonnie Sun, and I can't overstate how reassuring it was to know they approached my treatment as a team. When you're facing cancer, that kind of collaboration matters.
What really sets Dr. Fleury apart, though, is who he is as a person. He's warm, approachable, and has a calm confidence that puts you at ease even when you're overwhelmed. He greets me at every appointment with genuine enthusiasm and makes me feel like we're tackling this together. Those may seem like small things, but during one of the most difficult times of your life, they're anything but. You'll feel heard, respected, and genuinely cared for.
There are many talented plastic surgeons. What makes Dr. Fleury exceptional is the rare combination of elite surgical skill, cutting-edge expertise, deep understanding of breast cancer reconstruction, genuine respect for his patients' goals, and extraordinary compassion. Those qualities don't always exist in the same physician, but they do in him.
If you're facing breast reconstruction after a breast cancer diagnosis, I cannot recommend Dr. Fleury highly enough. I am incredibly grateful he's part of my team.
TTori
Dr. Fleury has the most amazing, down to-earth attitude and makes you feel comfortable from the moment you meet him. He spent a great deal of time talking with me about my upcoming reconstruction and DIEP flap surgery following my double mastectomy, answering my questions and making sure I understood my options.
Although I haven’t had my surgery yet, I would highly recommend Dr. Fleury based on the compassion, professionalism, and genuine care he has shown me throughout this process
I am beyond grateful to have found a surgeon who combines exceptional professionalism with genuine compassion.
VVirginia Lee John
I would like to thank Dr. Albino and his team for the wonderful work they did and do after my breast cancer reconstructive surgery! From the first visit everyone was so nice, respectful, loving and very professional! After my visits Dr. Albino himself took time out to reach out to me to see how I was doing. I really appreciated it because that's something you don't see often. Thanks again!
LLa'Tonya Copeland
I had a great experience working with Dr. Rao for my bilateral mastectomy with DIEP flap reconstruction. From beginning to end Dr. Rao and his team were very honest, patient, and kind, and performed at the highest level. I’m really pleased with the outcome, and feel like myself again! I would definitely recommend him and his practice to other women going through the same journey.
TTara D
I have worked for several plastic surgeons previously and I loved seeing Dr. Albino for a consultation for my breast reconstruction. He has excellent bedside manner, explained things in a way that made sense to both my husband and myself. His office is modern and comfortable. I also really appreciated that his recommendations took into account the age of my two children. Highly recommend him. His surgical results are 👌 for breast reconstruction.
Eemily taylor
Making the difficult decision of having a prophylactic bilateral mastectomy was one of the toughest decisions of my life. The idea of a mastectomy felt like a loss but one of my first-degree relatives was diagnosed with breast cancer and family history research revealed my risk was high so I knew I had to move quickly. However, the uncertainty of what I would look like after the surgery was extremely stressful. I consider myself a strong woman so it was difficult to admit to myself that no matter how strong I thought I could be, the results of a reconstruction had the potential to affect my self-esteem & self-confidence for the rest of my life.
I had a fantastic breast surgeon but was concerned about who to use for the breast reconstruction. My breast surgeon referred me to Dr. Albino, a plastic surgeon that specializes in post-mastectomy breast reconstruction.
Dr. Albino and his team created a calm and confident space. During the initial consultation, he explained all of my reconstruction options. Each question was answered and I never felt rushed to make any decision. I was shown before-and-after photos so I had an idea of what to expect. The approach felt like collaboration, with my emotional well-being and desired outcome at the forefront.
The results were life-changing for me. I consider Dr. Albino’s work to be artistic. The new breasts are beautifully shaped and symmetrical. They also feel natural. The scars from the mastectomy and reconstruction surgeries are well-hidden.
The compassionate care made a difference. The staff was kind, attentive, and reassuring. This surgery was about regaining confidence and feeling whole again. Dr. Albino gave me a new beginning. His brilliance, talent, and compassionate heart are appreciated.
I highly recommended Dr. Albino to anyone facing this journey.
VVanessa B
Excellent doctor and staff who provided me with the best care for a breast cancer related treatment. I highly recommend this practice!
QQuenton Burner
I’ve been a reconstruction patient of Dr Rao’s for three years and I cannot say enough about the level of care, concern, and attention I have received from the beginning. From the helpful front office staff, nurses who balance compassion with knowledge and professionalism, and always have a warm smile and uplifting spirit, to his PA and even on call partner providers, to Dr Rao himself. All top notch and the only team I’d trust with my reconstruction care.
CCortni Herod
Dr. Albino is Amazing and I am so grateful to have met him 3 years ago when deciding the route to take after breast cancer. He explained everything and did an exceptional job!!
He and his team are Awesome 🤩
PPmb Braud
Following a breast cancer diagnosis, I was looking for a good plastic surgeon to take care of the breast reconstruction after my double mastectomy. Dr. Fleury came highly recommended.
On my initial meeting with Dr. Fleury and his team, I immediately felt at ease. Dr. Fleury answered all my questions with precision and took the time to describe, in detail, all the steps that were ahead of us. He and his staff behaved in a professional manner, were encouraging and showed compassion.
I am now awaiting my breast reconstruction, which will take place in a couple of months. I am confident in Dr. Fleury’s skills and good quality care.
NNadia Protzuk
I had a wonderful experience with Dr. Kanuri for my breast reconstruction after my mastectomy. He was very thoughtful and thorough with all the procedures. His staff was also staff was also very informative and knowledgeable. They provided guidance every step of the way. I’m very thankful for him and the staff.
CCristina Sylvia
What started as a possible breast reduction surgical procedure to help with chronic back pain sadly became more complicated. I learned that I carry an unknown genetic mutation increasing my risk for breast, ovarian, and pancreatic cancers. I went from interviewing doctors to hiring one.
After multiple consultations around the DC & Northern VA areas, I felt certain in my choice. For anyone facing a similarly complex and emotional decision, I would strongly recommend considering Dr. Frank Albino.
What ultimately helped me make a decision was speaking with a few recently retired operating room nurses I knew that worked where my consultants practiced. Although they had not worked directly with my choices, they remained connected to colleagues who had. When asked who they would see for a reconstruction post-mastectomy, the response was 100% consistent and immediate: Dr. Albino.
He was described as respectful, exceptionally skilled, highly educated, efficient, and—most notably—deeply kind. After meeting him myself, I found those descriptions to be entirely accurate. Dr. Albino is transparent, supportive, reassuring, and empathetic. He has a remarkable ability to take complex, fragmented information and synthesize it into a clear and thoughtful plan. His approach is both analytical and compassionate.
In comparison to other offices, his stood out for its responsiveness. Calls were returned promptly, and communication was reliable. I’m indebted to Heather, Niya, Cameron, and many others for their continued guidance and compassion. The office was in constant communication through the entire process to make sure nothing was missed, especially with all my many questions and concerns.
The act of scheduling the plastic surgeon, oncology surgeon, hospital, operating room, handling the insurance company, paperwork, pre-op & post-op exams and more went very smoothly on my end BECAUSE of them. I am so very grateful.
Lastly, after meeting with the oncology surgeon, she was very happy to know that she would be working alongside Dr Albino. That approval solidified my heart and mind even more, if possible. Thank you, Dr Albino and THE Center for Plastic Surgery.
GG Bishop
I’ve had issues with my radiated breast from breast cancer for years (capsule contraction) and several surgeries later, I may have finally found a doctor that knows what he’s doing. I just had a tissue expander put in 2 weeks ago and everything went great! I will be getting a diep flap in a couple of months and judging from the pictures on his site, I have nothing to worry about
Sshirley grant
I was scared and vulnerable before I met Dr. Fleury but he became a true light in my life. He didn’t just operate on me; he cared for me as a whole person, with patience, gentleness, and genuine compassion. He takes time to explain every step, answer every question, and he never makes me feel rushed or alone in this process.
His staff is outstanding—warm, supportive, and always going out of their way to make me feel comfortable the moment I walk in. I am deeply grateful to have him and his team walking beside me through this chapter. I would recommend Dr. Fleury to anyone facing breast surgery reconstruction; he is an outstanding surgeon and one of the most amazing people I have ever met.
SSharmila Rasanayagam-Osuri
I met Dr. Fleury after having a complete mastectomy due to an aggressive form of cancer. I had a consult for reconstruction that I was still unsure I wanted. Dr. Fleury was very thorough in explaining all of my options. I eventually decided on the type of reconstruction I would have and again Dr. Fleury told me if I decided I didn't want to do it I could cancel the night before. I felt no pressure to have the reconstruction which in a way was incredibly helpful because I knew I had an out if needed.
I had my reconstruction in August. Dr. Fleury was incredibly kind and understanding about all of my concerns and addressed them fully. The first surgery was successful. He gave me back what cancer took from me. I had a revision in March to clean up the area a bit, which is pretty normal after the first surgery is done to see how things look. Again Dr. Fleury was amazing. He asked what I wanted to fix and added what his thoughts were on some issues I hadn't thought of.
Dr. Fleury gave me back my life in many ways.I feel like I am whole again. No more surgeries. I no longer feel embarrassed about how I look and see that I look pretty normal again. I look good in my clothes again and am not isolating and trying to hide what I look like.
It is with deep and heartfelt thanks I give to Dr. Fleury who has been there for my entire reconstructive journey. Cancer doesn't just stop after you are declared cancer free and Dr. Fleury understood that.
My husband and I thank him from the bottom of our hearts for putting me back together.
DDeb Pinard
Dr Rao & his staff were absolutely wonderful throughout my whole ordeal of having to have a double mastectomy and a total reconstruction of both breast! I highly recommend his office!! If I ever want to get anything else nipped or tucked he’s my man!!
BBernadette Lund
This review is for Dr. Fleury, who played an important part in my mastectomies (and upcoming reconstructive surgery). I personally don’t like to leave any internet footprints, but am more than happy to leave a review for him.
Dr. Fleury is the doctor you want to have when going through difficult time with the diagnosis of breast cancer. He knows how it is as a family member of breast cancer survivor. He still has so much passion, energy, and knowledge to give, other than providing surgery. The surgery outcome is great, but more importantly - the perspective toward this illness is also great under his care. He is truly special. He gives his cell phone number to patients, and hospital nurses who take care of his patients. He welcomes communication, and he is just soooo nice ! As a nurse myself, I see why other medical staff just love him and respect him so much - because he cares about people, and loves what he does. I feel very blessed that I was referred to him.
Yyachuan huang
Dr. Fleury is truly one of the most compassionate and skilled physicians I have ever met. From the very first visit, he made me feel safe, heard, and genuinely cared for during one of the most vulnerable times in my life.
As someone facing breast cancer and reconstruction, trust is everything—and I trust him completely. Knowing that this work is personal to him, as his own wife has gone through breast cancer, makes his level of empathy and dedication even more meaningful. You can feel that this is not just his profession—it’s his purpose.
His expertise speaks for itself. His background in hand surgery translates into an incredible level of precision, which gave me so much confidence moving forward with my DIEP flap reconstruction.
What truly sets him apart is his bedside manner. He is kind, patient, and always takes the time to explain everything clearly. The fact that he is accessible—even responding to messages—shows how deeply he cares about his patients.
His entire team is just as amazing. Every single person in the office made me feel comfortable, supported, and valued.
He helped me feel comfortable in my own body again during a time I never thought I would.
I never imagined I could feel this at peace going through cancer, surgery, and reconstruction—but Dr. Fleury made that possible. I am beyond grateful for him and his team. He is truly a blessing.
AAngela Fernandez
ESTABLISHED EXCELLENCE
Choose the experts that locals know and trust. Our multigenerational practice includes board-certified plastic surgeons who provide the best possible care with state-of-the-art technology.
During TUG/DUG flap reconstruction, skin, fat, and their blood supply is taken from the inner thigh and transferred to the chest to reconstruct the breast mound. For the TUG technique, the incision will be made across the inner thigh, while the DUG technique will use an incision angled down the thigh. Using microsurgery, the blood vessels are reconnected to establish blood flow in the chest. The flap is then shaped to look as identical as possible to the natural breast.
Results and Recovery
After TUG/DUG flap reconstruction, patients might experience swelling, bruising, and soreness in the donor site and the reconstructed breast. Because no important muscles were affected, patients do not have to worry about permanent muscle weakness after the procedure.
PAP Flap
What Is PAP Flap?
PAP flap is an autologous breast reconstruction technique using the profundal artery perforator blood vessel in the thigh. Along with the blood vessel, skin and fat from the upper thigh are taken as well to reconstruct the breast mound. This is a muscle sparing technique, leaving the thigh muscle intact. Breast reconstruction patients from Washington, DC; Chevy Chase and Bethesda, MD; Arlington and Fairfax, VA; visit the experienced team at Center for Plastic Surgery for this and many other advanced techniques.
The Benefits of PAP Flap
This technique allows for a natural looking and feeling breast without the use of muscle. By sparing the muscle, recovery is often shorter and there is a lower risk of muscle weakness after the operation. taking the flap from the upper thigh area leaves a scar that is well hidden within the natural crease of the buttocks. Blood vessels in this area are lengthy, giving the surgeon more control over tissue positioning.
Who Is a Candidate?
This technique is ideal for women who want to utilize a muscle sparing flap, but do not have enough abdominal tissue. PAP flap is also commonly used on those who have had a previous abdominal surgery, making them poor candidates for an abdominal flap. To be a good candidate for PAP flap, patients must have enough excess tissue in the upper thigh area. The PAP flap technique works best for women with small to medium sized breasts.
The Procedure
During a PAP flap procedure, a section of skin, fat, and their blood vessels are taken from the back of the thigh, just below the buttocks. The tissue is then moved to the chest to reconstruct the breast mound. Using microsurgery, blood flow will be restored to the blood vessels.
Results and Recovery
After PAP flap reconstruction, patients can expect some swelling, bruising, and soreness in the breast and thigh. Tightness in the thigh is also common, but this should improve over the next few months. Patients will need to avoid certain movements that could strain the incision sites and should refrain from strenuous activity for about six weeks. A complete list of aftercare instructions and physical restrictions will be provided. A scar will be left in the crease of the buttocks, but this should be well hidden and continue to fade with time.
Schedule Your Complimentary Consultation
To meet with a surgeon in person, request a complimentary consultation using our online form. CPS has been helping patients feel more confident since 1986. We pride ourselves on providing a comfortable, caring environment for our patients.