Fig. 1.

a Thirty seven year old patient (BMI 20.7 kg/m²) with implant failure of the right reconstructed breast after skin sparing mastectomy due to breast cancer. Patient is in supine position. Left leg in frog position with preoperative markings of the transverse musculocutaneous gracilis (TMG) flap in average flap dimension outlining the proximal skin island (SI), the subcutaneous fat extension to boost flap volume [beveling (BV)] and the gracilis muscle (GM). The skin island is limited to the medial aspect by the neurovascular bundle (black arrow) and to the inferior aspect by pinch grip (white arrow). b Circumferential incision of the TMG flap skin island. c Opened muscle fascia following complete soft tissue preparation of the TMG flap sparing the saphenous vein (SV) and lymphatic collectors. The vascular pedicle to the gracilis muscle is visualized between the adductor longus muscle (AM) and the gracilis muscle. d Preparation of the vascular pedicle (VP) in the septocutaneous space below the retracted adductor longus muscle to its origin from the medial circumflex artery. e Open donor site following complete lift of the TMG flap from the medial thigh. f Multiple layer closure of the TMG donor site on the medial thigh. g Closed incision negative pressure therapy on the TMG donor site