There are unique cases where patients wish to have autologous reconstruction but are unable to have a TRAM flap. Examples such as this include patients who have already had a tummy tuck, a TRAM flap, or simply do not have enough abdominal tissue to reconstruct a breast. Other situations may make a TRAM flap more difficult, such as prior abdominal surgery scars or underlying medical problems. When a TRAM-flap is not available, secondary autologous breast reconstructions are considered including using the soft tissue and muscle of your inner thigh (transverse upper gracilis free flap or TUG-flap), the soft tissue and muscle of your back (latissimus dorsi muscle flap) or your buttock (gluteal flap).