In this video, David Song, MD demonstrates the use of a VUG (Vertical Upper Gracilis) flap for breast reconstruction. The patient is a 37-year-old female, with previous attempted alloplastic breast reconstruction on the left side after a bilateral mastectomy. She has undergone radiation and lost the implant due to infection. The use of the VUG flap is the secondary option in this case, as the patient did not have enough abdominal nor buttock donor site tissue available. This video demonstrates the use of the penrose drain, used to identify both the proximal and distal portion of the gracilis muscle and to confirm that the skin and fat are centered over the muscle. The complexity of this procedure stems from the irradiated tissue, and multiple prior episodes of infection and scarring, making the anastomosis more challenging than usual.