A Novel Fat-Augmented Omentum-Based Construct for Unilateral and Bilateral Free-Flap Breast Reconstruction in Underweight and Normal Weight Women Receiving Nipple or Skin-Sparing Mastectomies

Current Research on the Use of the Omental Flap in Breast Reconstruction and Post-Mastectomy Lymphedema: A Focus on Omental-Vascularized Lymph Node Transfer

“…Current methods for autologous reconstruction involving free or pedicled myocutaneous tissue flaps have provided favorable outcomes for patients undergoing non-implant-based breast reconstruction. However, the requirements for free or pedicled flaps such as the latissimus dorsi, TRAM, DIEP, or SIEA flaps may make the option not appropriate or attainable for patients with a lower BMI or inadequate adipose tissue volume [ 13 , 31 ]. Additionally, patients opting for bilateral breast reconstruction that requires more tissue volume to appropriately reconstruct a breast mound ideal for their body frame may have to forgo the benefits of autologous reconstruction and may only have the option for implant-based reconstruction.…”

“…Additionally, patients opting for bilateral breast reconstruction that requires more tissue volume to appropriately reconstruct a breast mound ideal for their body frame may have to forgo the benefits of autologous reconstruction and may only have the option for implant-based reconstruction. While implant-based reconstruction is a comparable choice when considering long-term patient satisfaction, this option limits patients that may desire a non-implant-based reconstruction if they do not meet the appropriate criteria [ 8 , 31 ]. Omental fat-augmentation free flap (O-FAFF) reconstruction has been tested as an innovative technique to solve this problem, increasing the population of patients that can be considered candidates for autologous reconstruction by using a combination technique of omental flap harvesting in addition to fat harvesting to increase omental flap volume [ 8 , 23 , 31 ].…”

“…The technique as described by Nguyen et al begins after mastectomy, either nipple sparing or skin sparing, and it involves laparoscopic omentectomy that can be performed simultaneously with the mastectomy and ex vivo suturing of an acellular dermal matrix (ADM) mold to hold the harvested omental adipose tissue [ 31 ]. While previous abdominal surgery can present with certain risks for omental procurement, history of surgery is not an absolute contraindication.…”

“…While previous abdominal surgery can present with certain risks for omental procurement, history of surgery is not an absolute contraindication. The greatest risk in these reconstruction cases involves maintaining adequate blood flow to the omentum which can be confirmed by computed tomography (CT) angiography [ 31 ]. After clipping the vasculature and dissecting the borders of the omentum along its connection, the organ is removed along with its vasculature with the option to divide the tissue ex vivo if necessary for bilateral reconstruction.…”

“…Microsurgical anastomosis of the omentum via the gastroepiploic vessels to the internal mammary vessels in a post-mastectomy breast pocket provides adequate blood flow for the flap. The flap is then monitored postoperatively with transcutaneous dopplers [ 31 ]. Recovery for omental-based breast reconstruction is largely unchanged from the more traditional autologous reconstruction methods with improvement in pain management and less use of narcotics compared to the control group [ 31 ].…”