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

Abstract

The novel use of the omental flap in breast reconstruction has been increasing in research popularity within the last few decades. This technique has its roots in the early 20th century as surgeons explored the use of the omentum for a variety of reconstructive purposes across various surgical subspecialties. The current literature shows evidence of the benefits of using the omentum in autologous breast reconstruction compared to the more traditional abdominal, flank, thigh, and gluteal donor flap reconstruction. This method introduces a viable option for patients that do not meet the criteria for the traditional autologous reconstruction techniques allowing for the restoration of more natural appearing breasts without the added complication of donor-site mortality. Additionally, the omentum, with its rich source of vascularized lymph nodes, has been studied as a potential source for lymph node transfer in the treatment of mastectomy-associated lymphedema. In this review, we highlight the most recent research on the current practices of omental-based breast reconstruction techniques and their use in postmastectomy lymphedema. We discuss the history and natural progression of the development of omental-based reconstruction as an autologous breast reconstruction technique, highlight the latest advances and challenges for the utility of the omental flap in current surgical procedures, and present future directions for the potential role of omental-based breast reconstruction in postmastectomy breast surgery.

Fat-augmented omentum-based construct for breast reconstruction

“…However, there is a limit to how much fasciocutaneous tissue can be harvested from low BMI individuals for stacked and extended territory flaps [23] . Additionally, only performing fat grafting for breast reconstruction necessitates multiple grafting, making it less durable for women of any BMI [24] . By leveraging the abundant adipose tissue of the omentum, even in patients with low BMI, the O-FAFF technique overcomes these limitations, presenting a viable solution for those desiring autologous breast reconstruction.…”

“…Despite attempts using different imaging modalities such as computed tomography (CT), ultrasonography, and magnetic resonance imaging (MRI), accurately estimating the volume of the omentum remains elusive. Additionally, neither patient weight nor body mass index (BMI) reliably predicts omental volume [24] .…”

“…Beyond its role in adipose tissue storage, it serves as a protective barrier for visceral organs by supporting critical physiological processes such as hemorrhage control and scar formation. As such, the omentum has applications in limb salvage, osseous reconstruction, and wound coverage due to its vascularity and regenerative properties [2,3,[22][23][24]26] .…”

“…The greater omentum originates from the greater curvature of the gastric wall. Its dimensions vary from 14 to 36 cm in length and 20 to 46 cm in width, with a surface area ranging from 300 to 1,500 cm² and a weight of 300 to 2,000 g [Figure 1A] [24,26] . Comprising of fatty tissue, blood vessels, lymphatics, and lymph glands, the omental flap's vascular supply is primarily derived from the celiac trunk, specifically through the gastroepiploic vessels, which run between its layers, ensuring robust vascularization to the tissue [26] .…”

“…Notably, the right gastro-omental artery typically exhibits a bigger diameter compared to its left counterpart. Additionally, the venous drainage system of the omentum mirrors its arterial supply, ultimately draining into the portal system [24] .…”