Minimizing Postoperative Pain in Autologous Breast Reconstruction With the Omental Fat–Augmented Free Flap

Abstract

Introduction The omental fat–augmented free flap (O-FAFF) is a recently developed technique for autologous breast reconstruction. Our aim of the study is to evaluate the outcomes of our early case series. We assess the O-FAFF donor site morbidity in terms of postoperative pain, narcotic, and antiemetic use. Methods A retrospective analysis of patients undergoing O-FAFF from 2019 to 2021 was performed. Patients were evaluated for demographic data, operative time, hospital course, and complications. Mean pain scores (1–10 scale) and narcotic pain medication use in oral morphine equivalents and doses of antiemetic medications during their hospital course were analyzed. We compared outcomes of our O-FAFF group with those of a control group of patients who underwent breast reconstruction with traditional free abdominal tissue transfer. Results A total of 14 patients underwent O-FAFF breast reconstruction, representing 23 breasts. Patients had an average age of 48.5 years (±2.3 years) and body mass index of 22.6 kg/m2 (±1.09 kg/m2). Average follow-up was 232 days (±51 days). Average mastectomy weight was 245.6 g (±30.2 g) and average O-FAFF weight was 271 g (±31.7 g). Average pain scores on postoperative day 1 (POD1), POD2, and POD3 were 3.1 (±0.28), 2.8 (±0.21), and 2.1 (±0.35), respectively. The average narcotic use by patients in oral morphine equivalents on POD1, POD2, and POD3 are 24.3 (±5.5), 21.9 (±4.6), and 6.2 (±2.4), respectively. Total narcotic use during hospital stay was 79.4 mg (±11.1 mg). Average pain scores and narcotic use are significantly lower when compared with a previously published cohort of patients who underwent autologous breast reconstruction with free abdominal tissue transfer (P < 0.05). Average antiemetic use was lower in the O-FAFF group compared with the control group: 3.5 versus 4.8 doses (P = 0.6). Hospital length of stay was 3.0 days (±0.0 days). No complications were noted (0%). Patients were universally satisfied with their reconstructive outcome (100%). Conclusions The O-FAFF is proven to be a viable method of autologous breast reconstruction. Early series of patients undergoing O-FAFF reconstruction suggest a lower donor site morbidity as demonstrated by lower postoperative pain scores and lower consumptions of narcotic pain medications.

Concurrent management of lymphedema and breast reconstruction with single‐stage omental vascularized lymph node transfer and autologous breast reconstruction: A case series

“…A follow-up study showed that this technique resulted in less postoperative pain and shorter hospital stay compared to abdominally base free flaps (Deptula et al, 2022). Consistent with prior reports, T A B L E 1 (Continued) none of the patients in our series have reported symptoms suggestive of abdominal adhesions after omentum harvest or have required reoperations or readmissions for incarcerated bowel.…”

“…Nguyen et al describes the novel technique of the omental fat‐augmented free flap use as a free flap for autologous breast reconstruction in those patients lacking adequate abdominal adiposity as well as in those patients who desire minimizing donor site morbidity with the use of laparoscopically harvested free omentum, alloderm and grafted fat (Nguyen et al, 2022). A follow‐up study showed that this technique resulted in less post‐operative pain and shorter hospital stay compared to abdominally base free flaps (Deptula et al, 2022). Consistent with prior reports, none of the patients in our series have reported symptoms suggestive of abdominal adhesions after omentum harvest or have required reoperations or readmissions for incarcerated bowel.…”