A Novel Fat-Augmented Omentum-Based Construct Is A Superior Alternative For Unilateral And Bilateral Autologous Breast Reconstruction In Low-BMI Women
Pooja S. Yesantharao, MD, MS, Yulia Zak, MD, Monica M. Dua, MD, Irene L. Wapnir, MD, Dung H. Nguyen, MD, PharmD.
Stanford University, Palo Alto, CA, USA.
PURPOSE: Autologous breast reconstruction has demonstrated advantages over implant based reconstruction. However, women of low body mass index (BMI) often lack adequate tissue from traditional donor sites. A novel omental fat-augmented free flap (O-FAFF) technique involves laparoscopic omental harvest and creation of a “biologic” implant by encasing omentum in an acellular dermal matrix shell that is volume-augmented through lipoinjection and microsurgically anastomosed to internal mammary vessels. This study investigated the utility of the O-FAFF technique for autologous breast reconstruction in low BMI women. METHODS: This was a retrospective cohort investigation of O-FAFF breast reconstruction (2019-2022). Aesthetic outcomes, volume retention, and postoperative pain were compared to patients undergoing abdominally-based free flap reconstruction. RESULTS: Thirty-four women (50 breasts; 10 non-nipple-sparing, 40 nipple-sparing) received O-FAFF reconstruction. Twenty-one were immediate breast reconstructions and 13 were revisions of prior reconstructions. Mean age was 48.2 (range 23-73) years and mean BMI was 22.3 (range 17.6-32.4) kg/m2. Mean follow-up was 11.9 (range 1-30) months. The mean ratio of fat to omental weight was 0.73 (range 0.22-1.38) and 1.97 (range 0.24-3.8) for unilateral and bilateral cases, respectively. Postoperative pain scores and OME consumption were more favorable for the O-FAFF group compared to control (p<0.001). Clinical evaluation and postoperative MRI revealed soft, natural-appearing breasts without evidence of hypoperfusion or fat necrosis. CONCLUSION: The O-FAFF provides a viable method for autologous breast reconstruction in low-BMI women. Laparoscopic omentectomy minimizes donor site morbidity and perioperative pain. This technique can thus dramatically increase the number of women receiving durable autologous breast reconstruction.
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