The laparoscopically harvested omentum as a free flap for autologous breast reconstruction

Abstract

Background: In autologous breast reconstruction, abdominal based flaps are by far the most common choice from the wide range of free flaps available. In selected cases, a laparoscopically harvested omental free flap (LHOFF) can be used. Patient satisfaction has not been reported until now. In this article, we report our experience using LHOFF in breast reconstruction including our technique, patient satisfaction, and donor/recipient site complications.

Patients and methods: Between 2007 and 2014, six patients underwent autologous breast reconstruction with LHOFF. Four patients had undergone radical mastectomy and two patient developed prosthesis complications after lumpectomy and breast augmentation. The omentum was harvested laparoscopically. The gastroepiploic vessels were anastomosed to the internal mammary vessels. A retrospective chart review was performed to retrieve surgical data. All the patients completed a questionnaire about their outcome.

Results: Mean weight of the omentum was 224 g. There were no flap failures. Two patients required a second surgical procedure due to complications. In one patient, a salvage procedure was required due to a venous thrombosis, whereas in the other, there was necrosis of the skin flap. No abdominal complications or volume loss occurred. Mean follow-up was 30.5 months. The aesthetic results were very satisfactory with minimal scars and good breast volume.

Conclusion: Autologous breast reconstruction using an LHOFF can be used effectively in selected cases. The aesthetic results are pleasing with minimal scarring, good volume, and a soft, natural feeling breast.

Keywords: autologous; breast reconstruction; free flap; omental free flap; omentum.