Comparative study between laparoscopically harvested omental flap and glandular flap in immediate reconstruction after conservative surgery in breast cancer

Abstract

AbstractAimOncoplastic breast surgery involves reconstruction of the resection defect by either volume displacement or volume replacement. Glandular flap insertion is an easy, quick, and acceptable method to correct breast defects after breast conserving surgery (BCS). The value of the omentum in extraperitoneal reconstruction was not appreciated until the mid‐20th century. The aim of this study was to assess the aesthetic outcome after immediate breast reconstruction with either glandular flap or laparoscopic‐harvested omental flap in early breast cancer after BCS.Patients and MethodsThis study was conducted on 44 patients with early breast cancer in the Surgical Oncology Unit, General Surgery Department, Tanta University Hospital during the period from October 2018 to May 2019. All patients underwent breast conserving surgery followed by immediate breast reconstruction by either glandular flap (group I; 20 patients) or omentoplasty (group II; 24 patients). The operative time, postoperative complications, the length of hospital stay, and aesthetic outcome were compared between the two groups.ResultsThe operative time in group I ranged from 90 to 120 minutes with a mean time of 113 minutes, whereas that in group II ranged from 110 to 160 minutes with a mean of 133 minutes. The hospital stay in group I ranged from 4 to 5 days with a mean of 4 days, whereas that in group II it ranged from 4 to 6 days with a mean of 5 days. In group I, two patients (10%) developed wound seroma and two patients (10%) developed fat necrosis, whereas in group II, eight patients (33.3%) developed fat necrosis and two patients (8.3%) developed epigastric incisional hernia with no wound seroma reported. Concerning the aesthetic outcome evaluated using patient's self‐evaluation, in group I, 70% of the patients were satisfied with the overall aesthetic results and 30% were dissatisfied, whereas in group II, 91.7% of the patients were satisfied and 8.3% were dissatisfied. With regard to the aesthetic outcome evaluated based on objective assessment with the Breast Cancer Conservation Treatment Cosmetic results software (BCCT.core), in group I, excellent results were obtained in 20% of cases, good results in 40% of cases, fair results in 20% of cases, and poor results in 20% of cases, whereas in group II, excellent results were obtained in 41.7% of cases, good results in 33.3% of cases, fair results in 16.7% of cases, and poor results in 8.3% of cases. No local recurrence or distant metastasis was reported.ConclusionThe glandular flap has shorter operative time and requires less extensive surgery than the omental flap. The omental flap has the potential to recreate a soft, naturally ptotic breast shape that is ideal for matching with the contralateral breast.