Fat-augmented omentum-based construct for breast reconstruction

Abstract

In the landscape of breast reconstruction, autologous tissue procedures have provided viable alternatives, albeit restricted by donor site morbidity and patient-specific anatomical considerations, including donor tissue availability and surgical history. Amidst these challenges, a novel approach has emerged - the fat-augmented omentum-based construct for breast reconstruction. This comprehensive review endeavors to explore the historical evolution, anatomical considerations, surgical techniques, clinical outcomes, and future directions of the fat-augmented omentum-based approach in breast reconstruction. The omental fat-augmented free flap (O-FAFF) offers a promising choice for patients who might not be appropriate candidates for conventional autologous reconstruction methods due to low BMI, previous surgeries compromising traditional donor sites, or insufficient adipose tissue volume. Operative techniques for O-FAFF involve a coordinated team approach, with simultaneous mastectomy and laparoscopic omentectomy. The omentum is shaped within an acellular dermal matrix casing, allowing for precise control of reconstruction dimensions. In addition, utilizing the omentum with fat grafting effectively restores the natural breast volume. Clinical outcomes of O-FAFF reconstruction have shown promise, with patients reporting natural-looking and soft-feeling reconstructed breasts. However, challenges such as accurate tissue volume estimation and potential complications remain, highlighting the need for further research and refinement of the technique. Overall, O-FAFF represents a significant advancement in breast reconstruction, offering a promising alternative to traditional methods. Continued investigation and clinical experience will be instrumental in establishing O-FAFF as a standard of care, ultimately improving outcomes for a wide range of patients undergoing breast reconstruction.