Single-port laparoscopically harvested omental flap for immediate breast reconstruction

Immediate breast reconstruction using laparoscopically harvested omental flap is a safe and feasible technique, providing natural contour and softness to reconstructed breasts with reduced donor-site morbidity and deformity. We report our experience using single-port laparoscopically harvested omental flap (SLOF) for immediate breast reconstruction.

Between February 2015 and December 2018, 129 patients with malignant neoplasm of the breast underwent nipple-sparing mastectomy (NSM) or breast-conserving surgery (BCS) followed by immediate SLOF reconstruction at Seoul National University Bundang Hospital. We assessed their clinicopathological data, complications, and cosmetic and oncologic outcomes. Cosmetic outcomes were evaluated by three-panel assessment and the BCCT.core software program.

One hundred and six (82.2%) underwent NSM and 23 (17.8%) underwent BCS. Mean operation time was 205 (range, 134-316) minutes. Most patients had early-stage disease; 15 (11.6%) received neoadjuvant chemotherapy. Two had malignant phyllodes tumors. Cosmetic outcomes were excellent or good in 96.9% by three-panel assessment and 99.2% by the BCCT.core program with a nearly invisible donor-site scar in the umbilicus. Harvest-associated complications occurred in five (3.9%) patients, including two umbilical wound infections, one intra-abdominal infection, one umbilical hernia, and one pedicle injury. Fat necrosis (13.2%) and epigastric bulging (21.7%) were common mastectomy- or reconstruction-associated complications, but most were mild and some resolved spontaneously. Over a median 38-month follow-up, there were three local, two regional, and three systemic recurrences.

SLOF reconstruction is a feasible and safe option for immediate breast reconstruction after NSM or extensive BCS with minimal donor-site morbidity and great cosmetic outcomes.