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Omental Fat-Augmented Free Flaps: Applications and Lessons Learned After 100 Breast Reconstructions.

Mimi Y Wu Young1,2, Kassandra Carrion1, Nitya Devisetti1

  • 1Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.

Plastic and Reconstructive Surgery
|December 3, 2025
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The omental fat-augmented free flap (O-FAFF) offers a durable and versatile breast reconstruction option. This method demonstrates low complication rates and high patient satisfaction, making it a valuable choice for aesthetic and functional outcomes.

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Area of Science:

  • Plastic Surgery
  • Reconstructive Surgery
  • Oncology

Background:

  • The omental fat-augmented free flap (O-FAFF) is a versatile technique for breast reconstruction.
  • It serves as a biologic implant and aids in managing upper extremity lymphedema.
  • This study reviews the initial 100 O-FAFF reconstructions.

Purpose of the Study:

  • To evaluate the clinical applications, outcomes, and complications of O-FAFF breast reconstruction.
  • To assess patient-reported outcomes following O-FAFF procedures.
  • To analyze the efficacy of O-FAFF in improving quality of life and body image.

Main Methods:

  • Retrospective chart review of 71 patients undergoing 100 O-FAFF reconstructions (2019-2024).
  • Postoperative MRI for 3D volume reconstruction and fat retention assessment.
  • Modified BREAST-Q surveys for patient-reported outcomes, including quality of life and satisfaction.

Main Results:

  • Low complication rate (7.14% requiring intervention) and average 1.35 revisions, primarily for fat grafting.
  • High fat retention (≥100% omental weight) confirmed by MRI.
  • Significant improvements in patient self-confidence, emotional health, and quality of life (77.14% rated ≥8/10).
  • Laparoscopic omental harvest yielded higher satisfaction with abdominal scarring compared to open harvest (p<0.01).

Conclusions:

  • The omentum is a durable and versatile tissue for breast reconstruction.
  • O-FAFF demonstrates low complication rates and high patient satisfaction.
  • O-FAFF is an effective option for improving aesthetic and functional outcomes in breast reconstruction.