Omentum for Mammary Disorders: A 30-Year Systematic Review
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Although the safety of applying omentum to the female breast for total breast reconstruction is controversial, it has recently been used to treat certain mammary disorders as well. A systematic review was therefore conducted to analyze and establish the suitability and safety of applying omentum to the breast.
Covereing the interval from January 1984 to December 2013, we performed searches in MEDLINE, Embase, SciELO, and Google-Scholar for original articles describing the applicability of greater omentum to the breast and its clinical complications.
Sixty observational articles with 985 women were chosen. The main clinical indications were total breast reconstruction after mastectomy due to breast cancer (45 studies), radiation damage (23 studies), and congenital Poland syndrome (4 studies). Altogether, 273 complications were identified among the 985 women treated. The most frequent was flap necrosis (26.74 %). The most serious was injury to the digestive system (1.10 %). There was a 35.48 % incidence of local breast cancer recurrence in eight observational studies on oncological risk. Seven of the eight included only women with advanced cancer. One of these studies reported the incidence and relapse time predominantly according to the primary tumor size.
Although the oncological risk remains unclear, there was a high volume of complications that affected the digestive system. These findings suggest that omentum has well established applicability, but only for total breast reconstruction of huge defects, where muscular/myocutaneous or perforator flaps may be unsuitable.
KeywordsBreast Reconstruction Great Omentum Vascular Pedicle Flap Necrosis Primary Tumor Size
This research was supported by the salary provided to Dr. Claro Jr. by “Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES),” a Brazilian federal institution for postgraduate programs.
The authors of this manuscript have no conflicts of interest to disclose.
- 1.Kiricuta I. Lemploi du grand épiploon dans la chirurgie du sein cancéreux. Presse Med. 1963;71:1.Google Scholar
- 10.Claro Jr F, Sarian LOZ, Pinto-Neto AM. Current applicability of omentum for breast surgery. In: PROSPERO. York, UK: University of York Centre of Reviews and Dissemination; 2013. http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42013005493.
- 15.Góes JCS, Macedo ALV. Immediate reconstruction after mastectomy using a periareolar approach with an omental flap and mixed mesh support. Perspect Plast Surg. 1996;10(1):69–81.Google Scholar
- 17.Góes J, Macedo A. Immediate reconstruction after skin-sparing mastectomy using omental flap and synthetic mesh. In: Spear S, ed. Surgery of the Breast: Principles and Art. Philadelphia: Lippincott; 2006:786–93.Google Scholar
- 18.Góes JCS, Macedo ALV. Omentum reconstruction of the breast. In: Neligan PC, ed. Plastic Surgery, vol 5. New York: Elsevier Science; 2013:472–81.Google Scholar
- 20.Bocchi A, Merelli S, Papadia F, Caleffi E, Papadia F. Radiodermatitis and radionecrosis: clinical problems and present therapeutic principles. Chirurgia (Bucur). 2000;13(4):201–6.Google Scholar
- 21.Ruihua L, Xiaowu C, Jianxiong L. The use of omentum in clinical surgery. Lingnan Mod Clin Surg. 2002;4:10.Google Scholar
- 24.Peiper M, Langwieler T, Thomssen C, Busch C, Izbicki J, Knoefel W. Omentoplasty and secondary split skin grafting for reconstruction of large chest wall defects after resection of locally advanced breast cancer. Chir Prax. 2002;58(1):57–62.Google Scholar
- 34.Hoch J, Durst J. Transposition of the greater omentum for reconstruction of the chest wall after palliative excision of carcinoma of the breast. Med Welt. 1985;36(48):1535–9.Google Scholar
- 44.Milanov N, Bardyshev M, Shilov B, Trofimov E. Autotransplantation of the greater omentum in patients with radiation injuries of the integumentary tissues. Khirurgiia (Sofiia). 1989(5):84–7.Google Scholar
- 45.Nagadowska M, Luboiński G. Use of the greater omentum in the treatment of post-radiation necrosis of the whole thickness of the chest wall. Pol Tyg Lek. 1988;44(2-3):53–4.Google Scholar
- 50.Viiachki I, Viiachki D, Penkov N, Kirov R, Ivanov A. Omentoplasty in recurrent carcinoma of the chest wall following mammectomy. Khirurgiia (Sofiia). 1991;44(6)73–6.Google Scholar
- 52.Papadia F, Bocchi A, Caleffi E, Toschi S. Surgical treatment of radiation injures in post-mastectomy patients. Riv Ital Chir Plast. 1992;24(1):39–45.Google Scholar
- 55.Zhang YW. Treatment of 5 cases of thoracic wall radiation ulcer by pedunculated greater omentum and skin graft. Chin J Clin Oncol. 1993;20(6):417–8.Google Scholar
- 56.Ribuffo D, Codner M, Nahai F. Breast reconstruction with microsurgical flaps. Riv Ital Chir Plasta. 1994;26:283–90.Google Scholar
- 64.Cothier-Savey I, Tamtawi B, Dohnt F, Raulo Y, Baruch J. Immediate breast reconstruction using a laparoscopically harvested omental flap. Plast Reconstr Surg. 2001;107(5):1156–63; discussion 1164–5.Google Scholar
- 66.Peiper M, Langwieler T, Thomssen C, Busch C, Izbicki J, Knoefel W. Omentoplasty and secondary split skin grafting for reconstruction of large chest wall defects after resection of locally advanced breast cancer. Gynakol Praxis. 2002;26(2):287–92.Google Scholar
- 67.Ida K. Pedicle omental graft created by laparoscopic surgery for filling a radiation-induced ulcer in a woman with breast cancer. Nippon Rinsho Geka Gakkai Zasshi 2002;63(6):1366-9.Google Scholar
- 70.Kamei Y, Torii S, Toriyama K. Breast reconstruction using omentum harvested by endoscopic surgery: a case report. Jpn J Plast Reconstr Surg. 2003;46(5):509–14.Google Scholar
- 72.Kulakowski A, Sluszniak J, Zielinski A, Gozdz S. The greater omentum in the surgical treatment of radionecrosis considering breast cancer patients. Pol Przegl Chir. 2005;77(4):323–34.Google Scholar
- 76.Han MY, Qiu XD, Lian H, Liu H, Jin RT. Clinical application of breast reconstruction after mastectomy. Inner Mongolia Med J. 2008;9:15.Google Scholar
- 91.Mehrara BJ, Santoro TD, Arcilla E, Watson JP, Shaw WW, Da Lio AL. Complications after microvascular breast reconstruction: experience with 1195 flaps. Plast Reconstr Surg. 2006;118(5):1100–9; discussion 1110–1.Google Scholar
- 93.Claro Jr F, da Costa DV, Pinheiro AdS, Pinto-Neto AM. Complications in total breast reconstruction in patients treated for breast cancer: long-term comparative analysis of the influence of the technique, operative time, timing of reconstruction, and adjuvant treatment. Rev Bras Cir Plast. 2013;28(1):85–91.Google Scholar
- 105.Slavin SA, Love SM, Goldwyn RM. Recurrent breast cancer following immediate reconstruction with myocutaneous flaps. Plast Reconstr Surg. 1994;93(6):1191–204; discussion 1205–7.Google Scholar