Breast Reconstruction with the Laparoscopically Harvested Omental Free Flap

Abstract

Background: Although many methods are available for breast reconstruction, there are still times where finding the best solution remains a challenge. In selected cases, a laparoscopically harvested omental free flap (LHOFF) can be used for breast reconstruction with excellent results. Aims: The aim of this chapter is to discuss the anatomy, indication, limitations, and surgical technique of the LHOFF for primary or delayed breast reconstruction. Patient selection: Breast reconstruction using an LHOFF is indicated in selected cases: A lean patient with low breast volume and an intact skin envelope with unilateral reconstruction and patient choice to have a solely autologous reconstruction. Sufficient omentum volume must be confirmed through a diagnostic laparoscopy. Technique: The omentum is harvested laparoscopically by a general surgeon and extracted through a 1.5 inch (4 cm) Pfannenstiel incision. Simultaneously, the plastic surgeon’s team members prepare the mammary pocket and acceptor vessels. The gastroepiploic (GE) artery is anastomosed to the internal mammary artery in an end-to-end manner. The accompanying veins are anastomosed using a flow coupler device. The omentum is then carefully fixed in place in the pocket. Conclusion: Autologous breast reconstruction using a LHOFF can be an excellent option in select cases. It is a safe flap with minimal donor site morbidity and scarring with the use of laparoscopic harvesting. The aesthetic results are highly desirable with minimal scarring, good volume, and very soft tissue resembling the natural feeling of a nonreconstructed breast.