Immediate Breast Reconstruction with Laparoscopic Harvested Omental Flap after Breast Cancer Surgery

Here we present a rarely used technique for breast reconstruction after complete or subtotal subcutaneous mastectomy for breast cancer utilizing a laparoscopically harvested omental flap.

The procedure was performed in selected patients with multicentric carcinomas, large, central tumors (also post treatment with neoadjuvant chemotherapy), tumors with extensive intraductal components, diffuse carcinomas in situ and in patients desiring the procedure. To date, 65 of these procedures (39 complete and 26 partial mastectomies) have been performed. After the sentinel node biopsy, laparoscopy was performed in order to estimate the size of the omentum. The omentum was dissected, preserving the right gastroepiploic vessels as the pedicle of the omental flap.

After performing the subcutaneous mastectomy through an infra mammary incision, a subcutaneous tunnel was created, and the omentum pulled out through a 2-3 cm paraxyphoidal incision, and placed within the breast defect.

The cosmetic result was excellent to satisfactory in the majority of cases. There was one loss of the omental flap due to fat necrosis, and one gastric perforation was managed laparoscopically. In three patients, an additional augmentation with lipofilling became necessary. Small skin necrosis could be conservatively treated. Postoperative radiation in patients with positive lymph nodes and subtotal mastectomy was performed without complications. There was no local recurrence to date.

In selected patients, this technique produces good results, creating a breast with a natural, soft consistency, and with minimal donor site morbidity. It provides an esthetically appealing supplement to the established methods. Difficulties include preoperative estimation of the size of the omentum. However, if the volume should be inadequate in the beginning, it frequently increases within the first six months. Also this technique can only be applied for unilateral reconstruction.