Nguyen Dung H, Rochlin Danielle H, Deptula Peter L, Zak Yulia, Dua Monica, Wapnir Irene L
Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford University School of Medicine, Stanford, CA, USA.
Ann Surg Oncol. 2023 May;30(5):3048-3057. doi: 10.1245/s10434-022-12975-2. Epub 2022 Dec 25.
Autologous tissue has proven advantages, however it is often not an option for women of low or normal body mass index (BMI). Omentum has been used sparingly, typically as a pedicled flap to correct breast deformities, but is considered suboptimal for full breast reconstruction. We developed a new construct, the omental fat-augmented free flap (O-FAFF) as an alternative for breast reconstruction.
O-FAFF involves laparoscopic omentum harvesting, creation of an acellular dermal matrix shell for its encasement, and lipoinjection to augment volume. The gastroepiploic vessels are microsurgically anastomosed to internal mammary vessels. Tissue and O-FAFF construct weights as well as outcomes are reported.
Thirty-four consecutive women (50 breasts) received O-FAFF breast reconstruction after 18 unilateral and 16 bilateral mastectomies (10 non-nipple-sparing, 40 nipple-sparing). Thirty-seven were immediate and 13 were revisions of previous breast reconstructions. Patient mean age was 48.2 (range 23-73) years and mean BMI was 22.3 (range 17.6-32.4) kg/m. Mean follow-up was 14.8 (range 3-33) months. The median weight of the omentum was 161.7 g (range 81-852, interquartile range [IQR] 102) and the mean ratio of fat to omentum weight was 0.73 (range 0.22-1.38) and 1.97 (range 0.24-3.8) for unilateral and bilateral cases, respectively. Postoperative pain scores and oral morphine equivalent consumption were more favorable for the O-FAFF group compared with controls (p < 0.001). Follow-up breast MRI demonstrated intact perfusion and no fat necrosis.
The O-FAFF is ideally suited for women of lower BMI and could dramatically increase the number of women who are candidates for autologous breast reconstruction.
自体组织已被证明具有优势，然而对于体重指数（BMI）较低或正常的女性来说，它往往不是一个选择。大网膜的使用较少，通常作为带蒂皮瓣用于矫正乳房畸形，但被认为对于全乳重建并非最佳选择。我们开发了一种新的构建物，即大网膜脂肪增强游离皮瓣（O-FAFF）作为乳房重建的替代方案。
O-FAFF包括腹腔镜获取大网膜、制作用于包裹它的脱细胞真皮基质外壳以及脂肪注射以增加体积。胃网膜血管通过显微外科手术与胸廓内血管吻合。报告了组织和O-FAFF构建物的重量以及结果。
34名连续的女性（50个乳房）在18例单侧和16例双侧乳房切除术后（10例不保乳，40例保乳）接受了O-FAFF乳房重建。37例为即刻重建，13例为先前乳房重建的修复手术。患者平均年龄为48.2岁（范围23 - 73岁），平均BMI为22.3kg/m²（范围17.6 - 32.4）。平均随访时间为14.8个月（范围3 - 33个月）。大网膜的中位重量为161.7g（范围81 - 852g，四分位间距[IQR]为102），单侧和双侧病例的脂肪与大网膜重量的平均比值分别为0.73（范围0.22 - 1.38）和1.97（范围0.24 - 3.8）。与对照组相比，O-FAFF组的术后疼痛评分和口服吗啡等效剂量消耗情况更有利（p < 0.001）。随访乳房MRI显示灌注完整且无脂肪坏死。
O-FAFF非常适合BMI较低的女性，并且可以显著增加适合自体乳房重建的女性数量。
