Laparoscopically harvested pedicled omental flap for one<b>-</b>stage breast reconstruction：An analysis of 16 cases was presented_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YU Boyang , CHEN Jialin , HU Daixing , YANG Jiaxin , ZHAO Chengshan ,  YIN Guobing

Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China;

Corresponding author：

YIN Guobing, Email: yinguobing@cqmu.edu.cn

Keywords：

breast construction surgery; omental pedicle flap; laparoscopy; mastectomy

DOI：

10.7507/1007-9424.202405101

Video：

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Objective To explore the methods of breast reconstruction surgery with laparoscopically harvested pedicled omental flap (LHPOF), and analyze the patient’ evaluation, operation process and postoperative follow-up. Methods Patients with pathologically proven breast cancer or plasma cell mastitis who underwent LHPOF breast reconstructive surgery were retrospectively collected from the Department of Breast and Thyroid Surgery of The Second Affiliated Hospital of Chongqing Medical University from February 2022 to December 2023. Results A total of 16 patients were collected. The mean age of patients was 43.3 (ranging from 27 to 68) years old, the mean body mass index of patients was 23.0 kg/m² (ranging from 18.3 to 28.6 kg/m²). One patient underwent transplant omental flat removal surgery due to postoperative flap thrombosis, and one patient choose to give up breast reconstruction due to insufficient flap volume. The single-stage surgery was performed successfully in the rest patients with no requirement of laparotomy. All patients made an uneventful recovery after surgery. During the follow-up period, which averaged 13 months and ranged from 9 to 17 months, the major symptoms were mild epigastric bulge (2 patients) and flap atrophy (1 patient), no serious flap-related or donor site-related complications such as flap loss, bowel dysfunction and abdominal incisional hernia. In general, the aesthetic results were satisfactory. Conclusions Using LHPOF in immediate breast reconstruction surgery can achieve satisfied aesthetic result, for the soft and natural appearance of the reconstructed breast. In the mean time, compared with other autologous tissue reconstruction approaches, LHPOF has lower incidences of complications of donor-site and flap-site.

Citation： YU Boyang, CHEN Jialin, HU Daixing, YANG Jiaxin, ZHAO Chengshan, YIN Guobing. Laparoscopically harvested pedicled omental flap for one-stage breast reconstruction：An analysis of 16 cases was presented. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(9): 1046-1052. doi: 10.7507/1007-9424.202405101 Copy

1.	邬昊, 吕青. 全球及中国乳腺癌的流行病学趋势及防控启示: 2018–2022年《全球癌症统计报告》解读. 中国普外基础与临床杂志, 2024, 31(7): 796-802.
2.	Yap YS, Lu YS, Tamura K, et al. Insights into breast cancer in the East vs the West: a review. JAMA Oncol, 2019, 5(10): 1489-1496.
3.	Xing M, Zhang S, Zha X, et al. Current understanding and management of plasma cell mastitis: Can we benefit from what we know? Breast Care (Basel), 2022, 17(3): 321-329.
4.	Delgado JF, García-Guilarte RF, Palazuelo MR, et al. Immediate breast reconstruction with direct, anatomic, gel-cohesive, extra-projection prosthesis: 400 cases. Plast Reconstr Surg, 2010, 125(6): 1599-1605.
5.	Ribuffo D, Monfrecola A, Guerra M, et al. Does postoperative radiation therapy represent a contraindication to expander-implant based immediate breast reconstruction? An update 2012—2014. Eur Rev Med Pharmacol Sci, 2015, 19(12): 2202-2207.
6.	Khater A. Evaluation of pedicled omental flap delivered through a minilaparotomy for immediate breast reconstruction in obese patients. Aesthetic Plast Surg, 2013, 37(6): 1140-1145.
7.	Christensen BO, Overgaard J, Kettner LO, et al. Long-term evaluation of postmastectomy breast reconstruction. Acta Oncol, 2011, 50(7): 1053-1061.
8.	Zaha H, Sunagawa H, Kawakami K, et al. Partial breast reconstruction for an inferomedial breast carcinoma using an omental flap. World J Surg, 2010, 34(8): 1782-1787.
9.	Lipa JE, Youssef AA, Kuerer HM, et al. Breast reconstruction in older women: advantages of autogenous tissue. Plast Reconstr Surg, 2003, 111(3): 1110-1121.
10.	August DA, Wilkins E, Rea T. Breast reconstruction in older women. Surgery, 1994, 115(6): 663-668.
11.	Zaha H, Abe N, Sagawa N, et al. Oncoplastic surgery with omental flap reconstruction: a study of 200 cases. Breast Cancer Res Treat, 2017, 162(2): 267-274.
12.	Wang ZH, Qu X, Teng CS, et al. Preliminary results for treatment of early stage breast cancer with endoscopic subcutaneous mastectomy combined with endoscopic sentinel lymph node biopsy in China. J Surg Oncol, 2016, 113(6): 616-620. small breast—a single surgeon’s 10-year experience. Eplasty, 2012, 12: e55.
13.	Zaha H, Inamine S, Naito T, et al. Laparoscopically harvested omental flap for immediate breast reconstruction. Am J Surg, 2006, 192(4): 556-558.
14.	Zaha H. Oncoplastic volume replacement technique for the upper inner quadrant using the omental flap. Gland Surg, 2015, 4(3): 263-269.
15.	Zaha H. Partial breast reconstruction for the medial quadrants using the omental flap. Ann Surg Oncol, 2014, 21(10): 3358. doi: 10.1245/s10434-014-3907-z.
16.	Pusic AL, Klassen AF, Scott AM, et al. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg, 2009, 124(2): 345-353.
17.	Juhl AA, Christensen S, Zachariae R, et al. Unilateral breast reconstruction after mastectomy—patient satisfaction, aesthetic outcome and quality of life. Acta Oncol, 2017, 56(2): 225-231.
18.	Schwartz GF, Veronesi U, Clough KB, et al. Consensus conference on breast conservation. J Am Coll Surg, 2006, 203(2): 198-207.
19.	Kotti B. Optimizing the pedicled rectus abdominis flap: revised designs and vascular classification for safer procedures. Aesthetic Plast Surg, 2014, 38(2): 387-394.
20.	Kanchwala SK, Bucky LP. Optimizing pedicled transverse rectus abdominis muscle flap breast reconstruction. Cancer J, 2008, 14(4): 236-240.
21.	Bostwick J 3rd, Jones G. Why I choose autogenous tissue in breast reconstruction. Clin Plast Surg, 1994, 21(2): 165-175.
22.	Kiricuta I. The use of the great omentum in the surgery of breast cancer. Presse Med(1893), 1963, 71: 15-17.
23.	Kiricuta I, Popescu V. Treatment of hand radionecroses using plastic surgery with omental graft and autologous free skin transplants. Ann Chir Plast, 1974, 19(3): 243-246.
24.	Saltz R, Stowers R, Smith M, et al. Laparoscopically harvested omental free flap to cover a large soft tissue defect. Ann Surg, 1993, 217(5): 542-546.
25.	Shash H, Al-Halabi B, Aldekhayel S, et al. Laparoscopic harvesting of omental flaps for breast reconstruction—A review of the literature and outcome analysis. Plast Surg (Oakv), 2018, 26(2): 126-133.
26.	Ni C, Zhu Z, Xin Y, et al. Oncoplastic breast reconstruction with omental flap: A retrospective study and systematic review. J Cancer, 2018, 9(10): 1782-1790.
27.	Zaha H, Inamine S. Laparoscopically harvested omental flap: results for 96 patients. Surg Endosc, 2010, 24(1): 103-107.
28.	Salibian AA, Frey JD, Choi M, et al. Subcutaneous implant-based breast reconstruction with acellular dermal matrix/mesh: A systematic review. Plast Reconstr Surg Glob Open, 2016, 4(11): e1139. doi: 10.1097/GOX.0000000000001139.
29.	Scuderi N, Alfano C, Campus GV, et al. Multicenter study on breast reconstruction outcome using Becker implants. Aesthetic Plast Surg, 2011, 35(1): 66-72.
30.	Cothier-Savey I, Tamtawi B, Dohnt F, et al. Immediate breast reconstruction using a laparoscopically harvested omental flap. Plast Reconstr Surg, 2001, 107(5): 1156-1163.
31.	Guan D, Lin H, Lv Z, et al. The oncoplastic breast surgery with pedicled omental flap harvested by laparoscopy: initial experiences from China. World J Surg Oncol, 2015, 13: 95. doi: 10.1186/s12957-015-0514-9.
32.	Wang ZH, Xin P, Qu X, et al. Breast reconstruction using a laparoscopically harvested pedicled omental flap after endoscopic mastectomy for patients with breast cancer: an observational study of a minimally invasive method. Gland Surg, 2020, 9(3): 676-688.

1. 邬昊, 吕青. 全球及中国乳腺癌的流行病学趋势及防控启示: 2018–2022年《全球癌症统计报告》解读. 中国普外基础与临床杂志, 2024, 31(7): 796-802.
2. Yap YS, Lu YS, Tamura K, et al. Insights into breast cancer in the East vs the West: a review. JAMA Oncol, 2019, 5(10): 1489-1496.
3. Xing M, Zhang S, Zha X, et al. Current understanding and management of plasma cell mastitis: Can we benefit from what we know? Breast Care (Basel), 2022, 17(3): 321-329.
4. Delgado JF, García-Guilarte RF, Palazuelo MR, et al. Immediate breast reconstruction with direct, anatomic, gel-cohesive, extra-projection prosthesis: 400 cases. Plast Reconstr Surg, 2010, 125(6): 1599-1605.
5. Ribuffo D, Monfrecola A, Guerra M, et al. Does postoperative radiation therapy represent a contraindication to expander-implant based immediate breast reconstruction? An update 2012—2014. Eur Rev Med Pharmacol Sci, 2015, 19(12): 2202-2207.
6. Khater A. Evaluation of pedicled omental flap delivered through a minilaparotomy for immediate breast reconstruction in obese patients. Aesthetic Plast Surg, 2013, 37(6): 1140-1145.
7. Christensen BO, Overgaard J, Kettner LO, et al. Long-term evaluation of postmastectomy breast reconstruction. Acta Oncol, 2011, 50(7): 1053-1061.
8. Zaha H, Sunagawa H, Kawakami K, et al. Partial breast reconstruction for an inferomedial breast carcinoma using an omental flap. World J Surg, 2010, 34(8): 1782-1787.
9. Lipa JE, Youssef AA, Kuerer HM, et al. Breast reconstruction in older women: advantages of autogenous tissue. Plast Reconstr Surg, 2003, 111(3): 1110-1121.
10. August DA, Wilkins E, Rea T. Breast reconstruction in older women. Surgery, 1994, 115(6): 663-668.
11. Zaha H, Abe N, Sagawa N, et al. Oncoplastic surgery with omental flap reconstruction: a study of 200 cases. Breast Cancer Res Treat, 2017, 162(2): 267-274.
12. Wang ZH, Qu X, Teng CS, et al. Preliminary results for treatment of early stage breast cancer with endoscopic subcutaneous mastectomy combined with endoscopic sentinel lymph node biopsy in China. J Surg Oncol, 2016, 113(6): 616-620. small breast—a single surgeon’s 10-year experience. Eplasty, 2012, 12: e55.
13. Zaha H, Inamine S, Naito T, et al. Laparoscopically harvested omental flap for immediate breast reconstruction. Am J Surg, 2006, 192(4): 556-558.
14. Zaha H. Oncoplastic volume replacement technique for the upper inner quadrant using the omental flap. Gland Surg, 2015, 4(3): 263-269.
15. Zaha H. Partial breast reconstruction for the medial quadrants using the omental flap. Ann Surg Oncol, 2014, 21(10): 3358. doi: 10.1245/s10434-014-3907-z.
16. Pusic AL, Klassen AF, Scott AM, et al. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg, 2009, 124(2): 345-353.
17. Juhl AA, Christensen S, Zachariae R, et al. Unilateral breast reconstruction after mastectomy—patient satisfaction, aesthetic outcome and quality of life. Acta Oncol, 2017, 56(2): 225-231.
18. Schwartz GF, Veronesi U, Clough KB, et al. Consensus conference on breast conservation. J Am Coll Surg, 2006, 203(2): 198-207.
19. Kotti B. Optimizing the pedicled rectus abdominis flap: revised designs and vascular classification for safer procedures. Aesthetic Plast Surg, 2014, 38(2): 387-394.
20. Kanchwala SK, Bucky LP. Optimizing pedicled transverse rectus abdominis muscle flap breast reconstruction. Cancer J, 2008, 14(4): 236-240.
21. Bostwick J 3rd, Jones G. Why I choose autogenous tissue in breast reconstruction. Clin Plast Surg, 1994, 21(2): 165-175.
22. Kiricuta I. The use of the great omentum in the surgery of breast cancer. Presse Med(1893), 1963, 71: 15-17.
23. Kiricuta I, Popescu V. Treatment of hand radionecroses using plastic surgery with omental graft and autologous free skin transplants. Ann Chir Plast, 1974, 19(3): 243-246.
24. Saltz R, Stowers R, Smith M, et al. Laparoscopically harvested omental free flap to cover a large soft tissue defect. Ann Surg, 1993, 217(5): 542-546.
25. Shash H, Al-Halabi B, Aldekhayel S, et al. Laparoscopic harvesting of omental flaps for breast reconstruction—A review of the literature and outcome analysis. Plast Surg (Oakv), 2018, 26(2): 126-133.
26. Ni C, Zhu Z, Xin Y, et al. Oncoplastic breast reconstruction with omental flap: A retrospective study and systematic review. J Cancer, 2018, 9(10): 1782-1790.
27. Zaha H, Inamine S. Laparoscopically harvested omental flap: results for 96 patients. Surg Endosc, 2010, 24(1): 103-107.
28. Salibian AA, Frey JD, Choi M, et al. Subcutaneous implant-based breast reconstruction with acellular dermal matrix/mesh: A systematic review. Plast Reconstr Surg Glob Open, 2016, 4(11): e1139. doi: 10.1097/GOX.0000000000001139.
29. Scuderi N, Alfano C, Campus GV, et al. Multicenter study on breast reconstruction outcome using Becker implants. Aesthetic Plast Surg, 2011, 35(1): 66-72.
30. Cothier-Savey I, Tamtawi B, Dohnt F, et al. Immediate breast reconstruction using a laparoscopically harvested omental flap. Plast Reconstr Surg, 2001, 107(5): 1156-1163.
31. Guan D, Lin H, Lv Z, et al. The oncoplastic breast surgery with pedicled omental flap harvested by laparoscopy: initial experiences from China. World J Surg Oncol, 2015, 13: 95. doi: 10.1186/s12957-015-0514-9.
32. Wang ZH, Xin P, Qu X, et al. Breast reconstruction using a laparoscopically harvested pedicled omental flap after endoscopic mastectomy for patients with breast cancer: an observational study of a minimally invasive method. Gland Surg, 2020, 9(3): 676-688.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Laparoscopically harvested pedicled omental flap for one-stage breast reconstruction：An analysis of 16 cases was presented

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