Omental Fat-Augmented Free Flaps: Applications and Lessons Learned after 100 Breast Reconstructions

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BACKGROUND: The omental fat-augmented free flap (O-FAFF) is a versatile option for breast reconstruction, with additional applications as a biologic implant and for concurrent management of upper extremity lymphedema. In this study, the authors review the clinical applications, outcomes, complications, and patient-reported outcomes of their first 100 O-FAFF reconstructions. METHODS: A retrospective chart review including all patients who underwent O-FAFF reconstruction from 2019 through 2024 was conducted. Three-dimensional volume reconstruction was assessed based on postoperative magnetic resonance imaging. A modified BREAST-Q was sent to all patients. RESULTS: A total of 100 O-FAFF reconstructions were performed in 71 patients. The average body mass index at the time of surgery was 22.86 ± 3.74; average age, 49.44 ± 10.91 years; and average length of hospital stay, 3.25 ± 0.87 days. Five patients received a stacked O-FAFF with a myocutaneous flap; 5 patients underwent hybrid reconstruction with inflatable saline implants; and 4 patients underwent concurrent omental vascularized lymph node transfer. Five patients (7.14%) required a return to the operating room or procedural intervention. Patients required 1.35 ± 0.65 revision procedures, mostly for volume augmentation with fat grafting (46.48%). Postoperative magnetic resonance imaging confirmed fat retention, with a retained fat volume equivalent to at least 100% of the initial omental weight. Patients reported high rates of self-confidence, emotional health, and self-worth after O-FAFF reconstruction. Patients who had laparoscopic omental harvest reported more satisfaction with abdominal scarring than those with open harvest ( P < 0.01). A total of 77.14% of respondents selected ratings of 8 or greater out of 10 for overall quality of life. CONCLUSION: Long-term experience with the omentum has shown it to be a durable and versatile method of breast reconstruction with low complication rates and high patient satisfaction.

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