Peter Sandbichler
Department of surgery, Hospital St.Vinzenz, Austria
Title: Immediate breast reconstruction with laparoscopic harvested omental flap after breast cancer surgery
Biography
Biography: Peter Sandbichler
Abstract
Introduction: We present here a rarely used technique for breast reconstruction after complete or subtotal subcutaneous mastectomy for breast cancer utilizing a laparoscopically harvested omental flap.
Indication: The procedure was performed in selected patients with multicentric carcinomas, large, central tumors (also post treatment with neoadjuvant chemotherapy), tumors with extensive intraductal component, diffuse ductal carcinoma in situ (DCIS), and in patients desiring the procedure. To date, 58 procedures (37 complete and 21 partial mastectomies) have been performed.
Surgical Procedure: 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 inframammary incision, a subcutaneous tunnel was created, and the omentum pulled out through a 2 to 3 cm paraxiphoidal incision, and placed within the breast defect.
Results: 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 five patients an additional augmentation with lipofilling became necessary. Small skin necroses could be conservatively treated. Postoperative irradiation in patients with positive lymph nodes and subtotal mastectomy was performed without complications. There was no local recurrence to date.
Summary: 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 initially inadequate volume frequently increases within the first 6 months. The technique can only be applied for unilateral reconstruction.