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Single-port laparoscopically harvested omental flap for immediate breast reconstruction

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Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Immediate breast reconstruction using laparoscopically harvested omental flap is a safe and feasible technique, providing natural contour and softness to reconstructed breasts with reduced donor-site morbidity and deformity. We report our experience using single-port laparoscopically harvested omental flap (SLOF) for immediate breast reconstruction.

Methods

Between February 2015 and December 2018, 129 patients with malignant neoplasm of the breast underwent nipple-sparing mastectomy (NSM) or breast-conserving surgery (BCS) followed by immediate SLOF reconstruction at Seoul National University Bundang Hospital. We assessed their clinicopathological data, complications, and cosmetic and oncologic outcomes. Cosmetic outcomes were evaluated by three-panel assessment and the BCCT.core software program.

Results

One hundred and six (82.2%) underwent NSM and 23 (17.8%) underwent BCS. Mean operation time was 205 (range, 134–316) minutes. Most patients had early-stage disease; 15 (11.6%) received neoadjuvant chemotherapy. Two had malignant phyllodes tumors. Cosmetic outcomes were excellent or good in 96.9% by three-panel assessment and 99.2% by the BCCT.core program with a nearly invisible donor-site scar in the umbilicus. Harvest-associated complications occurred in five (3.9%) patients, including two umbilical wound infections, one intra-abdominal infection, one umbilical hernia, and one pedicle injury. Fat necrosis (13.2%) and epigastric bulging (21.7%) were common mastectomy- or reconstruction-associated complications, but most were mild and some resolved spontaneously. Over a median 38-month follow-up, there were three local, two regional, and three systemic recurrences.

Conclusions

SLOF reconstruction is a feasible and safe option for immediate breast reconstruction after NSM or extensive BCS with minimal donor-site morbidity and great cosmetic outcomes.

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Data availability

The datasets during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Kim HJ, Park EH, Lim WS, Seo JY, Koh BS, Lee TJ et al (2010) Nipple areola skin-sparing mastectomy with immediate transverse rectus abdominis musculocutaneous flap reconstruction is an oncologically safe procedure: a single center study. Ann Surg 251(3):493–498

    PubMed  Google Scholar 

  2. Yang JD, Lee JW, Cho YK, Kim WW, Hwang SO, Jung JH et al (2012) Surgical techniques for personalized oncoplastic surgery in breast cancer patients with small- to moderate-sized breasts (part 2): volume replacement. J Breast Cancer 15(1):7–14

    PubMed  PubMed Central  Google Scholar 

  3. Kiricuta I (1963) The use of the great omentum in the surgery of breast cancer. Presse Med 71:15–17

    CAS  Google Scholar 

  4. Arnold PG, Hartrampf CR, Jurkiewicz MJ (1976) One-stage reconstruction of the breast, using the transposed greater omentum. Case report. Plast Reconstr Surg 57(4):520–522

    CAS  PubMed  Google Scholar 

  5. Bouchet Y, Favier M, Bodin JP, Payan R, Pissas A, Dupre A et al (1978) [Kiricuta's method of epiplooplasty prethoracic graft together with mastectomy for carcinoma. Report of 14 cases (author's transl)]. Ann Chir 32(7):377–381

  6. McColl I (1979) Reconstruction of the breast with omentum after subcutaneous mastectomy. Lancet 1(8108):134–135

    CAS  PubMed  Google Scholar 

  7. Lopez JF, Bouchet Y, Dupre A (1990) The Kiricuta procedure in reconstructive surgical treatment of the breast. Surg Gynecol Obstet 170(3):209–211

    CAS  PubMed  Google Scholar 

  8. Shash H, Al-Halabi B, Aldekhayel S, Dionisopoulos T (2018) Laparoscopic harvesting of omental flaps for breast reconstruction—a review of the literature and outcome analysis. Plast Surg (Oakv) 26(2):126–133

    Google Scholar 

  9. Cothier-Savey I, Tamtawi B, Dohnt F, Raulo Y, Baruch J (2001) Immediate breast reconstruction using a laparoscopically harvested omental flap. Plast Reconstr Surg 107(5):1156–1163 discussion 64–65

    CAS  PubMed  Google Scholar 

  10. Jimenez AG, St Germain P, Sirois M, Hatheway M, Lethbridge R (2002) Free omental flap for skin-sparing breast reconstruction harvested laparoscopically. Plast Reconstr Surg 110(2):545–551

    PubMed  Google Scholar 

  11. Zaha H, Inamine S, Naito T, Nomura H (2006) Laparoscopically harvested omental flap for immediate breast reconstruction. Am J Surg 192(4):556–558

    Article  PubMed  Google Scholar 

  12. Zaha H, Inamine S (2010) Laparoscopically harvested omental flap: results for 96 patients. Surg Endosc 24(1):103–107

    Article  PubMed  Google Scholar 

  13. Song XY, Guan DD, Lin H, Dai Y, Zheng XY, Zhu YP et al (2011) Immediate breast reconstruction using laparoscopically harvested omental flap after breast-conserving surgery. Zhonghua Zheng Xing Wai Ke Za Zhi 27(6):401–405

    PubMed  Google Scholar 

  14. Zaha H, Abe N, Sagawa N, Unesoko M (2017) Oncoplastic surgery with omental flap reconstruction: a study of 200 cases. Breast Cancer Res Treat 162(2):267–274

    Article  PubMed  Google Scholar 

  15. Kim SJ, Ryu GO, Choi BJ, Kim JG, Lee KJ, Lee SC et al (2011) The short-term outcomes of conventional and single-port laparoscopic surgery for colorectal cancer. Ann Surg 254(6):933–940

    Article  PubMed  Google Scholar 

  16. Velthuis S, van den Boezem PB, Lips DJ, Prins HA, Cuesta MA, Sietses C (2012) Comparison of short-term surgical outcomes after single-incision laparoscopic versus multiport laparoscopic right colectomy: a two-center, prospective case-controlled study of 100 patients. Dig Surg 29(6):477–483

    Article  PubMed  Google Scholar 

  17. Ahn SH, Jung DH, Son SY, Park DJ, Kim HH (2014) Pure single-incision laparoscopic D2 lymphadenectomy for gastric cancer: a novel approach to 11p lymph node dissection (midpancreas mobilization). Ann Surg Treat Res 87(5):279–283

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ahn SH, Son SY, Jung DH, Park DJ, Kim HH (2014) Pure single-port laparoscopic distal gastrectomy for early gastric cancer: comparative study with multi-port laparoscopic distal gastrectomy. J Am Coll Surg 219(5):933–943

    Article  PubMed  Google Scholar 

  19. Kang SH, Lee Y, Park YS, Ahn SH, Park DJ, Kim HH (2017) Solo single-incision laparoscopic resectional Roux-en-Y Gastric bypass for morbid obesity with metabolic syndrome. Obes Surg 27(12):3314–3319

    Article  PubMed  Google Scholar 

  20. Harris JR, Levene MB, Svensson G, Hellman S (1979) Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys 5(2):257–261

    CAS  PubMed  Google Scholar 

  21. Cardoso JS, Cardoso MJ (2007) Towards an intelligent medical system for the aesthetic evaluation of breast cancer conservative treatment. Artif Intell Med 40(2):115–126

    PubMed  Google Scholar 

  22. Pusic AL, Matros E, Fine N, Buchel E, Gordillo GM, Hamill JB et al (2017) Patient-reported outcomes 1 year after immediate breast reconstruction: results of the mastectomy Reconstruction Outcomes Consortium Study. J Clin Oncol 35(22):2499–2506

    PubMed  PubMed Central  Google Scholar 

  23. Leberfinger AN, Behar BJ, Williams NC, Rakszawski KL, Potochny JD, Mackay DR et al (2017) Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Systematic Review. JAMA Surg 152(12):1161–1168

    PubMed  Google Scholar 

  24. Hall JC, Heel KA, Papadimitriou JM, Platell C (1998) The pathobiology of peritonitis. Gastroenterology 114(1):185–196

    CAS  PubMed  Google Scholar 

  25. Guan D, Lin H, Lv Z, Xin Y, Meng K, Song X (2015) The oncoplastic breast surgery with pedicled omental flap harvested by laparoscopy: initial experiences from China. World J Surg Oncol 13:95

    PubMed  PubMed Central  Google Scholar 

  26. van Garderen JA, Wiggers T, van Geel AN (1991) Complications of the pedicled omentoplasty. Neth J Surg 43(5):171–174

    PubMed  Google Scholar 

  27. Knox AD, Ho AL, Leung L, Tashakkor AY, Lennox PA, Van Laeken N et al (2016) Comparison of Outcomes following Autologous Breast Reconstruction Using the DIEP and Pedicled TRAM Flaps: A 12-Year Clinical Retrospective Study and Literature Review. Plast Reconstr Surg 138(1):16–28

    CAS  PubMed  Google Scholar 

  28. Schwabegger A, Ninkovic M, Brenner E, Anderl H (1997) Seroma as a common donor site morbidity after harvesting the latissimus dorsi flap: observations on cause and prevention. Ann Plast Surg 38(6):594–597

    CAS  PubMed  Google Scholar 

  29. Hamdi M, Decorte T, Demuynck M, Defrene B, Fredrickx A, Van Maele G et al (2008) Shoulder function after harvesting a thoracodorsal artery perforator flap. Plast Reconstr Surg 122(4):1111–1117 discussion 8–9

    CAS  PubMed  Google Scholar 

  30. Zaha H, Sunagawa H, Kawakami K, Touyama T, Yonaha T, Ohshiro N (2010) Partial breast reconstruction for an inferomedial breast carcinoma using an omental flap. World J Surg 34(8):1782–1787

    PubMed  Google Scholar 

  31. Zaha H (2015) Oncoplastic volume replacement technique for the upper inner quadrant using the omental flap. Gland Surg 4(3):263–269

    PubMed  PubMed Central  Google Scholar 

  32. Nieman KM, Kenny HA, Penicka CV, Ladanyi A, Buell-Gutbrod R, Zillhardt MR et al (2011) Adipocytes promote ovarian cancer metastasis and provide energy for rapid tumor growth. Nat Med 17(11):1498–1503

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Ni C, Zhu Z, Xin Y, Xie Q, Yuan H, Zhong M et al (2018) Oncoplastic breast reconstruction with omental flap: A retrospective study and systematic review. J Cancer 9(10):1782–1790

    Article  PubMed  PubMed Central  Google Scholar 

  34. Benediktsson KP, Perbeck L (2008) Survival in breast cancer after nipple-sparing subcutaneous mastectomy and immediate reconstruction with implants: a prospective trial with 13 years median follow-up in 216 patients. Eur J Surg Oncol 34(2):143–148

    Article  CAS  PubMed  Google Scholar 

  35. Boneti C, Yuen J, Santiago C, Diaz Z, Robertson Y, Korourian S et al (2011) Oncologic safety of nipple skin-sparing or total skin-sparing mastectomies with immediate reconstruction. J Am Coll Surg 212(4):686–693 discussion 93–95

    Article  PubMed  Google Scholar 

  36. Tokin C, Weiss A, Wang-Rodriguez J, Blair SL (2012) Oncologic safety of skin-sparing and nipple-sparing mastectomy: a discussion and review of the literature. Int J Surg Oncol 2012:921821

    PubMed  PubMed Central  Google Scholar 

  37. Kronowitz SJ, Feledy JA, Hunt KK, Kuerer HM, Youssef A, Koutz CA et al (2006) Determining the optimal approach to breast reconstruction after partial mastectomy. Plast Reconstr Surg 117(1):1–11 discussion 2–4

    Article  CAS  PubMed  Google Scholar 

  38. Rainsbury RM, Paramanathan N (1998) Recent progress with breast-conserving volume replacement using Latissimus Dorsi Miniflaps in UK Patients. Breast Cancer 5(2):139–147

    Article  CAS  PubMed  Google Scholar 

  39. Fischer JP, Nelson JA, Au A, Tuggle CT 3rd, Serletti JM, Wu LC (2014) Complications and morbidity following breast reconstruction—a review of 16,063 cases from the 2005–2010 NSQIP datasets. J Plast Surg Hand Surg 48(2):104–114

    Article  PubMed  Google Scholar 

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Author notes

  1. Eun-Kyu Kim and Sumin Chae contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea

    Eun-Kyu Kim & Sang-Hoon Ahn

  2. Department of Surgery, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea

    Sumin Chae

Authors
  1. Eun-Kyu Kim
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  2. Sumin Chae
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  3. Sang-Hoon Ahn
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Correspondence to Eun-Kyu Kim.

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The authors declare no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were done so in accordance with the ethical standards of the institutional and/or national research committee (Seoul National University Bundang Hospital, B-2001/586-116) and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual study participants.

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Kim, EK., Chae, S. & Ahn, SH. Single-port laparoscopically harvested omental flap for immediate breast reconstruction. Breast Cancer Res Treat 184, 375–384 (2020). https://doi.org/10.1007/s10549-020-05848-3

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