Evolution in breast reconstruction using the omentum

: Breast reconstruction after mastectomy is increasingly being performed for women diagnosed with breast cancer, as well as those with a genetic predisposition to developing breast cancer. Techniques include implant-based or autologous tissue reconstruction where the abdominal soft tissue is most commonly used. As more women seek to avoid the use of implants, minimize donor site morbidity, and desire a natural-appearing breast after reconstruction, an alternative to the standard approaches is needed. The omentum has historically been used as a pedicled flap for surgical defects or infection. It has been used for breast reconstruction, but primarily as a pedicled flap and for treatment of partial breast defects. To optimize the use of the omentum for breast reconstruction, a novel technique using an omental fat-augmented free flap (O-FAFF) has recently been reported. This approach allows 360 degrees of freedom in positioning the autologous tissue reconstruction while also increasing the volume of the autologous free flap using fat grafting. An acellular dermal matrix (ADM) mold is used to provide structure. The result is an augmented appearance that feels similar to biologic soft tissue. This review discusses the evolution of breast reconstruction using the omentum and the potential increasing role that the O-FAFF may have in breast reconstruction.