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

Background: The omental fat-augmented free flap (O-FAFF) has become a versatile option for breast reconstruction, particularly with the added use as a biologic implant and for concurrent management of upper extremity lymphedema. In this study, we review the clinical applications, outcomes, complications, and patient reported outcomes after the first 100 O-FAFF reconstructions. Methods: A retrospective chart review including all patients who received O-FAFF reconstruction from 2019-2024 was conducted. 3D volume reconstruction was performed on postoperative MRIs. A modified BREAST-Q was sent to all patients. Results: 71 patients received a total of 100 O-FAFF reconstructions. Average BMI at the time of surgery was 22.86±3.74, average age was 49.44±10.91, and average length of hospital stay was 3.25±0.87 days. 5 patients had stacked O-FAFF with myocutaneous flap, 5 patients had hybrid reconstruction with inflatable saline implants, and 4 patients received concurrent omental VLNT. 5 patients (7.14%) required return to the operating room or procedural intervention. Patients required 1.35±0.65 revision surgeries, mostly for volume augmentation with fat grafting (46.48%). Postoperative MRI confirmed fat retention of at least 100% of 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). 77.14% of respondents selected ratings of ≥8 out of 10 for overall quality of life. Conclusions: 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.