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Abstract：
BACKGROUND: The laparoscopically harvested omental flap (LHOF) has been used in partial or total breast reconstruction, but most studies on LHOF were case reports or small case series. However, the clinical feasibility and oncological safety of LHOF in oncoplastic breast surgery remains controversial. This study reported our experience applying LHOF for immediate breast reconstruction.
METHODS: Between June 2018 and March 2022, 300 patients underwent oncoplastic breast surgery using LHOF at our institution. Their clinicopathological data, complications, cosmetic outcomes, and oncologic outcomes were evaluated.
RESULTS: All patients underwent total breast reconstruction using LHOF after nipple-sparing mastectomy. The median operation time was 230 min (ranging from 155 to 375 min). The median operation time for harvesting the omental flap was 55 min (ranging from 40 to 105 min). The success rate of the laparoscopically harvested pedicled omental flap was over 99.0%. Median blood loss was 70 ml, ranging from 40 to 150 ml. The volume of the flap was insufficient in 102 patients (34.0%). The overall complication rate was 12.3%. Subcutaneous fluid in the breast area (7%) was the most common reconstruction-associated complication, but most cases were relieved spontaneously. The incidence rate of omental flap necrosis was 3.3%. LHOF-associated complications occurred in two cases, including one case of incisional hernia and one case of vascular injury. Cosmetic outcomes were satisfactory in 95.1% of patients on a four-point scale by three-panel assessment and 97.2% using the BCCT.core software. Two local and one systemic recurrence were observed during a median follow-up period of 32 months.
CONCLUSIONS: The LHOF for immediate breast reconstruction is a safe and feasible method that involves minimal donor-site morbidity, satisfactory cosmetic outcomes, and promising oncologic safety.
METHODS: Between June 2018 and March 2022, 300 patients underwent oncoplastic breast surgery using LHOF at our institution. Their clinicopathological data, complications, cosmetic outcomes, and oncologic outcomes were evaluated.
RESULTS: All patients underwent total breast reconstruction using LHOF after nipple-sparing mastectomy. The median operation time was 230 min (ranging from 155 to 375 min). The median operation time for harvesting the omental flap was 55 min (ranging from 40 to 105 min). The success rate of the laparoscopically harvested pedicled omental flap was over 99.0%. Median blood loss was 70 ml, ranging from 40 to 150 ml. The volume of the flap was insufficient in 102 patients (34.0%). The overall complication rate was 12.3%. Subcutaneous fluid in the breast area (7%) was the most common reconstruction-associated complication, but most cases were relieved spontaneously. The incidence rate of omental flap necrosis was 3.3%. LHOF-associated complications occurred in two cases, including one case of incisional hernia and one case of vascular injury. Cosmetic outcomes were satisfactory in 95.1% of patients on a four-point scale by three-panel assessment and 97.2% using the BCCT.core software. Two local and one systemic recurrence were observed during a median follow-up period of 32 months.
CONCLUSIONS: The LHOF for immediate breast reconstruction is a safe and feasible method that involves minimal donor-site morbidity, satisfactory cosmetic outcomes, and promising oncologic safety.
摘要：
背景：腹腔镜收获的网膜皮瓣（LHOF）已用于部分或全部乳房重建，但大多数关于LHOF的研究都是病例报告或小病例系列.然而,LHOF在肿瘤性乳腺手术中的临床可行性和肿瘤安全性仍存在争议.这项研究报告了我们将LHOF应用于立即乳房重建的经验。
方法：在2018年6月至2022年3月之间，有300例患者在我们机构使用LHOF接受了肿瘤增生性乳房手术。他们的临床病理资料,并发症,美容结果，并对肿瘤结局进行了评估.
结果：所有患者在保留乳头的乳房切除术后使用LHOF进行全乳房再造。中位手术时间为230分钟（155至375分钟）。采集网膜瓣的中位手术时间为55分钟（40至105分钟）。腹腔镜下收获带蒂网膜皮瓣的成功率超过99.0％。中位失血量为70ml,范围从40到150毫升。102例(34.0%)患者皮瓣体积不足。总并发症发生率为12.3%。乳房区域的皮下积液（7％）是最常见的重建相关并发症，但大多数病例是自发缓解的。大网膜皮瓣坏死发生率为3.3%。2例发生LHOF相关并发症,其中切口疝1例,血管损伤1例。通过三组评估，在四点量表上，95.1％的患者的美容结果令人满意，而使用BCCT的患者为97.2％。核心软件。在32个月的中位随访期内，观察到2例局部复发和1例全身复发。
结论：用于立即乳房重建的LHOF是一种安全可行的方法，涉及最小的供体部位发病率，令人满意的美容效果，和有希望的肿瘤安全性。
方法：在2018年6月至2022年3月之间，有300例患者在我们机构使用LHOF接受了肿瘤增生性乳房手术。他们的临床病理资料,并发症,美容结果，并对肿瘤结局进行了评估.
结果：所有患者在保留乳头的乳房切除术后使用LHOF进行全乳房再造。中位手术时间为230分钟（155至375分钟）。采集网膜瓣的中位手术时间为55分钟（40至105分钟）。腹腔镜下收获带蒂网膜皮瓣的成功率超过99.0％。中位失血量为70ml,范围从40到150毫升。102例(34.0%)患者皮瓣体积不足。总并发症发生率为12.3%。乳房区域的皮下积液（7％）是最常见的重建相关并发症，但大多数病例是自发缓解的。大网膜皮瓣坏死发生率为3.3%。2例发生LHOF相关并发症,其中切口疝1例,血管损伤1例。通过三组评估，在四点量表上，95.1％的患者的美容结果令人满意，而使用BCCT的患者为97.2％。核心软件。在32个月的中位随访期内，观察到2例局部复发和1例全身复发。
结论：用于立即乳房重建的LHOF是一种安全可行的方法，涉及最小的供体部位发病率，令人满意的美容效果，和有希望的肿瘤安全性。
