D. Nguyen1, K. Carrion1, P. Yesantharao1, Y. Zak1, M. Dua1, I. Wapnir1 1Stanford University, Plastic & Reconstructive Surgery, Palo Alto, CA, USA
Introduction: There is increased demand for autologous breast reconstruction due to growing concerns associated with breast implants. O-FAFF outcomes are reported and compared them to traditional free abdominal tissue transfer and implant-based reconstruction.
Methods: A retrospective analysis of patients undergoing breast reconstruction with O-FAFF from 2019-2023 was performed. Demographic data, operative time, complications, revision rates, mean pain scores, narcotic pain medication use, and incidence of postoperative lymphedema were recorded. Post-operative MRI was performed to assess viability of the grafted fat and transferred omental lymph nodes. Outcomes were compared to cohorts who had free abdominal tissue transfer and implant-based reconstruction.
Results:58 patients (83 breasts) underwent O-FAFF reconstruction (unilateral=33, bilateral=25). O-FAFF was successfully performed in immediate (n= 53), delayed (n=13), delayed-immediate (n= 12), and hybrid (n=5) reconstruction.10 patients had prior history of radiation therapy and 5 patients had concurrent omental VLNT and postoperative radiotherapy for lymphedema prevention at time of ALND. The average age was 49.5(11.3) years old and average BMI was 22.5(3.0) kg/m2. Average harvested omental weight was 174.9 (120.5)g and average free fat transfer was 120.1 (41.3)g. Average operative time was 535.5 (34.4) minutes with an omental harvest time of 235 (5.1) minutes. Average hospital stay was 3.2 days (1.3). Total narcotic use during hospital stay was 71.4 (6.5) OME. No patients required PCA (0.0%). No intraoperative complications were noted. Average pain scores, narcotic and antiemetic use were significantly lower compared to a cohort of patients who underwent free abdominal tissue transfer (p<0.05). Post-operative MRI showed fully integrated grafted fat without fat necrosis and presence of viable transferred lymph nodes in the axilla. 3D volume reconstruction from MRI showed stable volume comparable to immediate postop breast volume, except for the 3 patients who received post-op radiation therapy. Compared to abdominal flap reconstruction and implant reconstruction, there were no significant differences in reconstructive failure or takeback rates in O-FAFF group. O-FAFF has similar downstream revision rates as abdominal flap reconstruction, but significantly less than implant reconstruction.
Conclusion: O-FAFF is a reliable alternative to breast reconstruction that results in a natural appearing breast. It offers the same versatility for breast reconstruction as other tissue flaps and can also be used for lymphedema prevention in patients with concurrent ALND. Shorter hospital stays, quicker recovery and less post-operative narcotic use are additional advantages of this approach over traditional autologous breast reconstructive techniques. O-FAFF has comparable rates of reconstructive failures as abdominal flap and implant reconstruction with less long-term revisions.