Using omentum in breast reconstruction; a cautionary note

This paper reviewed whether or not using omentum in breast surgery is safe. 

The omentum is a fatty tissue that covers the intestines. It can be used in breast surgery, to treat deformities of breasts, for aesthetic breast procedures and for partial breast reconstruction (surgery to rebuild the breast after it is removed). However, the use of omentum for breast reconstruction is controversial. 

The authors aimed to review the safety and suitability of applying omentum to the breast. 60 studies that included more than 985 women were analyzed.

The studies found that the omentum was mainly used for breast reconstruction after mastectomy (removal of breast) due to breast cancer. the next most frequent use was due to radiation damage of the breast. Laparoscopy (surgery using a small incision) was  used to obtain part of the omentum for 26% of breast reconstruction procedures after mastectomy.

There were 273 clinical complications in 60 studies of more than 985 women. About a quarter of the complications were of partial omental flap necrosis (cell death of part of the omentum). 19% of complications involved infections. 16% of complications involved abdominal hernia (abdominal contents jutting into abdominal wall). More serious complications that happened less frequently were hematoma (collection of blood) or bleeding that required immediate surgery. 3 patients had to have a colectomy (surgery to remove part of intestines) due to damage to the intestine when the omentum was removed. Overall, 24 % of patients faced complications. 7% of patients who underwent laparoscopy (to obtain omentum) had complications. 

Cancer risk was assessed in 403 of the patients. Following breast reconstruction with omentum after mastectomy, the rate of breast cancer recurrence was 35%. 

The authors concluded that there were a large number of complications, the most serious of which affected the digestive system. The omentum should be used only for total breast reconstruction of huge defects if there are no other suitable tissues that can be used. 

The studies reviewed were considered 'low quality'.