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Minimizing post-operative pain in autologous breast reconstruction with the omental fat-augmented free flap.
Peter Deptula1, Dung Nguyen1 1Stanford University; Palo Alto, California.

Background: The use of the omental fat-augmented free flap (O-FAFF) has been described as a means for autologous breast reconstruction. Unlike traditional abdominal-based free flaps, this technique involves laparoscopic harvest of intraabdominal tissues. We aim to assess the O-FAFF donor site morbidity in terms of patient reported post-operative pain and narcotic use.

Methods: A retrospective analysis of patients undergoing immediate autologous breast reconstruction with O-FAFF technique was performed from 2019-2020. Patients were evaluated for demographic data, operative time, complications, mean pain scores and narcotic pain medication use during their hospital course. Pain was evaluated on a 1-10 scale. Patient narcotic use was recorded as oral morphine equivalents (OME). We compared outcomes to a control group of patients who underwent autologous breast reconstruction with free abdominal tissue transfer. Statistical analysis was performed using two-tailed t-test with p<0.05 indicating statistical significance.

Results: A total of 7 patients undergoing O-FAFF were identified (n=7). Patients on average were 48.1 years-old with an average BMI of 22.3 kg/m2. Indications for operation included invasive ductal carcinoma (42.9%), ductal carcinoma in situ (28.5%), BRCA1 mutation (14.3%), and malignant phyllodes (14.3%). Average harvested omental weight was 158.9 g and average free fat transfer was 119.3g. 4 patients underwent unilateral procedures while, 3 underwent bilateral procedures. Average operative time for all cases was 558 (39.2) minutes with an omental harvest time of 227 (6.1) minutes. Average pain scores during hospital during POD1, POD2, POD3 were 3.1 (0.38), 2.8 (0.27) and 2.2 (0.54), respectively. The average narcotic use by patients in oral morphine equivalents (OME) on POD1, POD2 and POD3 are 17.1 (6.5), 15.5 (6.6) and 4.8 (2.68), respectively. Total narcotic use during hospital stay was 71.3 (14.2) OME. No patients required the use of a PCA (0.0%). No complications were noted (0.0%). Average pain scores and narcotic use are significantly lower when compared to previously published cohort of patients who underwent autologous breast reconstruction with free abdominal tissue transfer (p<0.05) (Table 1).

Conclusion: The O-FAFF is proven to be a viable method of autologous breast reconstruction. Early series of patients undergoing O-FAFF reconstruction suggest a lower donor site morbidity as demonstrated by lower post-operative pain scores and lower consumptions of narcotic pain medications.

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