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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