Objective: 

• BMI is a key determinant in autologous breast reconstruction.
• Low BMI: limited donor tissue, yet higher satisfaction with autologous vs. implant-based reconstruction.
• High BMI: adequate tissue but increased donor-site morbidity and wound complications.
• The omental fat-augmented free flap (O-FAFF) utilizes laparoscopic harvest and may broaden autologous reconstruction options across BMI groups.
• Objective: Compare outcomes across low (<18.5), normal (18.5–24.9), and high (≥25) BMI patients.

Methods: 

• Design: Retrospective review of consecutive O-FAFF breast reconstructions by a single surgeon.
• Outcomes: Major and minor complications, abdominal donor-site morbidity, and revision procedures.
• Analysis: Fisher’s exact test for unadjusted comparisons.
• Adjusted analysis: Logistic regression controlling for preoperative radiotherapy.

Results/Conclusion: 

• O-FAFF demonstrates comparable safety across BMI groups, with no significant differences in overall or major complication rates.
• Major complications were rare, and delayed wound healing in low BMI patients did not remain significant after adjustment for radiation.
• No abdominal donor-site complications were observed in high BMI patients, supporting the benefit of laparoscopic harvest with minimal incision burden.
• Revision procedures were common across all cohorts as part of staged reconstruction, with no significant differences in overall revision patterns.
• Reconstructive volume was reliably achieved, with combined omentum and fat grafting approximating mastectomy specimen weight across BMI categories.
• Clinical implications:
• Expands autologous options for low BMI patients beyond implants
• May reduce donor-site morbidity in high BMI patients at increased risk for wound complications