[Breast reduction-plasty using the modified Strömbeck-McKissock technique]

We reported on the results of 703 breast reduction operations performed by a modified technique after McKissock/Strömbeck. Altogether we operated in the last 10 years 360 patients (15-65 years; mean 32 years) at the Johanniter Hospital in Geesthacht. Only such patients were operated on for whom a medical necessity for reduction of the breast was established, such as orthopaedic problems etc. Complications in healing, especially of the nipple, the supporting parts of the nipple, and parenchyma were examined with these different variables: age of the patients, nicotine consumption, weight of tissue taken out, preoperative distance between nipple and jugulum, body weight of the patient in relation to normal weight, length of operation, loss of blood, and parenchymal histology. Life-endangering complications did not occur in any patient. Infections were seen in 2/360 patients (0.6%). All patients were given a perioperative antibiotic prophylactic, usually with Baypen (mezlocillin). Removable haematoma was seen in only 2/703 (0.3%). 100% necrosis of the nipple was seen in 4/703 reduced breast (0.6%), which agrees with Strömbeck's results (10). Other authors count up to 7.1% complete necrosis of the nipple (2n, 15). Nipple necrosis in part (1/3-2/3) was seen in 14/703 (1.8%) mammaplasty. Statistically highly significant correlations were found in all healing disturbances in relation to the amount of reduced tissue, distance of jugulum to nipple and adipositas. Patients with parenchymal lipomatosis had more complications in relation to other histological types (p < 0.05 and p < 0.01). Especially smoking patients showed a correlation to necrosis of the nipple (p < 0.05%), not to parenchymal necrosis. The duration of operation was not in any way connected with the healing complications. With these results it is easier to obtain the patient's informed consent by means of individual explanations of the operation and its risks.