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Handchir Mikrochir Plast Chir 2017; 49(06): 390-398
DOI: 10.1055/s-0043-113132
Originalarbeit
Georg Thieme Verlag KG Stuttgart · New York

Die Ribeiro-Technik bei Gigantomastie – Review von 294 Reduktionsplastiken in 8 Jahren

Ribeiro-Technique in Gigantomastia – Review of 294 Reduction Mammaplasties in 8 Years
Andreas Wolter
,
Naja Pluto
,
Till Scholz
,
Jens Diedrichson
,
Andreas Arens-Landwehr
,
Jutta Liebau
Further Information

Publication History

02/20/2017

05/28/2017

Publication Date:
01 August 2017 (online)

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Zusammenfassung

Hintergrund Eine Mammareduktionplastik bei Gigantomastie stellt eine Herausforderung in der Mammachirurgie selbst bei sehr erfahrenen plastischen Chirurgen dar. Extrem lange Mamillenstiele beeinträchtigen die Blutversorgung des Mamillenareolenkomplexes. Der massiv gedehnte Hautmantel erschwert die Brustformung und effektive Reduktion. Die Ribeiro-Technik stellt einen etablierten Standard zur Mammareduktion in unserer Klinik dar. Ziel der Studie war ein Review unserer Vorgehensweise bei Gigantomastie im Vergleich mit der aktuellen Literatur.

Patienten und Methoden Im Zeitraum von 01/2009–12/2016 erfolgten in unserer Klinik bei 760 Patientinnen 1247 Mammareduktionsplastiken. In 294 Reduktionen (23,6 %) war das Einschlusskriterium der Gigantomastie (Resektionsgewicht > 1000 g pro Brust) erfüllt. Die Technik nach Ribeiro mit superomedialer Mamillenstielung und Bildung eines inferioren dermoglandulären Lappens zur Auffüllung des oberen Brustpols und Prävention eines bottoming outs wurde als Standard implementiert. Bei Patientinnen mit einem Mamillen-Jugulum-Abstand von > 40 cm erfolgte eine freie Brustwarzentransplantation. Die Outcome-Parameter Komplikationsrate, Patientenzufriedenheit, Brustwarzensensibilität und Notwendigkeit einer Korrekturoperation wurden retrospektiv überprüft.

Ergebnisse Bei 174 Patientinnen erfolgten 294 Mammareduktionsplastiken mit mehr als 1000 g pro Brust. Das Resektionsgewicht lag im Mittel bei 1389,6 g pro Brust (1000–4580 g). Das Durchschnittsalter betrug 43,5 (18–76) Jahre, der durchschnittliche Body-Mass-Index (BMI) war 29,2 (19–40) kg/m2, der durchschnittliche Mamillen-Jugulum-Abstand war 34,8 (27–52) cm, die durchschnittliche OP-Dauer betrug 117 (72–213) Minuten. Bei 30 Reduktionen erfolgte eine freie Brustwarzentransplantation. Die Komplikationsrate lag bei insgesamt 7,8 %. Korrekturoperationen erfolgten in 16 %. 93 % der Patientinnen waren „sehr zufrieden“ bis „zufrieden“ mit dem ästhetischen Ergebnis bei in 88 % „sehr gut“ bis „gut“ erhaltener Brustwarzensensibilität.

Fazit Bei der Ribeiro-Technik handelt es sich um eine gut etablierte, vielseitig einsetzbare Standardtechnik zur Mammareduktion, die reproduzierbare, formstabile Ergebnisse in hoher Qualität liefert. Bei Patientinnen mit Gigantomastie stellt dieses Verfahren ebenso eine effektive komplikationsarme Methode dar, um eine Volumenreduktion mit ästhetisch sehr zufriedenstellenden Ergebnissen zu erreichen.

Abstract

Introduction Reduction mammaplasty in patients with gigantomastia is challenging even to very experienced plastic surgeons. Extremely elongated pedicles impair the vascular supply of the nipple-areola complex. Breast shaping and effective reduction are difficult due to the severely stretched skin envelope. The Ribeiro technique is the standard technique for reduction mammaplasty in our clinic. The aim of this study is to review our approach in patients with gigantomastia in comparison to the current literature.

Patients und methods From 01/2009 to 12/2016, we performed 1247 reduction mammaplasties in 760 patients. In 294 reduction mammoplasties (23.6 %), resection weight was more than 1000 g per breast corresponding to the definition of gigantomastia. The Ribeiro technique with a superomedial pedicle and inferior dermoglandular flap for autologous augmentation of the upper pole was implemented as standard procedure. In cases with a sternal notch-nipple distance > 40 cm, free nipple grafting was performed. The outcome parameters complication rate, patient satisfaction with the aesthetic result, nipple sensitivity and surgical revision rate were obtained and retrospectively analysed.

Results In 174 patients, 294 reduction mammaplasties were performed with a resection weight of more than 1000 g per breast. Average resection weight was 1389.6 g (range, 1000–4580 g). Average age was 43.5 years (range, 18–76 years), average body mass index (BMI) was 29.2 kg/m2 (range, 19–40 kg/m2), average sternal notch-nipple distance was 34.8 cm (range, 27–52 cm), average operation time was 117 minutes (range, 72–213 minutes). A free nipple graft was necessary in 30 breasts. Overall complication rate was 7.8 %; secondary surgical revision rate was 16 %. 93 % of the patients were “very satisfied” and “satisfied” with the aesthetic result. Nipple sensitivity was rated “very good” and “good” in 88 %.

Conclusion The Ribeiro technique is a well established, versatile standard technique for reduction mammaplasty, which helps to create high-quality reproducible results with longterm formstable shape. In gigantomastia, this procedure is also very effective to achieve volume reduction and aesthetically pleasing results with a low complication rate.

Schlüsselwörter

Gigantomastie - Makromastie - Mammahypertrophie - Mammareduktion - Brustverkleinerung - Ribeiro Technik - Ribeiro

Key words

gigantomastia - mammahypertrophy - breast surgery - reduction mammaplasty - breast reduction - Ribeiro technique - Ribeiro
 

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