Risk factor analysis and clinical experience of treating red breast syndrome in acellular dermal matrix and implant-based breast reconstruction.

Background: Red breast syndrome (RBS) is represented as idiopathic cutaneous erythema overlying the acellular dermal matrix (ADM) after implant-based breast reconstruction without other signs and symptoms of infection. Although a number of etiologies including lymphatic disruption, delayed hypersensitivity reaction to ADM, and residual DNA within ADM have been suggested for RBS, consensus regarding risk factors and treatment for RBS has been reached yet. Thus, the aim of this study was to find risk factors for RBS and introduce our experience of successful treatment of RBS.

Methods: A retrospective study was conducted for patients who underwent implant-based breast reconstruction using ADM from October 2018 to February 2021. Demographics, types of ADM used, reconstructive characteristics, and incidence of RBS were analyzed. Risk factors for RBS were investigated using the logistic regression model.

Results: A total of 138 implant-based breast reconstructions using ADM were performed. Their average follow-up period was 17.33 months. The incidence of RBS was 5.8% (n=8) with a median onset time of 36 days. Based on the logistic regression analysis, prior history of radiotherapy [odds ratio (OR): 22.703, P=0.001] was the only significant risk factors for RBS. In most cases with RBS suspected (6 of 8), it was resolved with intravenous corticosteroid and 1 week course of oral antibiotics.

Conclusions: Prior history of radiotherapy was found to be significant risk factor for RBS. Single dose IV corticosteroid with 1 week course of oral antibiotics might be useful for RBS treatment.