ArticlePloS one2026
Predicting red breast syndrome after ADM-assisted breast reconstruction: An exploratory scoring model using routine hematologic markers.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundRed breast syndrome (RBS) is a challenging complication of acellular dermal matrix (ADM)-assisted breast reconstruction. Its incidence and hematologic predictors in patients receiving neoadjuvant chemotherapy (NAC) remain poorly characterized.
methodsThis retrospective cohort study included 70 patients who underwent skin-sparing mastectomy with immediate implant-based reconstruction following NAC (January 2011-May 2025) at a single tertiary institution. Patients were stratified into ADM (n = 47) and Non-ADM (n = 23) groups. Within the ADM group, Firth penalized logistic regression with backward elimination identified preoperative variables independently associated with RBS. Optimal cutoffs were determined by the Youden Index. A composite hematologic scoring model (WBC + PLT + Ki-67 High, cutoff ≥2) was developed and internally validated using bootstrap resampling (2,000 iterations).
resultsRBS occurred in 31.9% (15/47) of ADM patients versus 0% in Non-ADM patients (p = 0.001). The final model identified WBC (OR 1.235, 95% CI 1.066-1.502, p = 0.004), PLT (OR 1.013, 95% CI 1.001-1.028, p = 0.037), and Ki-67 High (OR 8.975, 95% CI 1.356-155.173, p = 0.020) as independently associated with RBS. Individual biomarkers showed modest discrimination (AUC 0.605-0.641, all p > 0.10), while the composite score achieved AUC = 0.816 (p < 0.001; sensitivity 86.7%, specificity 71.9%, NPV 92.0%). Bootstrap-corrected AUC was 0.817 (95% CI 0.636-0.959; optimism=-0.001). No significant temporal trend in RBS incidence was observed (Cochran-Armitage, p = 0.527).
conclusionsRBS incidence is substantially elevated in post-NAC ADM patients. This exploratory, single-center study develops a hypothesis-generating combination score for preoperative RBS risk stratification using routine laboratory and pathology assessment. External validation in prospective multi-institutional cohorts is required before clinical application.
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