Aesthetic surgery journal
September 1, 2026 · via Europe PMC
An Overview of Red Breast Syndrome: A Qualitative Systematic Review of the Literature and a Single-Center Case Series.
Zanetti E, Quaglia D, De Francesco F, +5 more, Zingaretti N.
AI summary — for doctors, generated from the abstract only
A systematic review of 29 studies plus a case series of 8 patients found red breast syndrome (an inflammatory complication after ADM-based implant breast reconstruction) has a reported incidence ranging widely from 0% to 29.6%, and corticosteroid therapy was the most consistently effective treatment.
What was studied
A qualitative systematic review (PubMed and Scopus searches) summarizing existing literature on red breast syndrome (RBS) etiology, clinical presentation, diagnosis, and treatment following ADM-based implant breast reconstruction, combined with a single-center case series of 8 patients who developed RBS after direct-to-implant reconstruction with ADM (January 2022-December 2024), proposing a management protocol based on the combined evidence.
Key findings
- 29 studies met inclusion criteria, with reported RBS incidence ranging from 0% to 29.6% across the literature.
- Proposed etiologies include endotoxin contamination, residual cellular debris, delayed hypersensitivity reactions, and lymphatic/vascular impairment of mastectomy flaps; most reports described localized erythema confined to the ADM area with normal inflammatory markers and negative imaging, with antibiotic therapy frequently failing to improve symptoms.
- Corticosteroids were the most consistently effective treatment across the reviewed literature, though some cases required ADM removal or replacement.
- In the institutional case series (n=8), symptoms began 4 weeks to 7 months postsurgery, inflammatory markers remained normal, and symptoms resolved within days to weeks with corticosteroid therapy or conservative management.
Clinical relevance
This review may be relevant to surgeons managing postoperative erythema after ADM-based breast reconstruction, helping distinguish red breast syndrome from surgical-site infection and supporting corticosteroid therapy (rather than antibiotics) as a first-line approach, as the proposed management algorithm suggests.
Who should care
Limitations
The reviewed literature shows wide variation in reported incidence (0-29.6%), reflecting heterogeneous diagnostic criteria and reporting across studies; the institutional case series is small (8 patients) and from a single center, and the authors call for prospective investigation and manufacturer-level endotoxin testing to clarify pathogenesis.
Red breast syndrome after ADM-based breast reconstruction typically presents with localized erythema and normal inflammatory markers, and responds to corticosteroids rather than antibiotics, per this review and case series.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Red breast syndrome (RBS) is an uncommon inflammatory complication that may occur following implant-based breast reconstruction and can clinically mimic surgical-site infection. This qualitative systematic review, based on comprehensive PubMed and Scopus searches, summarizes the existing literature on RBS, focusing on its etiology, clinical presentation, diagnostic characteristics, and therapeutic approaches following breast reconstruction using acellular dermal matrices (ADMs). A management protocol is proposed based on available data, and a single-center case series is presented from our Hospital, including patients who developed RBS after direct-to-implant reconstruction with ADM between January 2022 and December 2024. Twenty-nine studies met the inclusion criteria, comprising case reports, case series, and retrospective or prospective cohort studies. The reported incidence of RBS ranged from 0% to 29.6%. Proposed etiologies include endotoxin contamination, residual cellular debris, delayed hypersensitivity reactions, and lymphatic or vascular impairment of mastectomy flaps. Most reports described localized erythema confined to the area of the ADM, with normal inflammatory markers and negative imaging findings, whereas antibiotic therapy frequently failed to achieve improvement. Corticosteroids represented the most consistently effective treatment, although some cases required ADM removal or replacement. In our institutional case series (n = 8), symptom onset occurred between 4 weeks and 7 months postsurgery. Inflammatory markers remained within normal limits, imaging rarely demonstrated fluid collections, and symptoms resolved within days to weeks with corticosteroid therapy or conservative management. This review consolidates current evidence, proposes a diagnostic-therapeutic algorithm and highlights the need for prospective investigations and manufacturer-level endotoxin testing to elucidate pathogenesis and optimize clinical management. Level of Evidence: 2 (Risk) For image description, please refer to the figure legend and surrounding text.
DOI
10.1093/asj/sjag053
PMID
41784074
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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