Early Onset Red Breast Syndrome: The Incidence, Risk Factors, and Clinical Outcomes in Prepectoral Direct-to-Implant Breast Reconstruction

Background Red breast syndrome (RBS) is a concerning condition often mistaken for infection following acellular dermal matrix (ADM)-assisted breast reconstruction. Although various factors have been suggested as possible causes, the timing of onset has not been considered in diagnosing RBS. Objectives This study aims to investigate the incidence, risk factors, and clinical outcomes of RBS occurring within the first week after immediate ADM-assisted prepectoral direct-to-implant (DTI) breast reconstruction. Methods A retrospective chart review was conducted on patients who underwent DTI between April 2021 and March 2023. Early RBS was defined as redness confined to the mastectomy skin flap overlying the ADM, observed within 7 days postoperatively, without other signs of infection. Adjusted prevalence (AP) difference and AP ratio for risk factors and postoperative complications associated with RBS were evaluated. Results A total of 255 breasts were included. Early RBS was observed in 25 breasts (9.8%). The AP of RBS increased with age, significantly higher at age 60 compared with age 30 (P =. 030) and higher implant projections (P =. 021). A decreased AP was associated with prophylactic mastectomy (P <. 001), a larger difference between implant size and mastectomy specimen weight (P =. 031 for a difference of 300 compared with -200), and preoperative radiotherapy (P <. 001). Early RBS was associated with higher AP of total complications, delayed wound healing, wound revisions, and infections (all P <. 05). Conclusions Certain patient- and operation-related factors may predispose to early RBS, and patients who exhibit early RBS may have an increased risk of postoperative complications.