I appreciate the letter from Drs. Newman et al.1 regarding the “red breast syndrome” that is occasionally observed following prosthetic breast reconstruction using acellular dermal matrices. I agree that this is a poorly understood phenomenon that clearly deserves greater investigation. Red breast syndrome has been described with virtually all types of acellular dermal matrix regardless of product sterility, processing differences, and nature of the tissue (i.e., human, bovine, or porcine). At present, we are not able to predict who will develop red breast syndrome or what factors may predispose to its occurrence. We do know that it does not appear to have an infectious cause, that it is most likely an inflammatory response, and that it is self-limiting. It usually resolves after 1 to 2 months, although I have seen one patient with redness lasting 9 months. Biopsy of the tissue is nonspecific, with no specific abnormality or cell type identified.
Potential mediators of the inflammatory response may be related to the host or to the material itself. Host mediators may include the adhered or free fat along the lower mastectomy skin flap. The mechanical consequences of generating another tissue plane in this setting may also contribute to the inflammatory process. Finally, the initiation of the revascularization process may generate an inflammatory reaction that manifests as redness. Acellular dermal matrix mediators may contribute to this as well. It is not known what these substances are, but the erythema associated with acellular dermal matrix use does seem to be attenuated or eliminated by washing the product in at least two baths. We clearly need to study this phenomenon is greater detail.
Regardless of the cause, I agree with the authors that this condition should not be taken lightly. Infection must always be ruled out and a trial of antibiotic therapy initiated. Close observation is the rule to ensure that the process does not spread. Fortunately, red breast syndrome is relatively infrequent, occurring in less than 10 percent of breasts on a national level. In my practice, it occurs in less than 5 percent of cases. I am hopeful that future research will shed additional light on this topic.
Maurice Y. Nahabedian, M.D.
Department of Plastic Surgery
Georgetown University Hospital
3800 Reservoir Road NW
Washington, D.C. 20007
1.Newman MI, Hanabergh E, Samson MC. AlloDerm performance in the setting of prosthetic breast surgery, infection, and irradiation (Letter). Plast Reconstr Surg
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