Navarro Yelissa, Makarewicz Nathan, Hinson Chandler, Thawanyarat Kometh, Coleman-Belin Janet, Loan Phillip, Modi Suraj, Nazerali Rahim S
From the Medical College of Georgia at Augusta University, Augusta, GA.
Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA.
Ann Plast Surg. 2025 Feb 1;94(2):243-249. doi: 10.1097/SAP.0000000000004151. Epub 2024 Nov 12.
Red breast syndrome (RBS) has been noted in past literature as a possible complication of implant-based breast reconstruction (IBBR) with the use of acellular dermal matrices (ADMs). Since its first appearance in 2009, RBS has drawn growing medical attention with reported incidence ranging from 7%-9%. There has been a noted decrease in the emergence of RBS despite its inclusion among the analyzed complications in a number of studies. This systematic review aims to evaluate the trend in reported RBS incidence over time and appropriately determine an accurate incidence of RBS from reported literature since the emergence of the phenomena.
A systematic literature review was performed in July 2023 that analyzed the incidence of RBS among retrospective cohort studies on complication rates of IBBR with ADM. Patient demographics, RBS incidence rates, and all-cause complications were captured. The review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines and Methodological Index for Nonrandomized Studies criteria was used to assess study quality.
From 2009 to 2023, a total of 48 studies (n = 6251) met inclusion criteria of which 35 studies from 2017 to 2023 were not already included in a prior systematic review (n = 5246). The mean incidence of RBS in the unreported studies was 2.88% with a weighted mean of 3.22%. Analysis of the trend in RBS over time shows an increasing reported incidence rate from 2009 with a peak in incidence between 2016 and 2017, followed by a steady decline through 2022. Twenty-six of the studies were published from 2016 to 2019.
The incidence of RBS among prior studies and systematic reviews has fluctuated significantly since its initial emergence in 2009. Reported incidence rates have been on the decline since 2018 with a true weighted incidence of 3.22% from analysis of recent reported studies. Potential causes for the decline in incidence include practice changes in ADM preparation, changes in the ADM brand used for IBBR, and improved categorization of RBS compared to cellulitis/infection. Despite more robust criteria for diagnosis, no consensus for management has yet been established.
在以往文献中，红色乳房综合征（RBS）被认为是使用脱细胞真皮基质（ADM）进行植入式乳房重建（IBBR）可能出现的一种并发症。自2009年首次出现以来，RBS受到了越来越多的医学关注，报告的发病率在7%-9%之间。尽管在多项研究的分析并发症中都包括了RBS，但该综合征的出现已明显减少。本系统评价旨在评估报告的RBS发病率随时间的变化趋势，并根据该现象出现以来的报告文献适当确定RBS的准确发病率。
2023年7月进行了一项系统文献综述，分析了在关于使用ADM的IBBR并发症发生率的回顾性队列研究中RBS的发生率。收集了患者人口统计学数据、RBS发病率和全因并发症情况。该综述按照系统评价和Meta分析的首选报告项目指南进行，采用非随机研究的方法学指数标准评估研究质量。
2009年至2023年，共有48项研究（n = 6251）符合纳入标准，其中2017年至2023年的35项研究未被纳入之前的系统评价（n = 5246）。未报告研究中RBS的平均发病率为2.88%，加权平均发病率为3.22%。对RBS随时间变化趋势的分析表明，自2009年以来报告的发病率呈上升趋势，在2016年至2017年发病率达到峰值，随后到2022年稳步下降。其中26项研究发表于2016年至2019年。
自2009年首次出现以来，之前研究和系统评价中RBS的发病率波动显著。自2018年以来，报告的发病率一直在下降，根据近期报告研究的分析，实际加权发病率为3.22%。发病率下降的潜在原因包括ADM制备方法的改变、用于IBBR的ADM品牌的变化以及与蜂窝织炎/感染相比，RBS的分类有所改进。尽管诊断标准更加严格，但尚未建立管理方面的共识。
