Bilateral Red Breast Syndrome in Prepectoral Implant-based Immediate Breast Reconstruction Using Bovine Pericardium Acellular Collagen Matrix

Summary: Red breast syndrome (RBS) is a rare and intriguing clinical phenomenon that remains only partially understood. It is characterized by erythema and warmth of the breast following breast reconstructive surgery. This clinical condition is typically associated with the use of acellular dermal matrix (ADM) over breast implants. Currently, surgeons prefer using ADMs for immediate prepectoral implant-based breast reconstruction to enhance aesthetic outcomes and promote better implant integration. ADMs can induce a local inflammatory response that may mimic an actual implant infection. Although rare, the etiology, diagnosis, and treatment of RBS present a significant challenge for both patients and healthcare professionals due to its enigmatic nature. We present a case of bilateral RBS following bilateral nipple-sparing mastectomy and immediate prepectoral implant-based breast reconstruction using a specific acellular collagen matrix derived from bovine pericardium. We detail our diagnostic approach and treatment strategy, which successfully resolved the syndrome while preserving both the breast implants and the ADMs.