Delayed Hypersensitivity Reaction to Acellular Dermal Matrix in Breast Reconstruction

Abstract

We propose that the etiology of erythema overlying ADM grafts, and the so-called red breast syndrome, may in some patients be a delayed-type hypersensitivity reaction to the ADM product. Affected patients may benefit from treatment with corticosteroids or similar medications, and that such treatment may, in some cases, enable patients to retain the ADM grafts and enable salvage of the reconstructed breast.

Reducing Postoperative Infections and Red Breast Syndrome in Patients With Acellular Dermal Matrix–Based Breast Reconstruction

“…Additionally, all patients were responsive to corticosteroids and chemotherapy. 9 This study was the first to measure RBS as a complication in plastic surgery. In our patient population, those with presumed RBS were treated empirically for possible cellulitis.…”

“…Authors have suggested improper ADM orientation, foreign body reaction, lymphatic obstruction, dependent erythema, hyperemia secondary to neovascularization, or type IV hypersensitivity reactions. [9][10][11][12][13] Clinical findings include early erythema over the lower pole of the breast without systemic signs of infection or radiographic evidence of seroma or abscess. 1 We hypothesized that RBS and other complications, including infection and seroma, would have a decreased incidence with the change to terminally sterilized RTU ADM from the aseptic product.…”

Delayed‐immediate hybrid breast reconstruction—Increasing patient input and precision in breast reconstruction

“…Seroma and hematoma were defined as collections of serous fluid and blood, respectively, that required percutaneous or surgical drainage. “Red breast” syndrome was defined as otherwise asymptomatic breast erythema in the distribution of the ADM . Fat necrosis was defined as a postoperative (>12 weeks) palpable hardening in the reconstructed breast of greater than 1 cm.…”

Embrace the Change

“…The acellular dermal matrix should be hydrated with normal saline and not with an antibiotic solution to prevent the acellular dermal matrix to soak in and retain within the scaffold any antibiotics that could potentially stimulate an inflammatory response as has been reported with other acellular dermal matrices. [16][17][18][19][20] Orientation of the acellular dermal matrix over the sizer allows us to determine how much acellular dermal matrix will be needed (Fig. 2).…”