{
  "abstract": "Background: Red breast syndrome (RBS) is a challenging complication of acellular dermal matrix (ADM)-assisted breast reconstruction. Its incidence and hematologic predictors in patients receiving neoadjuvant chemotherapy (NAC) remain poorly characterized. Methods: This retrospective cohort study included 70 patients who underwent skin-sparing mastectomy with immediate implant-based reconstruction following NAC (January 2011–May 2025) at a single tertiary institution. Patients were stratified into ADM (n = 47) and Non-ADM (n = 23) groups. Within the ADM group, Firth penalized logistic regression with backward elimination identified preoperative variables independently associated with RBS. Optimal cutoffs were determined by the Youden Index. A composite hematologic scoring model (WBC + PLT + Ki-67 High, cutoff ≥2) was developed and internally validated using bootstrap resampling (2,000 iterations). Results: RBS occurred in 31.9% (15/47) of ADM patients versus 0% in Non-ADM patients (p = 0.001). The final model identified WBC (OR 1.235, 95% CI 1.066–1.502, p = 0.004), PLT (OR 1.013, 95% CI 1.001–1.028, p = 0.037), and Ki-67 High (OR 8.975, 95% CI 1.356–155.173, p = 0.020) as independently associated with RBS. Individual biomarkers showed modest discrimination (AUC 0.605–0.641, all p > 0.10), while the composite score achieved AUC = 0.816 (p < 0.001; sensitivity 86.7%, specificity 71.9%, NPV 92.0%). Bootstrap-corrected AUC was 0.817 (95% CI 0.636–0.959; optimism=−0.001). No significant temporal trend in RBS incidence was observed (Cochran–Armitage, p = 0.527). Conclusions: RBS incidence is substantially elevated in post-NAC ADM patients. This exploratory, single-center study develops a hypothesis-generating combination score for preoperative RBS risk stratification using routine laboratory and pathology assessment. External validation in prospective multi-institutional cohorts is required before clinical application.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Plastic Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea",
    "Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea",
    "Department of Neurosurgery, Busan Paik Hospital, Busan, Republic of Korea"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Dong Hun Lee"
    },
    {
      "affs": [
        1
      ],
      "name": "Kyung Do Byun"
    },
    {
      "affs": [
        2
      ],
      "name": "Tae Hyun Kim"
    },
    {
      "name": "Jin Lee"
    },
    {
      "name": "Jiyoung Yun"
    },
    {
      "name": "Hee Yeon Kim"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8mn79gtgzx9jn.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0359415",
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  "id": "8mn79gtgzx9jn",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0359415",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
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      "openalex",
      "2746|Breast Implant and Reconstruction"
    ],
    [
      "plos",
      "/Biology and life sciences/Bioengineering/Biotechnology/Medical devices and equipment/Medical implants"
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      "/Biology and life sciences/Immunology/Immune response/Inflammation"
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      "plos",
      "/Engineering and technology/Bioengineering/Biotechnology/Medical devices and equipment/Medical implants"
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      "plos",
      "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Inflammation"
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      "/Medicine and health sciences/Epidemiology/Medical risk factors/Cancer risk factors"
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      "plos",
      "/Medicine and health sciences/Hematology"
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      "plos",
      "/Medicine and health sciences/Immunology/Immune response/Inflammation"
    ],
    [
      "plos",
      "/Medicine and health sciences/Medical devices and equipment/Medical implants"
    ],
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      "plos",
      "/Medicine and health sciences/Oncology/Cancer risk factors"
    ],
    [
      "plos",
      "/Medicine and health sciences/Oncology/Cancers and neoplasms"
    ],
    [
      "plos",
      "/Medicine and health sciences/Oncology/Cancers and neoplasms/Breast tumors/Breast cancer"
    ],
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      "plos",
      "/Medicine and health sciences/Surgical and invasive medical procedures"
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      "plos",
      "/Medicine and health sciences/Surgical and invasive medical procedures/Surgical excision/Mastectomy"
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  "openalex": "W7220858156",
  "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0359415&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-07",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/8mn79gtgzx9jn.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:30Z",
      "native_id": "10.1371/journal.pone.0359415",
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      "url": "https://doi.org/10.1371/journal.pone.0359415"
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  "subjects": [
    {
      "field": "biology",
      "origin": "plos:immunology",
      "subfield": "immunology"
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    {
      "field": "biology",
      "origin": "plos:biotechnology",
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      "field": "medicine",
      "origin": "plos:oncology",
      "subfield": "oncology"
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  "title": "Predicting red breast syndrome after ADM-assisted breast reconstruction: An exploratory scoring model using routine hematologic markers",
  "title_text": "Predicting red breast syndrome after ADM-assisted breast reconstruction: An exploratory scoring model using routine hematologic markers",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:30Z",
  "url": "https://research.draconitic.com/paper/8mn79gtgzx9jn",
  "venue": "PLOS One",
  "versions": []
}