{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T18:00:15Z","timestamp":1791396015364,"version":"4.3.3"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included 70 patients who underwent skin-sparing mastectomy with immediate implant-based reconstruction following NAC (January 2011\u2013May 2025) at a single tertiary institution. Patients were stratified into ADM (n\u2009=\u200947) and Non-ADM (n\u2009=\u200923) 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\u2009+\u2009PLT\u2009+\u2009Ki-67 High, cutoff \u22652) was developed and internally validated using bootstrap resampling (2,000 iterations).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      RBS occurred in 31.9% (15\/47) of ADM patients versus 0% in Non-ADM patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). The final model identified WBC (OR 1.235, 95% CI 1.066\u20131.502,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004), PLT (OR 1.013, 95% CI 1.001\u20131.028,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.037), and Ki-67 High (OR 8.975, 95% CI 1.356\u2013155.173,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.020) as independently associated with RBS. Individual biomarkers showed modest discrimination (AUC 0.605\u20130.641, all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.10), while the composite score achieved AUC\u2009=\u20090.816 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; sensitivity 86.7%, specificity 71.9%, NPV 92.0%). Bootstrap-corrected AUC was 0.817 (95% CI 0.636\u20130.959; optimism=\u22120.001). No significant temporal trend in RBS incidence was observed (Cochran\u2013Armitage,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.527).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0359415","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:34:06Z","timestamp":1791394446000},"page":"e0359415","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predicting red breast syndrome after ADM-assisted breast reconstruction: An exploratory scoring model using routine hematologic markers"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4379-4937","authenticated-orcid":true,"given":"Dong Hun","family":"Lee","sequence":"first","affiliation":[{"name":"Busan Paik Hospital, Inje University College of Medicine","place":["Busan, Republic of Korea"],"department":["Department of Plastic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung Do","family":"Byun","sequence":"additional","affiliation":[{"name":"Busan Paik Hospital, Inje University College of Medicine","place":["Busan, Republic of Korea"],"department":["Department of Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tae Hyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Busan Paik Hospital, Inje University College of Medicine","place":["Busan, Republic of Korea"],"department":["Department of Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Lee","sequence":"additional","affiliation":[{"name":"Busan Paik Hospital","place":["Busan, Republic of Korea"],"department":["Department of Neurosurgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiyoung","family":"Yun","sequence":"additional","affiliation":[{"name":"Busan Paik Hospital, Inje University College of Medicine","place":["Busan, Republic of Korea"],"department":["Department of Plastic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2519-8837","authenticated-orcid":true,"given":"Hee Yeon","family":"Kim","sequence":"additional","affiliation":[{"name":"Busan Paik Hospital, Inje University College of Medicine","place":["Busan, Republic of Korea"],"department":["Department of Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"issue":"9938","key":"pone.0359415.ref001","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/S0140-6736(13)62422-8","article-title":"Pathological complete response and long-term clinical benefit in breast cancer: The CTNeoBC pooled analysis","volume":"384","author":"P 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