Publication:

The PDR-SEQS classification and reconstructive algorithm for breast defects after phyllodes tumor resection: a retrospective cohort study

Background Phyllodes tumors (PTs) are fibroepithelial neoplasms requiring surgical resection, frequently causing complex reconstructive defects. Currently, no standardized framework exists to guide reconstructive decision-making. This study proposes a novel classification and algorithm based on objective volumetric loss and skin-envelope quality.

Methods A retrospective cohort study was conducted at a tertiary referral center in the period between June 2020 and December 2024. Adult patients undergoing breast reconstruction following PT resection with a minimum 12-month follow-up were included. Two objective parameters were developed: the phyllodes defect ratio (PDR), quantifying volume loss relative to the contralateral breast, and the skin envelope quality score (SEQS), evaluating residual soft-tissue condition. These metrics informed a five-tier reconstructive decision-making algorithm.

Results Thirty-five patients met inclusion criteria. Mean PDR and SEQS values were 41.5%±34.3 and 4.8±1.5, respectively. The most prevalent subtype was IIIb (45.7%), followed by II (42.9%). Reconstructive strategies escalated according to algorithm-defined complexity, with autologous reconstruction predominating. Despite extensive defects, definitive reconstruction was achieved in most patients, with infrequent major complications and no compromise of algorithm applicability.

Conclusions The PDR–SEQS classification provides an objective, clinically applicable framework for managing breast defects following PT resection. By integrating proportional volumetric deficiency and soft-tissue quality, the proposed algorithm standardizes reconstructive decision-making, facilitating reproducible surgical planning from prosthetic to complex autologous approaches. External multicenter validation is warranted.