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

Sergio A. D. Hernández; Diego L. Gutiérrez; Diana V.  D. Ávila; Raymundo T. Piña; Elias A. E. Desentis

doi:10.18203/2320-6012.ijrms20262168

Authors

Sergio A. D. Hernández Servicio de Cirugía Plástica, Estética y Reconstructiva del Hospital General de México “Dr. Eduardo Liceaga”, Dr. Balmis 148, Doctores, Cuauhtémoc, 06720 Ciudad de México, Mexico
Diego L. Gutiérrez Servicio de Cirugía Plástica, Estética y Reconstructiva del Hospital General de México “Dr. Eduardo Liceaga”, Dr. Balmis 148, Doctores, Cuauhtémoc, 06720 Ciudad de México, Mexico https://orcid.org/0009-0009-2956-1075
Diana V. D. Ávila Servicio de Cirugía Plástica, Estética y Reconstructiva del Hospital General de México “Dr. Eduardo Liceaga”, Dr. Balmis 148, Doctores, Cuauhtémoc, 06720 Ciudad de México, Mexico https://orcid.org/0009-0002-3573-3426
Raymundo T. Piña Servicio de Cirugía Plástica, Estética y Reconstructiva del Hospital General de México “Dr. Eduardo Liceaga”, Dr. Balmis 148, Doctores, Cuauhtémoc, 06720 Ciudad de México, Mexico
Elias A. E. Desentis Servicio de Cirugía Plástica, Estética y Reconstructiva del Hospital General de México “Dr. Eduardo Liceaga”, Dr. Balmis 148, Doctores, Cuauhtémoc, 06720 Ciudad de México, Mexico

DOI:

https://doi.org/10.18203/2320-6012.ijrms20262168

Keywords:

Phyllodes tumor, Breast reconstruction, Reconstructive surgery, Skin envelope, Volumetric assessment, Surgical algorithm

Abstract

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.

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