Local Antibiotic Delivery Systems for Infection Prophylaxis in Implant-Based Breast Reconstruction: What Is the Evidence?

Abstract

Infection is a major complication of implant-based breast reconstruction (IBBR), leading to implant loss, increased healthcare costs, and poor outcomes. Local antibiotic delivery systems offer targeted infection prevention by providing sustained antibiotic release at the surgical site. The aim of this study is to review the existing literature on the efficacy of local antibiotic delivery systems in preventing infection in IBBR. A systematic review following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was conducted in Medline, Cochrane, and Embase (1990-2025). Studies assessing local antibiotic delivery in IBBR were included, while those evaluating systemic antibiotics, augmentation, and salvage procedures were excluded. Data on infection rates, implant loss, and complications were extracted and analyzed. Of 163 identified articles, 6 met inclusion criteria. Two studies examined calcium sulfate biodegradable antibiotic beads, which significantly lower implant loss rates (1.6% vs 9.4%, P = 0.031 and 1.5% vs 11.9%, P = 0.024). Two studies on polymethylmethacrylate antibiotic plates showed significant SSI reduction from 12.6% to 4.8% ( P < 0.01) and from 14% to 4% ( P = 0.047), with implant loss rates significantly lower in polymethylmethacrylate cohort (6% vs 18%, P = 0.036). Continuous postoperative antibiotic irrigation studies demonstrated SSI reduction from 6.4% to 1.9% ( P = 0.007) and decreased explant rate from 20% to 2.9% ( P = 0.037), but one study reported a higher seroma rate (4.7% vs 1.4%, P = 0.033). Preliminary studies suggest local antibiotic delivery may reduce infection and implant loss in breast reconstruction, but retrospective designs and methodological limitations preclude definitive conclusions. Prospective studies are needed to confirm efficacy, safety, and clinical value.