Addition of antibiotic-impregnated bone cement discs for reduction of periprosthetic infection in implant-based breast reconstruction.

Abstract

Periprosthetic infection is a frequent complication of implant-based breast reconstruction, often resulting in implant removal, additional surgery, and increased costs. This study evaluated whether polymethyl methacrylate (PMMA) discs impregnated with vancomycin and tobramycin, placed at tissue expander insertion, reduce infection rates in breast reconstruction. A retrospective cohort analysis was conducted of 91 patients who underwent two-stage pre-pectoral tissue expander reconstruction performed by a single surgeon between October 2021 and November 2024. Sixty-seven patients received antibiotic-impregnated discs positioned beneath the tissue expander, and 24 patients underwent tissue expander placement alone. Baseline demographic characteristics, comorbidities, and operative variables were comparable between the groups. All patients successfully underwent expansion with similar median fill volumes and times to exchange. Infection requiring removal of the tissue expander occurred in 2 of 113 breasts reconstructions in the group receiving antibiotic discs compared with 4 of 42 in the group without discs. Other postoperative complications, including seroma, hematoma, and mastectomy flap necrosis were infrequent and did not differ significantly between the groups. No complications were attributable to the placement of antibiotic discs. Overall rate of expander removal was numerically lower in patients who received discs (6.2% vs. 11.9%) but did not reach statistical significance (p = 0.17). However, the rate of explantation specifically due to infection was significantly lower in the disc cohort (1.8% vs. 9.5%, p = 0.03). These results suggest that prophylactic placement of antibiotic-impregnated PMMA discs at the time of tissue expander reconstruction may reduce implant-associated infection without increasing morbidity.