Use of Absorbable Antibiotic Delivery Beads in Implant-Based Breast Reconstruction.

Abstract

Bacterial infection remains a leading complication following implant-based breast reconstruction. Conventional prevention strategies have shown limited success. Drug delivery beads, widely used in orthopedic surgery for prophylaxis and localized infection control, may offer a similar benefit in breast reconstruction. This study evaluates their effectiveness in reducing infections and reconstructive loss. A retrospective cohort study was performed of patients undergoing implant-based breast reconstruction with tissue expanders at a single institution. All reconstructions used an acellular dermal matrix in conjunction with the implant. The experimental group received absorbable calcium sulfate beads containing vancomycin and gentamicin within the pocket before tissue expander/device placement. The control group underwent reconstruction without beads. Both cohorts received standardized perioperative and post-operative antibiotics. A total of 415 patients (709 breasts) were included: 206 patients (353 breasts) received antibiotic beads, and 209 patients (356 breasts) served as controls. The infection rate was significantly lower with beads (9.3%) compared with controls (21.4%) (p < 0.0001). Total reconstructive loss was also reduced (4.0% vs. 18.0%, p < 0.0001), including loss due to infection (2.3% vs. 14.0%, p < 0.0001). Prophylactic absorbable antibiotic beads significantly decreased infection and reconstructive loss in implant-based breast reconstruction. By providing localized, sustained antibiotic delivery through a fully resorbable carrier, this technique represents an effective adjunct to standard prophylaxis that may improve reconstructive outcomes and patient safety.