Prophylactic Absorbable Antibiotic Beads: Effect on Tissue Expander Reconstruction Outcomes following Mastectomy Skin...

Mastectomy skin necrosis (MSN) is problematic in tissue expander (TE) reconstruction. Partial- or full-thickness skin necrosis may harbor bacterial colonization, promoting infection and implant loss. Absorbable antibiotic beads have been described to reduce TE and implant infection when used prophylactically for prepectoral breast reconstruction. The purpose of this study was to evaluate the effect of absorbable antibiotic beads on outcomes in patients who develop MSN after immediate TE reconstruction.

Patients who underwent mastectomy with immediate prepectoral TE reconstruction who developed MSN were included. Patients were divided into 2 groups: group 1 received absorbable calcium sulfate antibiotic beads, and group 2 did not (no antibiotic beads). Surgical-site infection (at 90 days) and device removal were outcome variables. The study included 61 patients (75 total breasts) who underwent prepectoral TE reconstruction and developed MSN. The were 12 patients in group 1 (16 breasts) and 49 patients in group 2 (59 breasts).

Surgical management of MSN (débridement and reclosure) was required in 50% (6 of 12 patients) of group 1 compared with 73.5% (36 of 49 patients) of group 2 ( P = 0.1604). There was 1 occurrence (6.3%, 1 of 16 TEs) of surgical-site infection in group 1 and 21 cases (35.6%, 21 of 59 TEs) in group 2 ( P = 0.0178). TE removal was required in 6.3% of breasts (1 of 16 TEs) in group 1 and 33.9% of breasts (20 of 59 TEs) in group 2 ( p = 0.0310).

Patients who develop MSN are at high risk for infection and TE loss. Prophylactic absorbable antibiotic beads placed at the time of TE reconstruction decrease the risk of infection and TE loss in those who develop MSN.