Prophylactic Antibiotic-Loaded Cement, Absorbable and Nonabsorbable, for Implant-Based Breast Reconstruction

Periprosthetic infection after postmastectomy breast reconstruction remains a significant issue and may result in explantation, with many patients choosing to forego reconstruction thereafter.

The aim was to evaluate the effectiveness of absorbable and nonabsorbable prophylactic antibiotic cement in reducing infection rates in implant-based breast reconstruction.

A multi-institutional, retrospective review was performed of patients who underwent tissue expander (TE) reconstruction with permanent or absorbable antibiotic-loaded cement. Patients received either (1) nonabsorbable polymethylmethacrylate (PMMA) plates loaded with vancomycin and tobramycin or (2) absorbable calcium sulfate (CS) beads or discs loaded with gentamycin and vancomycin. Medical history, perioperative details, and complications were collected. Comparisons were made between those who received nonabsorbable PMMA and those who received absorbable CS.

A total of 295 TE reconstructions was performed on 189 patients. Ninety-three (31.5%) breasts received PMMA, and 202 (68.5%) received CS. Seven (2.4%) breasts had infections, with 1 (0.3%) occurring beyond 6 weeks postoperatively and 6 (2.0%) occurring within 6 weeks. Four infected breasts had previous debridement due to wound dehiscence or mastectomy flap necrosis, and 1 occurred within the setting of an infected drain site. One TE was lost from infection. Antibiotic-loaded, nonabsorbable PMMA and absorbable CS had no significant differences in infection rates (4.3% vs 1.5%, respectively). Patients did not receive prophylactic oral antibiotics.

Antibiotic-loaded cement can be effective for infection prevention in implant-based reconstruction. Nonabsorbable PMMA and absorbable CS for local antibiotic delivery resulted in similar safety profiles. Oral prophylactic antibiotics can be omitted safely with utilization of local antibiotic delivery.

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