Absorbable antibiotic bead prophylaxis for implant-based breast reconstruction

Periprosthetic infection is a serious complication in implant-based breast reconstruction (IBR). Local antibiotic delivery using biodegradable beads is a potential strategy to reduce infection risk. This study describes a single institution's preliminary experience with absorbable antibiotic beads for preventing infection in IBR.

A retrospective cohort study was performed of patients who underwent IBR between January 2021 and October 2023. Patients who met high-risk criteria for infection (BMI >30 kg/m², prior smoking history, diabetes, and history of radiation) received antibiotic-infused beads along with the standard of care. Outcomes included periprosthetic infection, infection requiring re-operation, and wound-healing complications. Multivariate logistic regression was performed to control for known risk factors for infection.

Two-hundred eighty-seven patients were included, with 27 (9.4%) receiving antibiotic beads and 260 (90.6%) receiving standard of care alone. No significant difference was observed in infection requiring re-operation between the antibiotic bead group compared to controls (11.1% vs. 16.5%, p=0.46), and no difference in explantation rate (7.4% vs. 10.8%, p=0.59). After controlling for confounders, BMI was significantly associated with increased odds of infection (OR 1.1 CI 1.04 - 1.14, p=.001). In patients who underwent salvage procedures for infection with the application of antibiotics beads (n=15), the overall salvage success rate was 86.7% (n=13).

These data suggest that prophylactic antibiotic beads may reduce infections in high risk patients undergoing IBR. In addition, antibiotic beads may be particularly useful in the case of implant salvage for infection. Additional prospective studies are currently ongoing, and are needed to elucidate safety and efficacy.