Absorbable Antibiotic Beads Prophylaxis in Immediate Breast Reconstruction

Background: Breast reconstruction with tissue expander is the most common mode of reconstruction following mastectomy. Infection necessitating tissue expander removal is a significant complication leading to patient distress as well as increased health care costs. Methods: Over 3 years, 127 breast reconstructions with tissue expanders were performed by a single surgeon. Fifty-nine of these reconstructions were performed using a standardized protocol in which patients washed with chlorhexidine several days prior to surgery and received intravenous antibiotics preoperatively. Intraoperatively, the submuscular pocket was irrigated with triple antibiotic solution and the skin was re-prepped with povidone iodine prior to expander placement. This group was referred to as the preintervention group. Sixty-eight of the reconstructions were performed using the standardized protocol with the addition of biodegradable antibiotic beads (Stimulan ® with vancomycin and gentamicin) in the submuscular pocket. This group made up the post intervention group. The primary outcome was the rate of infection necessitating tissue expander removal. Results: Tissue expander loss due to infection was 11.9% in preintervention group and 1.5% in the post intervention group, (p=0.024). Higher body mass index was associated with a statistically significant increase in infections necessitating implant removal. Conclusions: The use of absorbable antibiotic beads in the submuscular pocket reduced the risk of periprosthetic implant infection necessitating implant removal by 8-fold. Financial Disclosure Statement: The authors have the following to disclose: Nothing Presented at (if applicable): Robert Ivy Plastic Surgery Meeting, Philadelphia, PA on April 22 2017 Absorbable Antibiotic Beads Prophylaxis in Immediate Breast Reconstruction Corresponding Author: Kenna M. Denise M.D F.A.C.S , 2350 Freedom Way Ste 107, York, PA. USA. e-mail address: dmkenna@comcast.net ©2017American Society of Plastic Surgeons