Prophylactic Absorbable Antibiotic Beads for High-risk, Implant-based Prepectoral Reconstruction

Abstract

Summary: Infections are problematic in postmastectomy implant-based reconstruction with infection rates as high as 30%. Strategies to reduce the risk of infection have demonstrated various efficacies. A prolonged course of systemic, oral antibiotics has not shown evidence-based benefit. Although absorbable antibiotic beads have been described for orthopedic procedures and pressure wounds, their use has not been well studied during breast reconstruction, particularly for prepectoral implant placement. The purpose of this study was to evaluate the selective use of prophylactic absorbable calcium sulfate antibiotic beads during high-risk implant-based, prepectoral breast reconstruction after mastectomy. Patients who underwent implant-based, prepectoral breast reconstruction between 2019 and 2022 were reviewed. Groups were divided into those who received antibiotic beads and those who did not. Outcome variables included postoperative infection at 90 days. A total of 148 patients (256 implants) were included: 15 patients (31 implants) who received biodegradable antibiotic beads and 133 patients (225 implants) in the control group. Patients who received antibiotic beads were more likely to have a history of infection (66.7%) compared with the control group (0%) (P < 0.01). Surgical site infection occurred in 3.2% of implants in the antibiotic bead group compared with 7.6%, but this did not reach statistical significance. The incidence of infection in high-risk patients who have absorbable antibiotic beads placed during the time of reconstruction seems to be normalized to the control group in this pilot study. We present a novel use of prophylactic absorbable antibiotic beads in prepectoral breast implant reconstruction.

Effect of prolonged antibiotic prophylaxis on the occurrence of surgical site wound infection after instant breast reconstruction: A meta‐analysis

“…Following an assessment of 675 relevant papers, 18 papers that were released between 2009 and 2023 were included in the meta‐analysis since they matched the inclusion criteria 11,12,24–39 . Table 2 summarises the findings of these investigations.…”

“…Following an assessment of 675 relevant papers, 18 papers that were released between 2009 and 2023 were included in the meta‐analysis since they matched the inclusion criteria. 11 , 12 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 Table 2 summarises the findings of these investigations. A total of 19 301 females with instant breast reconstruction were the used studies' starting point, 12 235 of them utilised systemic antibiotic prophylaxis, 489 of them utilised topical systemic antibiotic prophylaxis and 6577 of them utilised standard of care.…”

“…The sample size was 37–7398 people. 11 , 12 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 The examined data revealed that systemic antibiotic prophylaxis had a significantly lower surgical site wound infection rate compared with the standard of care after instant breast reconstruction in females. Topical antibiotic prophylaxis had a significantly lower surgical site wound infection rate compared with the standard of care after instant breast reconstruction in females.…”

“…The sample size was 37-7398 people. 11,12,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] The examined data revealed that systemic antibiotic prophylaxis had a T A B L E 1 Database search strategy for inclusion of examinations.…”

“…For the current meta‐analysis, 18 exams from 2009 to 2023 were included; of these, 19 301 females with instant breast reconstruction were in the used studies' starting point; 12 235 of them utilised systemic antibiotic prophylaxis; 489 of them utilised topical systemic antibiotic prophylaxis; and 6577 of them utilised standard of care. The sample size was 37–7398 people 11,12,24–39 . The examined data revealed that systemic antibiotic prophylaxis had a significantly lower surgical site wound infection rate compared with the standard of care after instant breast reconstruction in females.…”