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

Shahnur Ahmed; Shozaf Zaidi; Carla S Fisher; Kandice K Ludwig; Folasade O Imeokparia; R Jason VonDerHaar; Ravinder Bamba; Rachel M Danforth; Aladdin H Hassanein; Mary E Lester

doi:10.1097/PRS.0000000000012220

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

Plast Reconstr Surg. 2025 May 20. doi: 10.1097/PRS.0000000000012220. Online ahead of print.

Affiliations

¹ Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN.
² Division of Breast Surgery, Indiana University School of Medicine, Indianapolis, IN.

PMID: 40403293
DOI: 10.1097/PRS.0000000000012220

Abstract

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/implant infection when used prophylactically for prepectoral breast reconstruction. The purpose of this study is 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 two groups: Group 1 (absorbable calcium sulfate antibiotic beads) and Group 2 (no antibiotic beads). Surgical-site infection (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 (debridement and reclosure) was required in 50% (6/12) of Group 1 compared to 73.5% (36/49) of Group 2 patients (p=0.1604). There was one occurrence (6.3%, 1/16 TEs) of surgical-site infection in Group 1 and 35.6% (21/59 TEs) in Group 2 (p=0.0178). TE removal was required in 6.3% (1/16 TEs) in Group 1 and 33.9% (20/59 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 that develop MSN.

Keywords: breast; calcium sulfate; infection; mastectomy skin necrosis; prepectoral reconstruction; prophylactic absorbable antibiotic beads; tissue expander.