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Breast Capsule Histology of Drainless, Infected Tissue Expanders With and Without Antibiotic Beads
Fiona R. Fragomen
1, Anna M. Vaeth
1, Alyssa Wan-Chei Lee
1 , Michael Stigliano
1, Paneed Jalili
1, Carson Gundlach
1, Annie McVeigh
1,
Baris Boyraz1 David Otterburn
1
1. Department of plastic surgery, Weil Cornell Medical, Woodside, NY, United States.
Background: The periprosthetic capsule influences implant-related complications, yet the impact of antibiotic beads in infected tissue expander (TE) reconstruction is unclear. This study evaluated whether bead use is associated with differences in capsule thickness, calcification, collagen organization, and lymphocytic infiltration.
Methods: A retrospective histologic analysis was performed on capsule specimens from infected drainless TE patients with and without antibiotic beads. Sections were stained with hematoxylin and eosin and analyzed using a validated semiquantitative tool. Capsule thickness (µm) was measured excluding synovial-like metaplasia and stromal layers. Fiber organization and lymphocytic infiltration were graded on 3-point scales, and calcification was recorded as present/absent. The assessor was blinded. Wilcoxon rank-sum and Fisher's exact tests were used.
Results: Capsule thickness was lower in the bead group (n=25, mean 0.312 mm, median 0.2 mm) versus the no-bead (n=13, mean 1.008 mm, median 0.6 mm; p=0.0023). Calcification was present in 58.3% of bead specimens and absent in all no-bead specimens (p=0.00035). No differences were observed in collagen organization (p=0.787) or lymphocytic infiltration (p=0.686).
Conclusion: Antibiotic beads appear safe in infected TE reconstruction, with no increase in inflammation or disorganized fibrosis and an association with thinner capsules. Increased calcification did not reflect greater inflammatory burden. These findings support the use of beads in expander salvage and suggest a favorable effect on fibrotic remodeling.
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