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Breast Reconstruction Trends in the Setting of Postmastectomy Radiotherapy: An Evaluation of the National Cancer Data Base from 2004-2013
Shantanu N. Razdan, MD, MSPH1, Peter G. Cordeiro, MD1, Claudia R. Albornoz, MD1, Babak J. Mehrara, MD1, Joseph J. Disa, MD1, Robert J. Allen, Jr., MD1, Joseph H. Dayan, MD1, Colleen M. McCarthy, MD1, Andrea L. Pusic, MD1, Adeyiza O. Momoh, MD2, Alice Y. Ho, MD1, Evan Matros, MD, MPH1.
1Memorial Sloan Kettering Cancer Center, New York, NY, USA, 2University of Michigan Health System, Ann Arbor, MI, USA.

Implant-based breast reconstruction is a well-established method for breast reconstruction. Although generally a safe procedure, there is a risk of infection. When an infection arises in the implant-pocket, it is often necessary for the patient to return to the operating room where the choices are to remove the implant and place the patient on antibiotics, or salvage the implant and give intravenous antibiotics. Recently, there has been a rise in the use of antibiotic-impregnated beads for the treatment of surgical site infections. These beads, made of biodegradable materials and loaded with antibiotics, are placed inside a surgical site prior to closure. The idea comes from the use of such beads in orthopedic joint salvage. As the beads break down, they release antibiotics locally over an extended period of time, thus allowing for implant salvage and eliminating the morbidity of systemic IV antibiotics. The goal of this study is to present a case series illustrating how the use of antibiotic beads prevents the need for IV antibiotics administered via a PICC line and, more importantly, increases the likelihood of implant salvage and infection recurrence.
A single-center, retrospective analysis of all patients who underwent implant-based breast reconstruction at Mount Sinai Hospital was performed. All patients who developed an implant infection and then underwent capsulectomy with implant exchange and STIMULAN beads impregnated with antibiotics were included. Patient demographics, medical history, operative complications, and surgical outcomes were reviewed.
Ten patients were identified at Mount Sinai Hospital who fit the criteria. Eight patients had prior diagnoses of cancer in the affected breast. Comorbidities included hypertension, smoking, and immunocompromised status. Infections were noted anywhere from 5 days to 3 months post initial implant surgery. The surgical team was able to successfully salvage seven out of the ten infected implants through the use of antibiotic bead therapy without the continued use of IV antibiotics.
The use of antibiotic beads is promising for salvaging infected breast implants and reducing the need for IV antibiotics. The study team was able to salvage 70% of the implants. Of the three patients who had unsalvageable implants, one was infected with antibiotic resistant rhodococcus that was refractory to bead therapy and one was noncompliant with post-operative instructions. Overall, antibiotic beads allowed the surgical team to salvage the majority of implants without the need for PICC lines and associated morbidity.

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