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Antimicrobial Advancements: Absorbable Antibiotic Beads Compared to Non-Absorbable Antibiotic Plates in Implant-Based Breast Reconstruction
Anna M. Vaeth
*, Annie McVeigh, Hao Huang, Nancy Qin, Makayla Kochheiser, Lucy Wei, David Otterburn
Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY
Background: Breast infection during tissue expander (TE)-based breast reconstruction remains a significant clinical challenge. This study evaluates the effectiveness of absorbable antibiotic beads compared to nonabsorbable antibiotic plates in preventing infection in TE-based breast reconstruction.
Methods: This was a single-surgeon retrospective review of patients undergoing mastectomy and immediate prepectoral, drainless TE reconstruction between October 2023 and March 2025. At the time of TE reconstruction, patients either underwent placement of absorbable antibiotic beads (vancomycin/gentamicin: October 2023-August 2024; vancomycin/tobramycin: July 2024-October 2024) or nonabsorbable antibiotic plates (November 2024-March 2025: vancomycin/tobramycin). Primary outcomes of interest were culture-positive infection and infection necessitating TE removal.
Results: 104 breasts from 57 patients were included (74 breasts with beads, 30 breasts with plates). The bead cohort had a significantly higher rate of culture-positive infection (16.2% vs 0%,
p=0.017), with infection occurring at, on average, 75 days postoperatively. The plate cohort had an average follow-up of 84 days (±34.8), with all patients having a minimum of 42 days follow-up. Subgroup analysis of the bead cohort revealed no differences in infection rate between gentamicin and tobramycin use (12% vs 26%,
p=0.17). After adjusting for demographic and clinically relevant covariates, plate use was associated with a 90% reduction in the odds of infection (OR = 0.10, 95% CI: 0.005-1.94), though it did not reach statistical significance (
p=0.13). There were no differences between cohorts in seroma rates, postoperative pain scores, or additional analgesic requirements after discharge.
Conclusions: Nonabsorbable antibiotic plates were associated with reduced infection rates without compromising postoperative comfort, drainage, and analgesic needs after discharge. These findings suggest that antibiotic plates are safe and effective for infection prevention in TE-based breast reconstruction.
Table 1: Demographics between breasts with antibiotic beads and antibiotic plates. Pain at discharge scored from 0 to10. Data are presented as mean (standard deviation) for continuous measures and n (%) for categorical measures. BMI = Body mass index; ADM = Acellular dermal matrix; TE = Tissue expander.
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