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A Propensity-Matched Analysis of Tissue Expander Morbidity Following Absorbable Antibiotic-Molded Disk Placement in the Prepectoral Plane
Timothy C. Olsen
*, Aamirah Mccutchen, Margaret M. Hornick, Amy MiHyun Jang, Ayaka N. Deguchi, Robyn B. Broach, Joseph Serletti, Sean Li
Division of Plastic Surgery, University of Pennsylvania, Philadelphia , PA
Background: Local antibiotic delivery systems are increasingly used in implant-based breast reconstruction to reduce periprosthetic infection. Of these, absorbable antibiotic-cements are being increasingly adopted for the tissue expander (TE) placement stage. While studies have investigated infection-related outcomes, antibiotic cement-related complications remains poorly understood.
Methods: A single-institution retrospective cohort study evaluated women who underwent immediate prepectoral TE reconstruction (January 2021-January 2025) with versus without prophylactic absorbable antibiotic-molded disks. Disks comprised calcium sulfate paste mixed with vancomycin and tobramycin, placed posterior to the TE. Breasts were propensity score matched 3:1 on age, BMI, and indication for surgery. Unadjusted and adjusted analyses assessed antibiotic cement-related wound complications, drain outcomes, and healthcare utilization.
Results: The matched cohort included 140 breasts (Disk, n=35; No Disk, n=105). Disk use was associated with higher rates of mastectomy skin flap necrosis (MSFN) (62.9% vs 5.7%; aOR 18.5; 95% CI, 5.7-60.1) and seroma (71.4% vs 22.9%; aOR 7.7; 3.0-19.5), as well as higher TE loss and reoperations (both p<0.001). Infection was not significantly different (25.7% vs 14.3%; p=0.120). Time-to-final drain removal did not differ (log-rank p=0.067).
Conclusion: Prophylactic placement of absorbable antibiotic disks behind the TE correlates with substantially higher rates of MSFN, seroma, TE loss, and reoperation without a detectable reduction in infection. These findings support careful and cautious consideration of wound morbidity risks associated with absorbable antibiotic disk constructs in prepectoral TE reconstruction. Future prospective studies are needed to further evaluate antibiotic disk-related outcomes.
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
Back to 2026 Abstracts
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
