Prophylactic Antibiotic-Loaded Cement, Absorbable and Non-Absorbable, for Implant-Based Breast Reconstruction

Background Periprosthetic infection after postmastectomy breast reconstruction remain a significant issue and may result in explantation, with many patients choosing to forego reconstruction thereafter. Objectives Evaluate the use of absorbable and non-absorbable prophylactic antibiotic cement to reduce infection rates in implant-based breast reconstruction. Methods A multi-institutional, retrospective review was performed of patients who underwent tissue expander (TE) reconstruction with permanent or absorbable antibiotic-loaded cement. Patients received either 1) non-absorbable polymethylmethacrylate (PMMA) plates loaded with vancomycin and tobramycin or 2) absorbable calcium sulfate (CS) beads or discs loaded with gentamycin and vancomycin. Medical history, perioperative details, and complications were collected. Comparisons were made between those who received non-absorbable PMMA and those who received absorbable CS. Results A total of 295 TE reconstructions were performed on 189 patients. Ninety-three (31.5%) breasts received PMMA, and 202 (68.5%) received CS. Seven (2.4%) breasts had infections, with 1 (0.3%) occurring beyond 6 weeks post-operatively and 6 (2.0%) occurring within 6 weeks. Four infected breasts had previous debridement due to wound dehiscence or mastectomy flap necrosis, and 1 occurred within the setting of an infected drain site. One TE was lost from infection. Antibiotic-loaded, non-absorbable PMMA and absorbable CS had no significant differences in infection rates (4.3% vs 1.5%, respectively). Patients did not receive prophylactic oral antibiotics. Conclusions Antibiotic-loaded cement can be effective for infection prevention in implant-based reconstruction. Non-absorbable PMMA and absorbable CS for local antibiotic delivery resulted in similar safety profiles. Oral prophylactic antibiotics can be omitted safely with utilization of local antibiotic delivery.