Reducing Infection in Drainless Tissue Expander-Based Breast Reconstruction With Local Antibiotic Delivery

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 cohort study of patients undergoing mastectomy and immediate prepectoral, drainless TE reconstruction between April 2024 and August 2025. At the time of TE reconstruction, patients either underwent placement of absorbable antibiotic beads (vancomycin/gentamicin: April 2024–August 2024; vancomycin/tobramycin: July 2024–October 2024) or nonabsorbable antibiotic plates (November 2024–August 2025: vancomycin/tobramycin). The primary outcome was clinical breast infection during the TE postoperative period. Results Ninety-three breasts from 52 patients were included (48 breasts with beads, 45 breasts with plates). The bead cohort had a significantly higher rate of clinical infection compared to the plate cohort (18.8% vs 2.2%, P = 0.016 ), with infection occurring at a mean of 93 days postoperatively. Subgroup analysis revealed that among the breast infections with beads, 3 occurred with the vancomycin and gentamicin combination and 6 occurred with the vancomycin and tobramycin combination (10.7% vs 30%, P = 0.137). 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, or analgesic needs after discharge. These findings suggest that antibiotic plates are a safe and effective strategy for infection prevention in TE-based breast reconstruction.