Prophylactic Absorbable Antibiotic Beads: Effect on Postoperative Drain Management Following Breast Reconstruction

Infection is common in postmastectomy tissue expander (TE) reconstruction with reported rates up to 24%.1–3 TE/implant infection is associated with significant patient morbidity from urgent, unplanned reoperations, which may ultimately lead to reconstructive abandonment.2,3 Absorbable calcium sulfate–coated antibiotic beads may reduce TE infection rates when delivered at the time of immediate postmastectomy prepectoral breast reconstruction.2,3 Literature on the use of absorbable antibiotic beads in orthopedic procedures indicates an increase in serous drainage as calcium sulfate absorbs and increased seroma when used for pressure ulcers.4–6 It is unknown if the use of absorbable antibiotic beads in immediate breast reconstruction with TE results in prolonged drain use as the calcium sulfate beads absorb. The purpose of this study is to evaluate the effect of prophylactic absorbable antibiotic beads on postoperative drain management following immediate postmastectomy TE reconstruction to guide patient counseling and surgical decision-making. A single-center retrospective review was performed for patients who underwent mastectomy with immediate prepectoral TE reconstruction (2019–2024). Patients were divided into 2 groups: group 1 (absorbable antibiotic beads) and group 2 (no antibiotic beads). Demographic information was recorded. The average time to postoperative drain removal was the variable of interest. Absorbable antibiotic-impregnated calcium sulfate beads (STIMULAN, Biocomposites, Ltd., UK) were prophylactically placed in the breast pocket during postmastectomy TE reconstruction.2,3 Antibiotic beads are formed into 3–6 mm spherical molds with 1 g of vancomycin and 240 mg gentamicin.2,3 The beads are placed in the pocket, and 1 drain is placed in each breast at the time of TE reconstruction. Drains were removed when output was less than 30 mL/d for 2 consecutive days. The study included 325 patients (548 TEs) who underwent immediate prepectoral TE breast reconstruction following mastectomy and had postoperative drain removal (2019–2024) (Table 1). Group 1 had 36 patients (68 TEs) who underwent mastectomy and immediate TE reconstruction with the placement of antibiotic beads. Group 2 (control) had 289 patients (480 TEs) who had a mastectomy and immediate TE reconstruction, and did not receive antibiotic beads. Baseline characteristics were not significantly different between groups (P = 0.8447). There was no difference between nipple-sparing mastectomy and skin-sparing mastectomy between groups (P = 0.1107). Acellular dermal matrix/mesh was used in 72.2% (26 of 36) of group 1 compared with 78.2% (226 of 289) of group 2 (P = 0.4033). The average time to drain removal was 17.2 ± 5.6 days in group 1 compared with 17.5 ± 7.5 days in group 2 (P = 0.7933). The mean follow-up time was 255 days (range 128–375 d). Table 1. - Baseline Characteristics and Outcomes of Interest Variables Group 1: Antibiotic Beads (n = 36, 68 TEs) Group 2: Control (n = 289, 480 TEs) P Average age, y 50.0 ± 10.9 48.3 ± 10.8 0.3702 Body mass index, kg/m2 29.9 ± 7.2 28.8 ± 6.7 0.3514 Diabetes mellitus, n (%) 4 (11) 22 (7.6) 0.5098 Active smoker, n (%) 4 (11) 23 (7.9) 0.52 Neoadjuvant chemotherapy, n (%) 9 (25) 79 (27.3) 0.8447 Adjuvant chemotherapy, n (%) 11 (30.5) 80 (27.7) 0.6978 Adjuvant radiation, n (%) 6 (16.7) 84 (29.1) 0.1655 Prior radiation, n (%) 4 (11.1) 10 (3.5) 0.0566 Nipple-sparing mastectomy, n (%) 15 (41.7) 163 (56.4) 0.1107 Skin-sparing mastectomy, n (%) 21 (58.3) 126 (43.6) 0.1107 Acellular dermal matrix or mesh, n (%) 26 (72.2) 226 (78.2) 0.4033 Drain removal time, d 17.2 ± 5.6 17.5 ± 7.5 0.7933 Although some studies have associated antibiotic beads with increased serous fluid potential in orthopedic and pressure ulcer management, our findings indicate that drain duration is not prolonged in TE reconstruction. Despite the limitations of our retrospective design, the mean drain duration was 17.5 days in both groups. Calcium sulfate beads may elute antibiotics for up to 40 days with a zone of inhibition that may begin to taper as early as day 26.7 Patients can be counseled that the use of prophylactic absorbable antibiotic beads does not lengthen drain time. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.