Prophylactic absorbable antibiotic beads: Effect on tissue expander reconstruction outcomes following mastectomy skin necrosis

Authors: Ahmed S, Zaidi SS, Fisher CS, Ludwig KK, Imeokparia FO, VonDerHaar RJ, Bamba R, Danforth RM, Hassanein AH, Lester ME. 

Affiliation: Div. of Plastic Surgery and Breast Surgery, Indiana University, Indianapolis, IN. 

Journal: Plastic and Reconstructive Surgery (Ideas & Innovations), 2025;156:642e–645e.

PMID: 40403293

Key takeaways

• In patients who developed mastectomy skin necrosis (MSN), prophylactic absorbable beads lowered 90-day surgical-site infection: 6.3% vs 35.6% (P=0.0178). 

• Tissue expander (TE) removal was reduced with beads: 6.3% vs 33.9% (P=0.0310). 

• Surgical management needed less often with beads: 50.0% vs 73.5% (P=0.1604). 

• Findings support placing absorbable antibiotic beads at TE insertion to mitigate infection/implant loss if MSN occurs. 

Background

MSN occurs in 7–30% of TE reconstructions and can harbor bacteria, driving infection and implant loss. Absorbable antibiotic beads have been described to reduce TE infection when used prophylactically following immediate breast reconstruction but the effect in the presence of skin necrosis is not clear.

Objective

Evaluate whether prophylactic absorbable calcium sulfate antibiotic beads reduce infection and implant loss among patients who later develop MSN after immediate prepectoral TE reconstruction. 

Methods

• Design/setting: Single-center cohort analysis of immediate prepectoral TE reconstructions that developed MSN.

• Groups:

  • Group 1: absorbable calcium sulfate antibiotic beads at time of TE placement

  • Group 2: no beads 

• Sample: 61 patients (75 breasts): beads 12 pts/16 breasts; no beads 49 pts/59 breasts. 

• Endpoints (90 days): Surgical-site infection (SSI), device removal, and surgical management of MSN

• Stats: Fisher’s exact test and independent-samples t tests 

Results

• Surgical-site infection:  6.3% (1/16 breasts) with beads vs 35.6% (21/59 breasts) without beads, P=0.0178. 

• TE loss:  6.3% (1/16 breasts) with beads vs 33.9% (20/59 breasts) without beads, P=0.0310. 

• Surgical management of MSN: 50.0% (6/12 breasts) with beads vs 73.5% (36/49 breasts) without beads, P=0.1604. 

Conclusion

Among TE patients who develop MSN, prophylactic absorbable antibiotic beads placed at initial reconstruction were associated with significantly fewer infections and TE loss. 

Strengths & limitations

• Focused MSN cohort answers a common, high-risk clinical scenario. 

• Clear, clinically meaningful endpoints (SSI, explantation) with absolute counts. 

• Retrospective, single-center design with small, imbalanced groups (16 vs 59 breasts) limits power and adjustment for confounders. 

Clinical relevance

Consider prophylactic absorbable antibiotic beads at time of TE insertion, especially when skin-flap perfusion is marginal, given the observed decrease in SSIs and explants among the subset that later develops MSN.