Prophylactic absorbable antibiotic-loaded cement and oral antibiotics for breast reconstruction: A multi-institutional study.

Implant infection is common in breast reconstruction. Infection rates up to 10- 24% following reconstruction using tissue expanders (TEs) have been reported. Prophylactic absorbable antibiotic calcium sulfate (CS) cement is known to decrease infection in TE reconstruction. Oral antibiotics are not proven to prevent TE infection. However, it is unknown if oral antibiotics when used concurrently with absorbable antibiotic cement may be synergistic. The purpose of this study was to compare TE reconstruction outcomes using antibiotic-loaded CS with and without postoperative oral antibiotics. A multi-institutional retrospective study of patients who underwent mastectomy, immediate prepectoral TE reconstruction, and placement of absorbable antibiotic-loaded CS cement at two academic centers was performed (2019-2025). Patients were divided into two groups: Group 1 (TE, antibiotic CS, and no postoperative oral antibiotics) and Group 2 (TE, antibiotic CS, and 2 weeks of postoperative oral antibiotics). Both groups received perioperative intravenous antibiotics. Surgical-site infection and TE loss were the variables of interest. The study included 253 patients (402 total breasts) who underwent prepectoral TE reconstruction and received absorbable antibiotic CS. There were 178 patients in Group 1 (273 breasts) and 75 patients (129 breasts) in Group 2. Surgical-site infection occurred in 1.1% of Group 1 compared to 2.3% of Group 2 (p=0.3907). TE removal was performed in 2.2% of Group 1 compared to 6.2% in Group 2 (p=0.0752). Oral antibiotics do not have a synergistic effect when combined with antibiotic eluting absorbable cement. These data further support the recommendations to omit postoperative antibiotics with TE reconstruction.