Oral antibiotics and antibiotic pocket irrigation are common measures against tissue expander (TE) infection, yet the evidence reviewed in one session on implant salvage did not support either as a standalone preventive measure.
Dr. Al Hassanein is associate professor and James Bennett Scholar in the Division of Plastic Surgery at Indiana University School of Medicine. He presented ‘Keepin’ it local: absorbable antibiotic beads in breast reconstruction’ at Plastic Surgery The Meeting 2026, organized and hosted by the American Society of Plastic Surgeons (ASPS). The meeting was held October 15 to 18, 2026, in Houston, Texas. His talk was part of the panel ‘(Almost) 28 years later: current strategies in salvaging the infected implant.’ He examined whether local antibiotic delivery can improve infection rates in TE reconstruction.
Risk of TE infection is linked to thin or compromised skin, foreign material, drains, and mastectomy skin necrosis. Because the evidence he discussed did not support routine oral antibiotics or antibiotic pocket irrigation as standalone measures, his team delivers antibiotics directly into the pocket.
How Antibiotic Beads Perform in Tissue Expander Reconstruction
The absorbable beads are placed in the pocket at the time of reconstruction. Dr. Hassanein noted that bead use in prepectoral reconstruction is off-label, and he showed a patient's result 5 months after surgery. Placement in the prepectoral pocket can be difficult, and beads may cause palpability or pressure when skin is thin.
In his team's reported institutional results, prophylactic beads were associated with lower rates of infection and TE loss, including among patients who developed mastectomy skin necrosis after prepectoral TE reconstruction. Drain duration was similar with and without beads. Their unpublished work also found no gain from pairing beads with oral antibiotics. ‘The infection risk was essentially the same,’ he said. ‘So we don't use oral antibiotics; we just use antibiotic beads.’
Are Antibiotic Beads Cost-Effective, and Can They Reduce Capsule Biofilm?
Cost analysis showed prophylactic beads to be cost-effective for immediate TE reconstruction but not for TE-to-implant exchange.
His team is now studying capsules. ‘We're studying capsules during second stage reconstruction, studying the capsules anteriorly and posteriorly,’ Dr. Hassanein said. The goal is to learn whether beads reduce bacterial biofilm and whether any effect depends on capsule site. In theory, a lower biofilm burden could reduce the risk of capsular contracture and, if biofilm proves to be involved, breast implant illness. ‘We don't have good data on this yet,’ he said.
For now, his approach centers on local delivery at the first stage of reconstruction, where both the infection outcomes and the cost analysis he presented supported bead use.
Abbreviation: TE, tissue expander.