Prophylactic Local Antibiotics for Tissue Expansion (PLATE) Improve Breast Reconstruction Outcomes

Robert Craig Clark; Priscila Cevallos; Benyamin Dadpey; Andrea Yessaillian; Elizabeth Turner; Augustine Kang; Brian Thornton; Rahim Nazerali; Chris M Reid

doi:10.1097/PRS.0000000000011832

Prophylactic Local Antibiotics for Tissue Expansion (PLATE) Improve Breast Reconstruction Outcomes

Plast Reconstr Surg. 2024 Oct 18. doi: 10.1097/PRS.0000000000011832. Online ahead of print.

Authors

Robert Craig Clark¹, Priscila Cevallos², Benyamin Dadpey¹, Andrea Yessaillian¹, Elizabeth Turner², Augustine Kang², Brian Thornton³, Rahim Nazerali², Chris M Reid¹

Affiliations

¹ Division of Plastic Surgery, UC San Diego Health, San Diego, CA.
² Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA.
³ Thornton Plastic Surgery, Louisville, KY.

PMID: 39451154
DOI: 10.1097/PRS.0000000000011832

Abstract

Introduction: Infection following tissue expander (TE) breast reconstruction is frequent and impactful. Preliminary reports demonstrate value of local antibiotic delivery for implant salvage and prophylactic potential. Herein is a multi-institutional retrospective study employing surgeon-crafted tobramycin-vancomycin PMMA plates (PLATE) during TE implantation for infection prophylaxis. The authors hypothesized the intervention would be associated with fewer infections compared to historical practice.

Methods: In 2021, surgeons at three institutions began independently offering PLATE for primary TE breast reconstructions. After independent IRB approvals, data were retrospectively collected for PLATE subjects and pre-intervention cohorts of equivalent sizes. Subjects were followed for seven months, or to second stage removal. The primary outcome, complication requiring readmission/reoperation, was compared between aggregated cohorts. Analysis included logistic modeling and Kaplan-Meyer survival.

Results: The aggregate sample included 183 intervention subjects (292 breasts) and 183 controls (301 breasts), each with 5+/-2-month follow-up. Overall, complications were significantly less frequent with PLATE (13.1% vs 21.9%, p<0.01*). This was driven by significantly fewer infections (4.8% vs 12.6%, p<0.01*) with no difference in rates of tissue necrosis, seroma, or other complications (p>0.05). In multivariable regression, the intervention was associated with significantly reduced odds of any complication (OR=0.53, 95%CI: [0.3-0.93]) and infection (OR=0.22, 95%CI: [0.08-0.50]). Kaplan-Meyer curves demonstrated significant longitudinal reduction in complication and infection (p<0.01*) without notable rebound throughout dissipation of the antibiotic eluent.

Conclusion: Prophylactic employment of intraoperatively-crafted PLATE during TE implantation was associated with significant infection reduction without increase in local or systemic complications. This reproducible tool may be highly valuable in alloplastic breast reconstruction.