Use of antibiotic-impregnated discs in breast reconstruction among the obese population: A retrospective propensity score-matched analysis

Abstract

Two-stage breast reconstruction is a well-established post-mastectomy surgical technique. Unfortunately, periprosthetic infections in tissue expanders remain a prevalent concern. Antibiotic-impregnated polymethylmethacrylate (PMMA) plates for infection prophylaxis in TE–based reconstruction have been shown to lower infection rates. With the growing obesity epidemic in the US, this propensity-score matched retrospective study aimed to evaluate the impact of PMMA plates on the obese population. A retrospective chart review was performed for patients with a BMI of 30 and above to record patient demographics, complications, operative details, and post-operative details. One-to-one propensity score matching was used to match the intervention and control group on age, diabetes status, smoking status, neoadjuvant chemotherapy, prior radiation history, and laterality of breast reconstruction, resulting in 48 patients in each group. Chi-squared analysis, and Barnard exact tests assessed significant differences between groups and infection rates. T-tests compared the normally distributed continuous variables. Logistic regression controlled for confounders that have been reported in previously published literature. Chi-square analysis revealed a significant association between PMMA plate usage and infection rate (4.2% compared to 16.7%; p = 0.045). Logistic regression analysis found that the PMMA antibiotic plate group had a statistically significant decrease in infection rate (OR: 0.18 [0.033–0.962]; p = 0.045). Though antibiotic-impregnated PMMA plates have demonstrated effective infection prophylaxis in the general population, this study is the first to explore their use in the obese population. Within our cohort, placing an antibiotic plate resulted in a reduced infection rate.