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Prophylactic Local Antibiotic Therapy in Tissue Expander-Based Breast Reconstruction: A Systematic Review and
Hussain Salim1, Syeda Muzna Gillani2, Muhammad Talha Qureshi3
1Dow University of Health Sciences, Karachi, Pakistan.
Background:
Tissue Expander-based Breast Reconstruction (TEBR) is a common and effective post-mastectomy procedure, but surgical site infections (SSIs) and reconstruction failure remain major complications. While prophylactic local antibiotic therapy for tissue expansion (PLATE) may reduce these complications, standardized guidelines are lacking, and evidence is limited.
Methods:
A systematic search of PubMed, Cochrane Library, Embase, and Scopus was conducted from inception to June 2025 for studies evaluating PLATE in TEBR. Eligible studies included randomized controlled trials and observational studies reporting surgical site infections and expander loss. Data extraction and risk of bias assessment were performed independently using Newcastle-Ottawa Scale and Cochrane Risk of Bias tool. Meta-analyses were performed using random-effects models, with heterogeneity assessed via I2 statistics.
Results:
Eleven studies comprising 2,570 participants were included. PLATE was associated with a lower risk of overall infections (RR: 0.54, 95% CI: 0.38-0.77; p = 0.0006, I2: 26%) and expander loss (RR: 0.46; 95% CI: 0.31-0.67, p < 0.0001, I2: 0%) compared to control. Secondary analyses showed potential reductions in capsular contracture, infections requiring surgery, and drain infections but no significant differences in wound dehiscence, hematoma, seroma, or necrosis. Subgroup analyses suggested antibiotic delivery method may influence overall infection rates (p = 0.01), but not expander loss (p = 0.20). Smoking and radiotherapy prevalence were not definitive effect modifiers.
Conclusion:
PLATE may be associated with reduced rates of SSIs and expander loss in TEBR and could serve as a potential adjunct to systemic antibiotics. However, given the predominance of retrospective studies and underlying clinical heterogeneity, these findings should be interpreted as hypothesis generating, rather than definitive evidence. Larger, prospective trials particularly among high-risk populations are needed to confirm long-term safety, cost-effectiveness, and optimal delivery methods.
Level Of Evidence Iii:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
