Antibiotic prophylaxis in prosthesis-based mammoplasty: a systematic review

Area of Science:

• Plastic Surgery
• Infectious Disease Prevention
• Evidence-Based Medicine

Background:

• Infection is a primary complication following prosthesis-based mammoplasty, despite its classification as aseptic surgery.
• Antibiotic prophylaxis is commonly used to prevent surgical site infection (SSI) and capsular contracture (CC), but high-quality evidence is limited.

Purpose of the Study:

• To evaluate the efficacy of antibiotic prophylaxis in reducing SSI and CC after prosthesis-based breast surgery.
• To analyze the impact of extended duration and topical antibiotic use on infection and complication rates.

Main Methods:

• A comprehensive literature search was performed across Medline, Embase, and CENTRAL databases up to June 2014.
• Included studies involved prosthesis-based breast surgery with a control group and antibiotic prophylaxis.
• Data were analyzed using meta-analysis or summarized qualitatively.

Main Results:

• Extended systemic antibiotic prophylaxis (>24h) significantly decreased infection risk (pooled RR=0.638) compared to shorter durations.
• Extended prophylaxis specifically reduced SSI risk in implant reconstruction (pooled RR=0.508) but not aesthetic surgery.
• Topical antibiotic irrigation reduced CC risk (pooled RR=0.472) but showed no significant effect on infection risk.

Conclusions:

• Extended systemic antibiotic prophylaxis is recommended to decrease SSI risk in breast implant surgery, especially for reconstruction.
• Topical antibiotic irrigation is effective in reducing capsular contracture risk.
• Patient-specific risk factors like diabetes and chest irradiation warrant consideration in prophylaxis strategies.