Nipple-Sparing Mastectomy: Are We Providing Proper Prophylactic Antibiotic Coverage?

Area of Science:

• Oncology
• Plastic Surgery
• Infectious Disease

Background:

• Nipple-sparing mastectomy with implant-based reconstruction (NSM-IBR) carries a risk of devastating surgical site infections (SSIs).
• The retained nipple may harbor organisms, potentially necessitating broader antibiotic coverage than currently recommended.
• Understanding SSI bacteriology is crucial for optimizing prophylaxis in NSM-IBR.

Purpose of the Study:

• To evaluate the relationship between antibiotic choice and SSI outcomes in patients undergoing NSM with IBR.
• To identify the microbial species responsible for SSIs in this patient population.
• To determine if more aggressive antibiotic regimens improve SSI rates or reconstruction success.

Main Methods:

• Prospective review of a database of patients who underwent NSM with IBR between 2010 and 2019.
• Analysis of patient characteristics, operative details, and antibiotic regimens (pre- and postoperative).
• Evaluation of SSI incidence, timing, causative organisms, and impact on reconstruction, including prosthesis removal.

Main Results:

• A total of 571 NSMs with IBR were analyzed in 347 patients.
• Surgical site infections (SSIs) occurred in 12% of reconstructions, with 6% requiring prosthesis removal.
• Staphylococcal species were the most common SSI pathogens; neither pre- nor postoperative antibiotic choice correlated with SSI incidence, type, or prosthesis explantation.

Conclusions:

• More aggressive antibiotic choices do not improve SSI rates in nipple-sparing mastectomy with implant-based reconstruction.
• Patient-specific factors and treatment variables are the predominant risk factors for SSIs after NSM-IBR.
• Current antibiotic prophylaxis strategies may not require significant alteration based on SSI bacteriology in this setting.