Antibiotic Prophylaxis in Alloplastic Breast Reconstruction: Regimens and Outcomes

Area of Science:

• Plastic Surgery
• Infectious Disease
• Surgical Oncology

Background:

• Prosthesis-based breast reconstruction carries a risk of surgical site infections (SSI).
• Current Centers for Disease Control and Prevention (CDC) guidelines recommend 24 hours of postoperative antibiotics, but optimal duration remains debated.
• Various perioperative antimicrobial strategies are employed, necessitating clarity on efficacy.

Purpose of the Study:

• To compare the incidence of surgical site infections (SSI) in patients undergoing alloplastic breast reconstruction based on varying postoperative antibiotic durations.
• To evaluate the association between antibiotic regimen length and SSI development in breast reconstruction patients.

Main Methods:

• Retrospective cohort study including 507 consecutive patients undergoing expander/implant-based breast reconstruction (2009-2014).
• Data collected on patient demographics, risk factors, operative details, and antibiotic use (preoperative and postoperative duration).
• Surgical site infection (SSI) defined by CDC criteria; minimum follow-up of 1 year.

Main Results:

• Overall SSI incidence was 14%, with 8% requiring explantation.
• Patients receiving one week of postoperative antibiotics had a significantly higher SSI rate (80% of infected cases) compared to those with prolonged use (2-3 weeks; 20% of infected cases; P = .003).
• Prior radiation treatment was a significant risk factor for SSI (P = .02).

Conclusions:

• The overall infection rate and identified risk factors align with existing literature.
• A one-week postoperative antibiotic regimen was associated with a higher incidence of SSI compared to more prolonged regimens in prosthesis-based breast reconstruction.
• Findings suggest that longer antibiotic durations may be beneficial in reducing SSI in this patient population.