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Updated: Aug 12, 2025
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Oral Antibiotics Do Not Prevent Infection or Implant Loss after Immediate Prosthetic Breast Reconstruction
Mark Sisco1, Kristine Kuchta2, Duanny Alva3
1From the Department of Surgery, Division of Plastic Surgery.
Background:
Infectious complications following implant-based postmastectomy breast reconstruction (PMBR) are a significant cause of morbidity. Nationwide, antimicrobial stewardship efforts have sought to reduce the use of prophylactic antibiotics postoperatively. However, there are conflicting data regarding the utility of extended antibiotic prophylaxis (EAP) after PMBR, and many surgeons continue to prescribe them.
Methods:
The authors conducted a retrospective study of 1077 women who underwent immediate prosthetic PMBR from January of 2008 to May of 2020. All patients received intravenous antibiotics preoperatively and up to 24 hours postoperatively. Before October of 2016, patients were also prescribed oral antibiotics until drain removal; thereafter, this practice was abandoned. Ninety-day outcomes were compared between EAP-positive and EAP-negative patients. Descriptive statistics and multivariable logistic regression analysis were used to assess the efficacy of EAP in preventing infection-related complications.
Results:
There were 1004 breasts in the EAP-positive group and 683 in the EAP-negative group. Three hundred sixty-one reconstructions (21.4%) were prepectoral. Multivariable analysis demonstrated no difference in surgical-site infection (OR, 0.83; 95% CI, 0.56 to 1.25; P = 0.38), admission (OR, 0.78; 95% CI, 0.41 to 1.48; P = 0.44), reoperation (OR, 1.01; 95% CI, 0.68 to 1.48; P = 0.97), or explantation rates (OR, 1.06; 95% CI, 0.66 to 1.71; P = 0.81) between the EAP groups. The EAP-positive group was more likely to develop Gram-negative infections ( P < 0.001). Thirteen EAP-positive women (2.0%) developed allergic reactions, and four (0.6%) developed Clostridium difficile colitis attributable to the EAP.
Conclusions:
EAP after PMBR did not improve outcomes. Although use of EAP did not appear to worsen clinical outcomes, marked differences in the microbiology of associated infections may render them more difficult to treat. Moreover, a small but significant proportion of women experienced adverse reactions to the EAP.
Clinical Question/Level Of Evidence:
Therapeutic, III.
Insights
Extended antibiotic prophylaxis (EAP) after implant-based postmastectomy breast reconstruction (PMBR) does not improve outcomes and may increase Gram-negative infections. EAP also led to adverse reactions in some patients.
Area of Science:
- Plastic Surgery
- Infectious Disease
- Surgical Oncology
Background:
- Infectious complications are a major cause of morbidity after implant-based postmastectomy breast reconstruction (PMBR).
- Antimicrobial stewardship initiatives aim to reduce postoperative antibiotic use.
- Conflicting data exist on the necessity of extended antibiotic prophylaxis (EAP) following PMBR.
Purpose of the Study:
- To evaluate the efficacy of extended antibiotic prophylaxis (EAP) in preventing infectious complications after implant-based postmastectomy breast reconstruction (PMBR).
Main Methods:
- Retrospective study of 1077 women undergoing prosthetic PMBR from 2008 to 2020.
- Comparison of 90-day outcomes between patients receiving EAP and those not receiving EAP.
- Multivariable logistic regression analysis to assess EAP's impact on infection-related complications.
Main Results:
- No significant differences in surgical-site infection, admission, reoperation, or explantation rates were observed between EAP groups.
- The EAP group had a higher incidence of Gram-negative infections (P < 0.001).
- Adverse reactions, including allergic reactions and Clostridium difficile colitis, occurred in a small percentage of EAP patients.
Conclusions:
- Extended antibiotic prophylaxis (EAP) following PMBR does not enhance clinical outcomes.
- While not worsening overall outcomes, EAP may alter infection microbiology, potentially complicating treatment.
- EAP is associated with a small but significant rate of adverse patient reactions.
