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Extended Antibiotic Prophylaxis in Implant-Based Breast Reconstruction: A Systematic Review and Meta-Analysis.

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    Extended prophylactic antibiotic use after breast reconstruction does not reduce infection or reoperation rates. This finding supports shorter antibiotic durations to mitigate risks like C. difficile infection and antibiotic resistance.

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    Area of Science:

    • Plastic Surgery
    • Infectious Diseases
    • Surgical Oncology

    Background:

    • Extended prophylactic antibiotic (EPA) regimens are frequently used post-implant or tissue expander (TE)-based breast reconstruction.
    • The clinical benefit of EPA in preventing infection-related complications remains uncertain.

    Purpose of the Study:

    • To evaluate the efficacy of EPA (>48 hours) versus short-course antibiotic regimens (≤48 hours) in reducing surgical site infections (SSIs), explantation, and reoperation after breast reconstruction.
    • To provide evidence for antibiotic stewardship in breast reconstruction practices.

    Main Methods:

    • Systematic review and meta-analysis adhering to PRISMA guidelines.
    • Searched four databases through May 2025.
    • Included 16 studies (8,173 patients in EPA group, 2,676 in non-EPA group).
    • Assessed outcomes including overall, minor, and major infections, explantation, and reoperation rates.
    • Calculated risk ratios (RR) with 95% confidence intervals (CI) and evaluated study quality using the Downs and Black checklist.

    Main Results:

    • No statistically significant differences were found between EPA and short-course regimens for overall infection (RR 0.90, 95% CI: 0.75-1.06).
    • No significant differences observed for minor infection (RR 0.62, 95% CI: 0.28-1.33), major infection (RR 0.83, 95% CI: 0.50-1.38), explantation (RR 0.77, 95% CI: 0.46-1.30), or reoperation (RR 1.17, 95% CI: 0.78-1.78).

    Conclusions:

    • Extended prophylactic antibiotics do not offer additional clinical benefit in reducing postoperative complications following implant-based breast reconstruction.
    • Findings support judicious, evidence-based prescribing to avoid risks of prolonged antibiotic use, such as gastrointestinal issues and antibiotic resistance.
    • Results aid in standardizing care and promoting antibiotic stewardship in breast reconstruction.