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

Extended prophylactic antibiotic (EPA) regimens are commonly used following implant- or tissue expander-based breast reconstruction, although their efficacy in preventing infection-related complications remains unclear. The authors of this systematic review and meta-analysis evaluated whether EPA use (>48 h postoperatively) reduces surgical site infections, explantation, or reoperation events compared with short-course antibiotic regimens (≤48 h). A comprehensive search of 4 databases was conducted through May 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Sixteen studies were included, comprising 8173 patients in the EPA group and 2676 in the non-EPA group. Outcomes assessed included overall, minor, and major infections, as well as explantation and reoperation rates. Risk ratios (RRs) with 95% CIs were calculated, and study quality was evaluated using the Downs and Black checklist. No statistically significant differences were found between groups for overall infection (RR 0.90, 95% CI, 0.75-1.06), 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). These findings suggest that EPA does not confer additional clinical benefit in reducing postoperative complications following implant-based breast reconstruction. In light of the known risks associated with prolonged antibiotic use-including gastrointestinal disturbances, Clostridium difficile infection, and antibiotic resistance-these results support more judicious, evidence-based prescribing practices. The authors of this study provide updated evidence to inform antibiotic stewardship efforts and standardize care in breast reconstruction. Level of Evidence: 3 (Risk).