Antibiotic Prophylaxis in Prepectoral Alloplastic Breast Reconstruction: Establishing Standards

Postoperative antibiotic prophylaxis after expander/implant-based breast reconstruction is an important consideration, but existing literature is largely focused on subpectoral reconstruction. With the prevailing paradigm shift towards prepectoral reconstruction, there is concern for greater infection risk given less vascularized tissue coverage of the expander/implant when compared to partial or total submuscular approaches, along with adjunct use of acellular dermal matrix. We investigate the optimal duration of postoperative antibiotic prophylaxis specifically for prepectoral expander/implant breast reconstruction with the use of ADM.

This is a retrospective cohort investigation of women undergoing immediate prepectoral tissue expander/implant placement following mastectomy at a high-volume breast reconstruction center, between 2015 and 2025.

In total, 748 women met inclusion criteria. Of these, 344 (46%) received 24 hours of prophylactic antibiotics and 404 (54%) received extended antibiotic prophylaxis up to 72 hours. Following propensity score matching, 222 patients were included in each cohort and study cohorts differed only in terms of race and ethnicity. There were no significant differences in 30-day surgical site infection rates (odds ratio 1.13, 95% confidence interval 0.43 - 2.98, p = 0.8) and 90-day infection rates (odds ratio 1.67, 95% confidence interval 0.85-3.28, p=0.14) between matched cohorts. Similarly, there were no significant differences between cohorts in the rate of successful salvage of infected breasts with antibiotics alone versus surgical washout (odds radio: 0.8, 95% confidence interval 0.2-3.8, p=1).

Extending antibiotic prophylaxis beyond 24 hours does not confer protective advantage against infection amongst patients undergoing prepectoral expander/implant-based breast reconstruction.