American Association of Plastic Surgeons

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The Impact of Post-Operative Prophylactic Antibiotics in Immediate 2-Stage Prepectoral Breast Reconstruction
Michael Holland, M.D., Jami Rothman, M.D., Rachel Lentz, M.D., Clara Gomez-Sanchez, M.D., Rita Mukhtar, M.D., Jasmine Wong, M.D., Michael Alvarado, M.D., Laura Esserman, M.D., M.B.A., Cheryl Ewing, M.D., William Hoffman, M.D., Hani Sbitany, M.D..
University of California, San Francisco, San Francisco, CA, USA.

Immediate tissue expander placement remains a preferred method for breast reconstruction after mastectomy. The use of prophylactic post-operative antibiotic administration is thought to reduce rates of surgical site infection and reconstructive failure, but has not been studied in patients undergoing reconstruction in the prepectoral plane.
We retrospectively identified all patients undergoing immediate prepectoral tissue expander placement following mastectomy by a single plastic surgeon (H.S.) from 2015 to 2018. We identified two cohorts of patients - one group that received prophylactic antibiotics at the time of discharge, and one group that did not. We collected treatment and outcomes data to compare rates of post-operative complications between groups.
We identified 69 patients with 115 breasts who received discharge antibiotics, and 63 patients with 106 breasts who did not. There were no significant differences in terms of age or comorbidities, although the group receiving antibiotics had significantly more patients receiving neoadjuvant chemotherapy (42% vs. 28%; p=0.037) and nipple-sparing mastectomies (88% vs. 79%; p=0.031). The antibiotic group had significantly lower rates of tissue expander loss, infection, and return to operating room (Table 1).
The use of prophylactic post-operative antibiotics in prepectoral breast reconstruction is associated with significantly lower rates of post-operative complications. As a result, our current practice is to prescribe all patients undergoing immediate prepectoral tissue expander placement a one-week course of antibiotics.

Association of antibiotic use with post-operative outcomes
OutcomeNo Antibiotics (N = 106)%Antibiotics (N = 115)%OR (95%CI)P
Unplanned return to OR2624.53%1210.43%0.36 (0.17-0.75)0.006
TE Exposure65.66%00.00%NC0.010
TE Loss1816.98%54.35%0.22 (0.08-0.62)0.002
Skin Necrosis98.49%32.61%0.29 (0.08-1.09)0.054
Wound Breakdown109.43%54.35%0.44 (0.14-1.32)0.133
Any Infection2624.53%86.96%0.23 (0.10-0.54)<0.001
Infection Requiring IV Antibiotics1312.26%43.48%0.26 (0.08-0.82)0.014
Infection Requiring Reoperation1110.38%21.74%0.15 (0.03-0.71)0.006
Recurrent Infection76.60%00.00%NC0.005

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