American Association of Plastic Surgeons

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Are Prophylactic Post-operative Antibiotics Indicated For Implant-based Breast Reconstruction?: A Randomized-controlled Pilot Study
Laura Barnes, MD, Nisha Parmeshwar, MD, Jacquelyn Knox, MD, Aileen Gozali, BS, Catherine Lu Dugan, BS, Anne Patterson, BS, Merisa Piper, MD
University of California, San Francisco, San Francisco, CA, USA

PURPOSE:Implant infections are a significant cause of morbidity after mastectomy with tissue expander placement. Many plastic surgeons opt to give post-operative prophylactic antibiotics to these patients, however there is inconclusive data regarding whether this practice leads to reduced infection rates.
We designed a two-armed randomized-controlled trial in patients undergoing mastectomy with immediate tissue expander reconstruction. Patients were randomized to either receive 24 hours of peri-operative antibiotics only, or an additional 7 days of post-operative antibiotics as well. Patients were followed for clinical signs of infection for at least ninety days, and infection rates and treatments were compared between groups.
Fifty-nine patients have been enrolled in this study. Thirty patients (52 breasts) were randomized to receive 24 hours of antibiotics, while 28 patients (46 breasts) were randomized to receive seven days of antibiotics. Results between groups for infections rates and treatments are displayed in Table 1.
Within our small pilot study, we found no significant differences in infection rates between groups of patients who received 24 hours compared to seven days of prophylactic antibiotics. A longer course of antibiotics was not noted to be protective against infection, thus we should re-evaluate the purpose of prolonged prophylactic antibiotic courses. At this time, we are continuing to enroll patients in this study to further add power to these results.

Table 1: Results comparing infection data between groups
OutcomeCohort A (7 days)28 patients, 46 breastsCohort B (24 hours)30 patients, 52 breastsp-value
Any infection13 breasts (28.2%)9 breasts (17.3%)0.230
Infection requiring IV antibiotics8 breasts (17.4%)6 breasts (11.5%)0.565
Infection requiring explant6 breasts (13.0%)4 breasts (7.7%)0.508
Mean time to tissue expander removal75 +/-66 days68 +/-55 days

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