Are Prophylactic Postoperative Antibiotics Necessary for Immediate Breast Reconstruction? Results of a Prospective Randomized Clinical Trial

Phillips, Brett T.; Fourman, Mitchell S.; Bishawi, Muath; Zegers, Mary; O’Hea, Brian; Ganz, Jason C.; Huston, Tara L.; Dagum, Alexander B.; Khan, Sami U.; Bui, Duc T.

doi:10.1016/j.jamcollsurg.2016.02.018

Cited by 74 publications

(71 citation statements)

References 38 publications

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“…After all, most complications occurred in the Meso BioMatrix® group, despite the difference in drain- and antibiotic prophylaxis regime, which can be considered an advantage for the Meso BioMatrix® group. Considering that prolonged drain use can be associated with postoperative infection and although 24 h of prophylactic postoperative antibiotics seems equivalent to extended oral antibiotics for infections of TE-based breast reconstruction, it is not certain if this is also the case in SSBR with AMs [2, 38]. Nevertheless, despite of the limitations in the study, it does establish a strong suggestion.…”

Section: Discussionmentioning

confidence: 81%

Is single-stage implant-based breast reconstruction (SSBR) with an acellular matrix safe?

et al. 2018

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BackgroundAcellular matrices (AM) might enable a direct single-stage breast reconstruction procedure resulting in an improved efficacy of the reconstruction phase for patients. Safety concerns are an important issue due to a recent study which shows that single-stage breast reconstruction with Strattice™ resulted in more complications versus a two-stage reconstruction. Therefore, the goal of this study is to compare the short- and long-term complications of a single-stage breast reconstruction with the use of two types of AM (Strattice™ and Meso Biomatrix®) versus two-stage breast reconstruction without the use of an AM.MethodsCohort study with single-stage breast reconstruction with Strattice™ (n = 28) or Meso BioMatrix® (n = 20) or two-stage breast reconstruction without an AM (n = 36) at the Maastricht Academic Hospital, the Netherlands. All complications, in particular major complications with the need for re-admission to the hospital, re-exploration, and implant explantation, were the primary outcome measures. A 1-year follow-up was achieved for all patients.ResultsBaseline characteristics of all 52 patients were similar between groups. There was a significantly higher complication rate in the single-stage AM groups with loss of the implant in 40.0% of the breasts from the Meso BioMatrix® group and in 10.7% of the Strattice™ group compared to no implant loss in the control group.ConclusionsThis cohort study clearly suggests that the use of a single-stage breast reconstruction is not safe with the use of these AMs. Well-designed prospective studies that guarantee the safety of those matrices should be published before these AMs are used in implant-based surgery.Level of Evidence: Level III, risk / prognostic study.

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Section: Discussionmentioning

confidence: 81%

Is single-stage implant-based breast reconstruction (SSBR) with an acellular matrix safe?

et al. 2018

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“…Infections following breast reconstruction are a challenging reality for all plastic surgeons. While a large array of studies have attempted to assess etiologies, fewer have analyzed ways in which infection rates can be reduced, and fewer still have demonstrated actionable and successful conclusions . In fact, to our knowledge, only one prospective study has assessed TE infection rates by postoperative antibiotic length .…”

Section: Discussionmentioning

confidence: 99%

“…While a large array of studies have attempted to assess etiologies, fewer have analyzed ways in which infection rates can be reduced, and fewer still have demonstrated actionable and successful conclusions . In fact, to our knowledge, only one prospective study has assessed TE infection rates by postoperative antibiotic length . Additionally, plastic surgeons have low clinical symptom thresholds for prescribing TE patients additional antibiotics, likely due to the fact that the literature does not clearly demonstrate which patients actually require antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Classification of breast tissue expander infections: Back to the basics

Kraenzlin

Saunders

Aliu

et al. 2019

Journal of Surgical Oncology

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Background Infections following tissue expander (TE) placement are frequent complications in breast reconstruction. While breast surgery is a clean case, implant‐based breast reconstruction has rates of infection up to 31%, decidedly higher than the typical 1% to 2% rate of surgical site infections (SSI). Few authors use the Center for Disease Control's (CDC) SSI definition for TE infections. We highlight how adoption of a consistent definition of TE infection may change how infections are researched, categorized, and ultimately managed. Methods Two researchers with definitional discrepancies of infection performed an independent analysis of all postmastectomy patients receiving TEs (n = 175) in 2017. Results Researcher One, using a clinical definition, delineated an infection rate of 19.4%. Antibiotics alone successfully treated 50% of cases. Researcher Two found an infection rate of 13.7% using CDC criteria. These infections were further delineated by a SSI rate of 6.3% and a TE infection rate post port access of 7.4%. Only 45.5% SSI's and 15.4% of TE infections were salvaged with antibiotics alone. Conclusions Rigorous adoption of CDC criteria for infection characterization in published research will help standardize the definition of infection and allow surgeons to create evidence‐based infection prevention regimens.

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“…Evidence regarding the optimal duration of antibiotics for infection prevention is also lacking. A recent single-centre RCT of two-stage IBBR with ADM compared infection rates in patients receiving 24 h of antibiotic treatment vs. continuing antibiotics until the surgical drains were removed [25]. This non-inferiority study which included 112 patients, demonstrated no significant difference in infection rates between the treatment groups (19.4% vs 22.0%).…”

Section: Discussionmentioning

confidence: 99%

Adherence to best practice consensus guidelines for implant-based breast reconstruction: Results from the iBRA national practice questionnaire survey

Blazeby

Branford

Conroy

et al. 2018

European Journal of Surgical Oncology

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IntroductionThe 2008 National Mastectomy and Breast Reconstruction Audit demonstrated marked variation in the practice and outcomes of breast reconstruction in the UK. To standardise practice and improve outcomes for patients, the British professional associations developed best-practice guidelines with specific guidance for newer mesh-assisted implant-based techniques. We explored the degree of uptake of best-practice guidelines within units performing implant-based reconstruction (IBBR) as the first phase of the implant Breast Reconstruction Evaluation (iBRA) study.MethodsA questionnaire developed by the iBRA Steering Group was completed by trainee and consultant leads at breast and plastic surgical units across the UK. Simple summary statistics were calculated for each survey item to assess compliance with current best-practice guidelines.Results81 units from 79 NHS Trusts completed the questionnaire. Marked variation was observed in adherence to guidelines, especially those relating to clinical governance and infection prevention strategies. Less than half (n = 28, 47%) of units obtained local clinical governance board approval prior to offering new mesh-based techniques and prospective audit of the clinical, cosmetic and patient-reported outcomes of surgery was infrequent. Most units screened for methicillin-resistant staphylococcus aureus prior to surgery but fewer than 1 in 3 screened for methicillin-sensitive strains. Laminar-flow theatres (recommended for IBBR) were not widely-available with less than 1 in 5 units having regular access. Peri-operative antibiotics were widely-used, but the type and duration were highly-variable.ConclusionsThe iBRA national practice questionnaire has demonstrated variation in reported practice and adherence to IBBR guidelines. High-quality evidence is urgently required to inform best practice.

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Are Prophylactic Postoperative Antibiotics Necessary for Immediate Breast Reconstruction? Results of a Prospective Randomized Clinical Trial

Cited by 74 publications

References 38 publications

Is single-stage implant-based breast reconstruction (SSBR) with an acellular matrix safe?

Is single-stage implant-based breast reconstruction (SSBR) with an acellular matrix safe?

Classification of breast tissue expander infections: Back to the basics

Adherence to best practice consensus guidelines for implant-based breast reconstruction: Results from the iBRA national practice questionnaire survey

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