Routine Postoperative Antibiotics After Tissue Expander Placement Postmastectomy Does Not Improve Outcome

Abstract

Purpose In an attempt to reduce the incidence of infectious complications after tissue expander–based breast reconstruction, the routine administration of postoperative antibiotics regimen is common in many practices. In recent years, there has been a plethora of reports scrutinizing the prophylactic use of postoperative antibiotics in this setting. The aim of this study was to determine the efficacy of prolonged administration of postoperative antibiotics compared with perioperative-only antibiotic administration for prophylaxis after tissue expander placement for immediate mastectomy reconstruction. Methods and Materials A retrospective chart review of all patients who underwent immediate tissue expander placement after mastectomy at our institution from June 2005 to September 2018 was performed. All patients in the study received perioperative intravenous antibiotics 30 to 60 min preoperatively and for 24 hours postoperatively. Patients were divided into 2 groups. Patients in group A did not receive antibiotics beyond the perioperative period. Patients in group B received oral antibiotics for at least 7 days postoperatively in addition to the perioperative intravenous antibiotics. The 2 groups were compared for demographics and prevalence of risk factors such as radiation, chemotherapy, smoking, and diabetes. The incidence of complications such as infection, wound complications, hematoma, seroma, capsular contracture, loss of tissue expander, and reoperations was assessed. Summary of Results A total of 529 patients were included in the study, of which 241 were in group A and 288 were in group B. The total number of breasts reconstructed in group A was 398, whereas in group B, it was 466 breasts. Patients were followed up to 5 months postoperatively in each group. There were no statistically significant differences in the demographic and patient characteristics among the 2 groups. The incidence of infection in group A was 23.24% and in group B was 21.53% (P = 0.412). The incidence of other complications follows the same trend when comparing group A versus B. Conclusions This retrospective study shows that the routine use of postoperative antibiotics after tissue expander placement for immediate mastectomy reconstruction does not result in reduction in the incidence of common complications or improvement of clinical outcomes.

Postoperative antibiotics and infection rates after implant-based breast reconstruction: A systematic review and meta-analysis

“…The types of procedures in the McCullough et al ( 14 ) and Ranganathan et al ( 15 ) studies were all immediate breast reconstruction approaches. In addition to this, subjects in three studies involved expander placement, which was performed in both the anterior thoracic and submuscular planes ( 14 , 16 , 20 ). Moreover, five studies addressed the duration of antibiotic application after breast implant reconstruction, including >48 h and until drainage removal ( 16 – 20 ).…”

“…In addition to this, subjects in three studies involved expander placement, which was performed in both the anterior thoracic and submuscular planes ( 14 , 16 , 20 ). Moreover, five studies addressed the duration of antibiotic application after breast implant reconstruction, including >48 h and until drainage removal ( 16 – 20 ). For the specific application of antibiotics, four of the included studies noted the use of cephalosporin antibiotics for general patients and clindamycin or vancomycin for allergic patients ( 14 , 17 – 19 ).…”

“…In the following years after this milestone study, several physicians have tried a plethora of therapeutic approaches, without achieving universal guidelines and concordance. On the contrary, other studies demonstrated that postoperative antibiotics failed to reduce the incidence of infection ( 14 – 16 ), while Townley et al suggested that only preoperative antibiotics and postoperative antibiotics were equally effective on reducing the infection rates ( 17 ). Nevertheless, some cohort prospective studies have indicated that postoperative antibiotic use was effective in reducing the incidence of infection ( 18 – 21 ).…”

AGO Recommendations for the Surgical Therapy of Breast Cancer: Update 2022

“…Im Gegensatz dazu ließ sich ein entsprechender Vorteil durch eine Verlängerung der intravenösen Antibiose gegenüber einer Antibiose für 24 Stunden nicht zeigen (RR = 0,80, 95%-KI: 0,60 – 1,08, p = 0,13). Daher wird eine perioperative Antibiose lediglich für maximal 24 Stunden empfohlen (LoE 2a/B/+) 17 , 18 .…”

Postdischarge prophylactic antibiotics following mastectomy with and without breast reconstruction

“…11 Conversely, numerous studies demonstrated no effect of postdischarge antibiotics on SSI following mastectomy, although many of these studies lacked sufficient power to detect an association with only a moderate effect. [12][13][14][15][16][17][18][19][20][21] Exposure of patients to prolonged antibiotic regimens results in higher costs, selection of antibiotic-resistant organisms, and increased risk of Clostridioides difficile infection. [22][23][24][25][26] The importance of outpatient antibiotic stewardship is increasingly recognized because outpatient antibiotic prescriptions constitute the majority of antibiotic use.…”