Antibiotic Prophylaxis After Immediate Breast Reconstruction: The Reality of its Efficacy

Purpose: Numerous techniques are used to prevent infection after immediate implant-based breast reconstruction. Postoperative antibiotic prophylaxis (PAP) is commonly prescribed to decrease the risk of reconstructive failure, despite conflicting evidence regarding its effectiveness. We sought to determine whether PAP decreases the risk of infection-related explantation in the setting of immediate prosthesis-based breast reconstruction. Methods: Using Truven MarketScan databases, we identified all patients who underwent immediate implant reconstruction between 1/2010-6/2014 with at least 6 months of follow-up. PAP was defined as any oral antibiotic course to be taken postoperatively based on prescriptions filled within 14 days prior to surgery through 24 hours post-discharge. Reconstructive failure defined as explantation due to infection was the primary outcome. Secondary outcomes of interest included wound complications, infection, and readmission for infection. Multivariable regression analyses controlled for demographic variables/comorbidities. Results: Of the 7,443 patients, 6,049 (81%) filled prescriptions for PAP. These patients were equally likely to develop a wound complication (OR=0.93 95%CI:0.71-1.23), infection (OR=0.89 95%CI:0.70-1.14), undergo explantation due to infection (OR=0.82 95%CI: 0.57-1.18), or require readmission for infection (OR=1.21 95%CI:0.82-1.78) compared to those who did not receive PAP. There was no significant difference in the risk of infection-related outcomes based on PAP duration. Conclusion: PAP was not associated with a reduced risk of infection or explantation following prosthesis-based breast reconstruction. Given rising rates of antibiotic resistance, focusing instead on technical considerations and the management of comorbid conditions may more effectively enhance the safety of breast reconstruction. Disclosure: This research was supported by a Mentored Clinical Investigator Award to Dr. Waljee through the Agency for Healthcare Research and Quality (1K08HS023313-01). Research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number 2K24-AR053120-06 (Dr. Kevin Chung). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This work was funded by the Chang Gung Memorial Hospital (project CORPG3G0111 and CORPG3G0161). This work was presented at the annual Plastic Surgery Research Council in 2017. Corresponding Author: Jennifer F. Waljee MD, MPH, MS, Michigan Medicine, Section of Plastic Surgery,, 2130 Taubman Center, SPC 5340, Ann Arbor, MI, 48109-5340, filip@med.umich.edu, Phone 734-998-6022, Fax 734-798-6696 ©2017American Society of Plastic Surgeons