There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.
Abstract
PURPOSE: Immediate tissue expander placement remains the preferred method for breast
reconstruction after mastectomy. Placement of the prosthesis in the prepectoral rather
than submuscular plane is a relatively novel strategy to reduce post-operative pain
and potential for animation deformity with overall equivalent cosmetic outcomes. Prophylactic
post-operative antibiotic administration is a common practice for reducing reconstructive
infection, but raises concerns regarding indiscriminate and prolonged use of antibiotics.
Additionally, this has not been studied specifically in the setting of prepectoral
tissue expander placement. We sought to determine the impact of routine post-operative
antibiotics on complication rates in patients undergoing prepectoral tissue expander
placement.
METHODS: We retrospectively identified all patients undergoing immediate prepectoral
tissue expander placement following mastectomy by a single plastic surgeon from December
2015 to October 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, and used IBM SPSS Version 23.0 to compare rates
of post-operative complications. Our primary outcome was tissue expander loss, and
secondary outcomes were infection, skin necrosis, and return to operating room.
RESULTS: We identified 69 patients with 115 breasts who received prophylactic antibiotics
upon discharge from the hospital, and 63 patients with 106 breasts who did not. There
were no significant differences between the groups in terms of age, indications for
mastectomy, or comorbidities. The group receiving antibiotics had significantly more
patients who received neoadjuvant chemotherapy (42% vs. 28%; p=0.037) and underwent
nipple-sparing mastectomies (88% vs. 79%; p=0.031). The antibiotic group had significantly
lower rates of tissue expander loss, infection, and return to the OR. There was no
difference in skin necrosis rates.
CONCLUSION: No current guidelines exist to guide routine antibiotic use following
immediate breast reconstruction with prepectoral tissue expanders. These data show
a strong association between post-operative antibiotics and reduced post-operative
complication rates in women undergoing prepectoral tissue expander placement, despite
the antibiotic group having higher baseline risk for complications. As a result, our
current practice is to prescribe all patients undergoing immediate prepectoral tissue
expander placement a one-week course of antibiotics.
This is an open-access article distributed under the terms of the
Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited.
The work cannot be changed in any way or used commercially without permission from
the journal.