Preoperative β-lactam antibiotic prophylaxis is superior to bacteriostatic alternatives in immediate expander-based breast reconstruction

Abstract

Background: Staged implant-based breast reconstruction is the most common reconstructive modality following mastectomy. Postoperative implant infections can have a significant impact on adjuvant oncologic care and reconstructive outcome. Here, we investigate the impact of β-lactam antibiotics (i.e., bactericidal) compared to alternative antibiotic agents on postoperative outcomes for implant-based breast reconstruction. Methods: A retrospective analysis of patients who underwent immediate sub-pectoral tissue expander placement with an inferior acellular dermal matrix (ADM) sling at a single institution between May 2008 and July 2018 was performed. Patient demographics, comorbidities, and complication rates were retrieved. The impact of antibiotic regimen on postoperative outcomes, including infection rate and reconstructive failure, was investigated. Results: A total of 320 patients with a mean age and BMI of 48.2 years and 25.0 kg/m2, respectively, who underwent 542 immediate breast reconstructions were included in the study. The use of a β-lactam antibiotic was protective against postoperative infection (odds ratio [OR] = 0.467, p =.046), infection requiring operative management (OR = 0.313, p =.022), and reconstructive failure (OR = 0.365, p =.028). Extended, that is, post-discharge, prophylaxis was not associated with any clinical benefit. Conclusion: The use of β-lactam antibiotics for pre-/peri-operative prophylaxis is superior to alternative antibiotics with a bacteriostatic mechanism of action regarding rates of postoperative infection and reconstructive failure following immediate tissue expander-based breast reconstruction. Extended, that is, post-discharge, prophylaxis does not appear to be indicated, regardless of the antibiotic chosen.