Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Effect of Perioperative Prophylactic Intravenous Antibiotic Use in Immediate Implant-Based Breast Reconstruction: A Retrospective Matched Cohort Study

  • Seok Kyung In (Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Seok Won Park (Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Yujin Myung (Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • Received : 2023.01.09
  • Accepted : 2023.08.26
  • Published : 2024.01.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background Among breast reconstruction methods, implant-based breast reconstruction has become the mainstream. However, periprosthetic infection is still an unresolved problem. Although published articles have revealed that limited use of antibiotics is sufficient to reduce infection rates, the number of surgeons still preferring elongated usage of antibiotics is not less. The aim of our study is to validate the appropriate duration of antibiotic use to reduce infection rate after implant-based breast reconstruction. Methods A retrospective study reviewed medical record of 235 patients (274 implants for reconstruction) who underwent prepectoral direct to implant breast reconstruction using acellular dermal matrix wrapping technique. Infection rates were analyzed for the patients administered postoperative prophylactic antibiotics until drain removal and those who received only perioperative prophylactic antibiotics for 24 hours. Results Of the 274 implants, 98 who were administered prophylactic antibiotics until drain removal had an infection rate of 3.06% (three implants) and 176 who received prophylactic antibiotics no longer than 24 hours postoperatively had an infection rate of 4.49% (eight implants). A total of 11 patients diagnosed with postoperative infection clinically, 8 were salvaged by antibiotic treatment, and 3 had implant removal and replacement with autologous flap. Postoperative antibiotic prophylaxis duration had no statistically significant effects in the risk of infection (p = 0.549). Conclusion The duration of prophylactic antibiotics after surgery was not related to infection risk. Further study with a large number of patients, randomized control study, and route of antibiotics is needed.

Keywords

Acknowledgement

We would like to thank Editage (www.editage.co.kr) for English language editing.

References

  1. Frey JD, Salibian AA, Karp NS, Choi M. Implant-based breast reconstruction: hot topics, controversies, and new directions. Plast Reconstr Surg 2019;143(02):404e-416e
  2. American Society of Plastics Surgeons. 2014 plastic surgery statistics report. Accessed September 1, 2022 at: https://www. plasticsurgery.org/documents/News/Statistics/2014/plastic-surgery-statistics-full-report-2014.pdf.
  3. Kim JW, Lee JH, Kim TG, Kim YH, Chung KJ. Breast reconstruction statistics in Korea from the big data hub of the health insurance review and assessment service. Arch Plast Surg 2018;45(05):441-448
  4. Sbitany H, Piper M, Lentz R. Prepectoral breast reconstruction: a safe alternative to submuscular prosthetic reconstruction following nipple-sparing mastectomy. Plast Reconstr Surg 2017;140(03):432-443
  5. Schmitz M, Bertram M, Kneser U, Keller AK, Horch RE. Experimental total wrapping of breast implants with acellular dermal matrix: a preventive tool against capsular contracture in breast surgery? J Plast Reconstr Aesthet Surg 2013;66(10):1382-1389
  6. Song JH, Kim YS, Jung BK, et al. Salvage of infected breast implants. Arch Plast Surg 2017;44(06):516-522
  7. Spear SL, Howard MA, Boehmler JH, Ducic I, Low M, Abbruzzesse MR. The infected or exposed breast implant: management and treatment strategies. Plast Reconstr Surg 2004;113(06):1634-1644
  8. Azouz V, Mirhaidari S, Wagner DS. Defining infection in breast reconstruction: a literature review. Ann Plast Surg 2018;80(05):587-591
  9. Mladick RA. Significance of Staphylococcus epidermidis causing subclinical infection. Plast Reconstr Surg 2005;115(05):1426--1427, author reply 1427-1428
  10. Phillips BT, Bishawi M, Dagum AB, Khan SU, Bui DT. A systematic review of antibiotic use and infection in breast reconstruction: what is the evidence? Plast Reconstr Surg 2013;131(01):1-13
  11. Maisel Lotan A, Ben Yehuda D, Allweis TM, Scheflan M. Comparative study of meshed and nonmeshed acellular dermal matrix in immediate breast reconstruction. Plast Reconstr Surg 2019;144(05):1045-1053
  12. Xu F, Sun H, Zhang C, et al. Comparison of surgical complication between immediate implant and autologous breast reconstruction after mastectomy: a multicenter study of 426 cases. J Surg Oncol 2018;118(06):953-958
  13. Tadiparthi S, Staley H, Collis N, O'Donoghue JM. An analysis of the motivating and risk factors for conversion from implant-based to total autologous breast reconstruction. Plast Reconstr Surg 2013;132(01):23-33
  14. Adams WP Jr, Rios JL, Smith SJ. Enhancing patient outcomes in aesthetic and reconstructive breast surgery using triple antibiotic breast irrigation: six-year prospective clinical study. Plast Reconstr Surg 2006;117(01):30-36
  15. Ooi ASh, Song DH. Reducing infection risk in implant-based breast-reconstruction surgery: challenges and solutions. Breast Cancer (Dove Med Press) 2016;8:161-172
  16. Eun YN, Hong BK, Hyunok B, et al. Appropriateness of surgical antibiotic prophylaxis in a tertiary hospital. Korean J Nosocomial Infect Control 2014;19:64-70
  17. Ranganathan K, Sears ED, Zhong L, et al. Antibiotic prophylaxis after immediate breast reconstruction: the reality of its efficacy. Plast Reconstr Surg 2018;141(04):865-877
  18. Clayton JL, Bazakas A, Lee CN, Hultman CS, Halvorson EG. Once is not enough: withholding postoperative prophylactic antibiotics in prosthetic breast reconstruction is associated with an increased risk of infection. Plast Reconstr Surg 2012;130(03):495-502
  19. Phillips BT, Wang ED, Mirrer J, et al. Current practice among plastic surgeons of antibiotic prophylaxis and closed-suction drains in breast reconstruction: experience, evidence, and implications for postoperative care. Ann Plast Surg 2011;66(05):460-465
  20. Centers for Disease Control and Prevention (CDC): National Healthcare Safety Network. Surgical site infection event (SSI) [Internet]. 2022. Accessed December 19, 2022 at: https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf
  21. Bartsich S, Ascherman JA, Whittier S, Yao CA, Rohde C. The breast: a clean-contaminated surgical site. Aesthet Surg J 2011;31(07):802-806
  22. Johnson AC, Colakoglu S, Siddikoglu D, et al. Impact of dermal matrix brand in implant-based breast reconstruction outcomes. Plast Reconstr Surg 2022;150(01):17-25
  23. Wu PS, Winocour S, Jacobson SR. Red breast syndrome: a review of available literature. Aesthetic Plast Surg 2015;39(02):227-230
  24. Cohen JB, Carroll C, Tenenbaum MM, Myckatyn TM. Breast implant-associated infections: the role of the national surgical quality improvement program and the local microbiome. Plast Reconstr Surg 2015;136(05):921-929
  25. Banuelos J, Abu-Ghname A, Asaad M, Vyas K, Sohail MR, Sharaf B. Microbiology of implant-based breast reconstruction infections: a systematic review. Ann Plast Surg 2020;85(02):194-201
  26. Antony AK, McCarthy CM, Cordeiro PG, et al. Acellular human dermis implantation in 153 immediate two-stage tissue expander breast reconstructions: determining the incidence and significant predictors of complications. Plast Reconstr Surg 2010;125(06):1606-1614
  27. Dicuonzo S, Leonardi MC, Radice D, et al. Long-term results and reconstruction failure in patients receiving postmastectomy radiation therapy with a temporary expander or permanent implant in place. Plast Reconstr Surg 2020;145(02):317-327