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Routine Postoperative Antibiotics Following TE Placement Postmastectomy Does not Reduce Infection Rates
Feras Yamin, MD, Phoebe McAuliffe, BA, Vasileios Vasilakis, MD, Duc Bui, MD.
Stony Brook University, Stony Brook, NY, USA.

BACKGROUND: In an attempt to reduce infectious complications following tissue expander-based breast reconstruction, Routine administration of postoperative antibiotics 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. Our aim is to determine the efficacy of prolonged administration of postoperative antibiotics compared to perioperative-only antibiotics for prophylaxis following tissue expander placement for immediate mastectomy reconstruction.
METHODS: A retrospective chart review of all patients who underwent immediate tissue expander placement following mastectomy at our institution from June, 2005 to September, 2018 was performed. All patients in the study received perioperative intravenous antibiotics 30 to 60 mins preoperatively and for 24 hours postoperatively. Patients were divided into two groups. Patients in Group A did not receive antibiotics beyond the perioperative period. Patients in Group B received oral antibiotics for at least seven days postoperatively in addition to the perioperative intravenous antibiotics. The two groups were compared for demographics and prevalence of risk factors. The incidence of complications such as infection, wound complications, hematoma, seroma, capsular contracture, loss of tissue expander, and reoperations was assessed.
RESULTS: A total of 529 patients were included in the study, of which patients, 241 were in group A, and 288 in group B. Total number of breasts reconstructed in group A were 398, while in group B were 466. The average age of the patient in group A was 51 years (range, 24 - 79) and in group B it was 53 years (range, 27 - 77). 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 two 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 follow the same trend when comparing group A versus B, as follows: skin necrosis and wound dehiscence 9.54% versus 12.85% (p = 0.347), tissue expander loss requiring reoperation 2.9% versus 7.29% (p = 0.327), hematoma 4.98% versus 6.6% (p = 426), seroma formation 14.94% versus 13.19% (p = 0.414), and capsular contracture 6.22% versus 7.64% (p = 0.434), respectively.
CONCLUSIONS:
This retrospective study shows that the routine use of postoperative antibiotics following tissue expander placement for immediate mastectomy reconstruction does not result in reduction in the incidence of common complications or improvement of clinical outcomes.


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