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Real-World Outcomes of Postoperative Antibiotic Duration in ADM Assisted Tissue Expander Breast Reconstruction: A 20-Year Multicenter Study
Paige Richards
1, Kanika Yadav
*1, Gabriel De la Cruz Ku
2, Ambroise H. Gilles
3, Christopher Fullmer
3, Ruyan Zhang
4, John Roberts
3, Adam Walchak
5, Sameer A. Patel
51Penn State College of Medicine, Hershey, PA; 2Universidad Científica del Sur, Lima, Peru; 3Division of Plastic Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA; 4Department of Surgery, University of Hawaii, Honolulu, HI; 5Division of Plastic and Reconstructive Surgery, Temple University Hospital, Philadelphia, PA
BACKGROUND: Post mastectomy tissue expander-based immediate breast reconstruction (TE-IBR) with acellular dermal matrix (ADM) has been linked to higher rates of infection and seroma. Multicenter evidence on optimal postoperative antibiotic duration remains limited despite substantial practice variation. Using real-world multicenter data, we evaluated whether extending postoperative antibiotics beyond 24 hours decreases risk of infection or complications following ADM-assisted TE-IBR.
METHODS: This retrospective cohort study used the TriNetX Global Collaborative Network (2006- 2025) to identify adult women undergoing ADM-assisted TE-IBR. Inclusion required same-day prophylactic antibiotics; prior antibiotic use within 30 days was excluded. Patients were stratified by short (≤24 hours) versus prolonged (>24 hours), postoperative antibiotic duration, and matched 1:1 to balance demographics, comorbidities, and infection risk modifiers. The primary outcome was localized infection at 30, 60, and 90 days. Secondary outcomes included wound dehiscence, seroma, hematoma, severe infection, expander-related complications and explantation. Risk ratios (RR) with 95% confidence intervals (CI) were calculated and p<0.05 was considered significant.
RESULTS: Among 4,647 patients who underwent ADM-assisted TE-IBR, 3,932 (84.6%) received ≤24 hours of antibiotics. After matching, 710 pairs were analyzed. Antibiotic duration was not associated with rates of localized or severe infection, wound dehiscence, tissue expander complications, or expander removal at any time point (Figure 1). Prolonged duration was associated with a significantly higher composite outcome of seroma or hematoma (4.93% vs 1.97%; RR 2.50; p=0.002) at 60 days, but not 30 or 90 days.
CONCLUSION: Over 20 years, extended postoperative antibiotics (>24 hours) did not reduce infection or complication rates following ADM-assisted TE-IBR in this cohort, but the increased seroma and hematoma rates warrant further investigation. These findings support limiting prophylaxis to ≤24 hours and reinforce antibiotic stewardship.
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