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Postoperative Antibiotic Prophylaxis for Implant-Based Breast Reconstruction with Acellular Dermal Matrix

Avashia, Yash J. B.S.; Mohan, Raja M.D.; Berhane, ChiChi M.D.; Oeltjen, John C. M.D., Ph.D.

Plastic & Reconstructive Surgery: March 2013 - Volume 131 - Issue 3 - p 453–461
doi: 10.1097/PRS.0b013e31827c6d90
Breast: Original Articles

Background: The use of acellular dermal matrix in implant-based breast reconstruction has been described for improving inferolateral prosthesis coverage and support and inframammary fold reconstruction. Recommended guidelines for infection prophylaxis are the same as for any clean procedure—antibiotic administration only before surgery. Previous studies have demonstrated increased postoperative rates of infection and seroma associated with the use of acellular dermal matrix. The authors evaluated the impact of postoperative antibiotic prophylaxis on infection rates in postmastectomy expander-based breast reconstruction with acellular dermal matrix.

Methods: A retrospective study reviewed data of 96 patients who underwent either immediate or delayed expander-based breast reconstruction using AlloDerm allogenic acellular dermal matrix. Infection rates were analyzed after patients received postoperative antibiotic prophylaxis for at least 48 hours compared with those who received only perioperative antibiotics.

Results: Infection rates for breast reconstructions with a postoperative antibiotic course were 7.9 and 3.2 percent. Patients with only perioperative antibiotics had an infection rate of 31.6 percent. Infections were defined by the endpoint of implant removal. Patient demographics, comorbidities, and intraoperative variables were recorded. Uncontrolled variables were time course between mastectomy and reconstruction, nodal dissection, operative history, and whether reconstruction was unilateral or bilateral.

Conclusions: This study demonstrates significant differences in the rate of infection between the groups of patients undergoing the first stage of two-stage implant-based breast reconstruction who received postoperative antibiotic prophylaxis and the group that received only perioperative antibiotics. This study suggests that the optimal duration of postoperative antibiotic prophylaxis is at least 48 hours.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Miami, Fla.; and Baltimore, Md.

From the University of Miami Miller School of Medicine; the Department of Plastic and Reconstructive Surgery, The Johns Hopkins University; and the DeWitt Daughtry Family Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine.

Received for publication June 25, 2012; accepted September 10, 2012.

Presented at Plastic Surgery 2011: American Society of Plastic Surgeons Annual Meeting, in Denver, Colorado, September 23 through 26, 2011.

Disclosure: Dr. Oeltjen has been a member of the LifeCell Corporation speaker's bureau since September of 2009. All other authors have no financial disclosures to report.

John C. Oeltjen, M.D., Ph.D.; Division of Plastic and Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Health System, Clinical Research Building, 1120 NW 14th Street, 4th Floor, Miami, Fla. 33136, joeltjen@med.miami.edu

©2013American Society of Plastic Surgeons