We read with great interest the recent article by Hardwicke et al. entitled: “Are Systemic Antibiotics Indicated in Aesthetic Breast Surgery? A Systematic Review of the Literature.”1 In their work, a systematic review of the literature concerning the use of systemic antibiotics in aesthetic breast surgery is performed. We congratulate the authors for the proficient analysis of the literature and the interesting findings they reported, and we would like to further discuss some aspects of this common issue.
Frequently, surgeons deal with compelled choices, resulting from common sense more than from scientific evidence. For example, many surgeons dip the prosthesis in povidine-iodine, other disinfectants, or antibiotic solutions before breast implantation for the purpose of reducing the incidence of capsular contracture and/or infections. Until now, only a few studies succeeded in assessing the true benefit of such procedures, with contrasting results in the literature.2,3 The same applies to the choice of whether to prescribe postoperative antibiotic therapy or not after dismissal from the hospital.4 In the past decade, the fear of medicolegal lawsuits and claims has become a major reason leading to infection-reducing strategies or so-claimed ones in clinical practice. The surgeons had to protect themselves from further risk5 in a context where a surgical complication, such as a postoperative infection, is very likely to become an accusation by a lawyer, on the chance of procedural errors such as type and timing of antibiotic prophylaxis. As a consequence, the choice of using antibiotic therapy up to the removal of the drain or to limit it to a single dose of preoperative antibiotic is certainly an interesting and meaningful topic in the postsurgery treatment geared to prevent infections. We strongly believe that the procedures performed to reduce the risk of infection should be codified by international protocols. In our opinion, the article by Hardwicke and colleagues1 is an important piece of evidence on this topic. Nevertheless, as long as surgeons will have to answer to a judge regarding any postoperative issue, they will always be conditioned to implement any procedure protecting them from possible legal issues. Official international guidelines are of paramount importance to overcome the need for “defensive medicine.”
The authors have no conflict of interest to declare; they received no funding for this research.
Pierluigi Gigliofiorito, M.D.
Luca Piombino, M.D.
Stefano Campa, M.D.
Francesco Segreto, M.D.
Alfonso Luca Pendolino, M.S.
Paolo Persichetti, M.D., Ph.D.
Plastic and Reconstructive Surgery Unit
Università Campus Bio-Medico di Roma
1. Hardwicke JT, Bechar J, Skillman JM. Are systemic antibiotics indicated in aesthetic breast surgery? A systematic review of the literature. Plast Reconstr Surg. 2013;131:1395–1403
2. Giordano S, Peltoniemi H, Lilius P, Salmi A. Povidone-iodine combined with antibiotic topical irrigation to reduce capsular contracture in cosmetic breast augmentation: A comparative study. Aesthet Surg J. 2013;33:675–680
3. Gylbert L, Asplund O, Berggren A, Jurell G, Ransjö U, Ostrup L. Preoperative antibiotics and capsular contracture in augmentation mammaplasty. Plast Reconstr Surg. 1990;86:260–267; discussion 268
4. Mirzabeigi MN, Mericli AF, Ortlip T, et al. Evaluating the role of postoperative prophylactic antibiotics in primary and secondary breast augmentation: A retrospective review. Aesthet Surg J. 2012;32:61–68
5. Murray JE. On ethics and the training of the plastic surgeon. Plast Reconstr Surg. 1978;61:270–271
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