I would sincerely like to thank Drs. Gigliofiorito et al. for their considerate letter regarding our article.1 I agree that international agreement for the use of antibiotic prophylaxis in aesthetic breast surgery is key to safer practice. This will allow the provision of the best quality of care to our patients and avoid the need to practice empirical “defensive medicine.” Some of the current national guidance available is limited in its scope and has drawn broad conclusions that could be applied to reduction and augmentation mammaplasty from evidence that has been gleaned from other surgical specialities.2 The American Society of Plastic Surgeons guidelines3 do at the outset provide a disclaimer stating that “…this guideline should not be construed as a rule, nor should it be deemed inclusive of all proper methods of care or exclusive of other methods of care reasonably directed at obtaining the appropriate results,” and although our systematic review did not attempt to provide a clinical guideline, our aim was to present the available evidence, on which the clinician could base their best practice. We attempted to show that the best available evidence was sometimes insufficient for drawing substantial conclusions. Based on this, we cannot refute current U.K. guidelines2 with respect to augmentation mammaplasty and U.S. guidelines3 with respect to reduction mammaplasty for the reduction of surgical-site infection, and would therefore consider these to be current best practice and could be used as a framework for the development of future international protocols/guidelines. I agree that not all decisions in medicine are based on scientific fact, and the role of personal experience and common sense in practicing the art of medicine, tailored uniquely to the patient’s requirements, is an important skill to learn and master. Although systematic reviews of randomized and blinded patient cohorts are considered to be the best evidence available, we always need to recognize the needs of the individual patient under our duty of care, and weigh the risks associated with extended antibiotic administration.
The author has no financial interest to declare in relation to the content of this communication.
Joseph Hardwicke, Ph.D.
University Hospitals of Birmingham
Queen Elizabeth Hospital
Mindelsohn Way, Egbaston
Birmingham B15 2WB, United Kingdom
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. National Collaborating Centre for Women’s and Children’s Health. Surgical Site Infection: Prevention and Treatment of S urgical Site Infection. 2008 London Royal College of Obstetricians and Gynaecologists Clinical Guideline, October 2008 Available at: http://www.nice.org.uk/nicemedia/live/11743/42378/42378.pdf
Accessed May 11, 2012.
3. Kalliainen LKASPS Health Policy Committee. . ASPS clinical practice guideline summary on reduction mammaplasty. Plast Reconstr Surg. 2012;130:785–789
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