Utility of Postoperative Prophylactic Antibiotics in Prepectoral Breast Reconstruction: A Single-Surgeon Experience.

BACKGROUND Immediate tissue expander placement remains a preferred method for breast reconstruction after mastectomy. The use of prophylactic postoperative antibiotic administration is thought to reduce rates of surgical site infection and reconstructive failure, but has not been studied in patients undergoing reconstruction in the prepectoral plane. METHODS We retrospectively identified all patients undergoing immediate prepectoral tissue expander placement after mastectomy by a single plastic surgeon from 2015 to 2018. We identified 2 cohorts of patients: one group that received prophylactic antibiotics at the time of discharge and one group that did not. We collected treatment and outcomes data to compare rates of postoperative complications between cohorts. RESULTS We identified 69 patients with 115 breasts who received discharge antibiotics and 63 patients with 106 breasts who did not. The antibiotic cohort had significantly lower rates of tissue expander loss (4.3% vs 17.0%, P = 0.003), unplanned operation (10.4% vs 24.5%, P = 0.007), and infection (7.0% vs 24.5, P < 0.001). CONCLUSIONS The use of prophylactic postoperative antibiotics in prepectoral breast reconstruction is associated with significantly lower rates of postoperative complications. Further randomized controlled studies are warranted to explore the effect of antibiotic therapy on outcomes and to determine what the optimal duration of antibiotic therapy may be.