Efficacy of a Single Dose of Peri-Operative Antibiotics in Breast Implant Surgery and Risk Factors for Infection in Post-Mastectomy Patients Undergoing Placement of Permanent Breast Implants.
Academic Article
Overview
abstract
Background: Breast implant placement is a common operation performed by plastic surgeons, with more than 78,664 implant-based breast reconstructions carried out in the United States in 2016. Infection is a major concern for the reconstructive surgeon, with rates estimated at 2%-4% for implant exchanges. Use of peri-operative antibiotics is variable and provider dependent and is not without risk. Methods: Charts for all women undergoing mastectomy and immediate reconstruction at our institution from July 1, 2011-January 1, 2020 by a single plastic surgeon were reviewed. Patient characteristics, operative technique, and history of radiation, chemotherapy, hormonal treatment, and antibiotic protocols were collected for each patient. The data were analyzed using Ļ2 and Student t-tests. Results: Chart review was performed for 234 consecutive patients undergoing exchange of breast implants. Patients received only a single dose of peri-operative antibiotics before the first incision without post-operative antibiotics. In these patients, a total of 407 implant exchanges occurred. Post-operative cellulitis was found in 13 instances in 12 patients (infection rate of 3.1%) and was treated successfully with oral antibiotics in 11 of 13 cases. Two patients required operative washout (0.04%). Most of the infections (69%) were found on the side of the cancer. Patients experiencing post-operative infections were more likely to have had adjuvant chemotherapy (pā=ā0.007) than patients without infection. There was no significant difference between the two groups with regard to neo-adjuvant chemotherapy, radiation to the affected breast, or hormonal therapy or in terms of age, Body Mass Index, or the presence of diabetes mellitus. Intra-operative povidone-iodine (Betadine) swabbing and antibiotic selection did not have an impact on infection risk. Conclusions: A single dose of antibiotics results in sufficiently low rates of infection in patients undergoing breast implant exchange. Adjuvant chemotherapy is a clinically significant risk factor for infection in these patients.
