Antibiotic prophylaxis in prosthesis-based mammoplasty: A systematic review

Introduction: Although considered as an aseptic surgery, infection after prosthesis-based mammoplasty represents the leading cause of morbidity after reconstructive and aesthetic surgery. Antibiotic prophylaxis is supported by several studies to prevent surgical site infection (SSI) and capsular contracture (CC). However, there is no high quality evidence on antibiotic prophylaxis in this area. Methods: A comprehensive literature search of Medline, Embase and CENTRAL databases was conducted for studies published through June 2014. Studies of prosthesis-based breast surgery with control group and antibiotic prophylaxis were included. Data was analyzed by meta-analysis or summarized if not qualified for meta-analysis. Results: A total of 13 studies were included. Based on random effect model, extended systemic antibiotic prophylaxis more than 24h postoperatively could significantly decrease infection risk (pooled RR=0.638, 95%CI 0.453-0.898) compared with antibiotic prophylaxis within 24h. In subgroup analysis, extended antibiotic prophylaxis could significantly decrease SSI risk in implant reconstruction surgery (pooled RR=0.508, 95%CI 0.349-0.739), but not in aesthetic breast surgery (pooled RR=1.458, 95%CI 0.602-3.528). Topical antibiotic irrigation could reduce CC risk (pooled RR=0.472, 95%CI 0.316-0.707), while might not be able to reduce infection risk. Cephalosporin was the most commonly preferred antibiotic regimen in included studies, which could cover the most commonly identified implant-associated bacteria. Conclusion: Extended systemic antibiotic prophylaxis should be considered to decrease SSI risk in breast implant surgery, especially in breast reconstruction. Topical antibiotic irrigation would decrease CC risk. Risk factors such as chest irradiation and diabetes should be taken into consideration when prescribing antibiotic prophylaxis.