Postoperative Antibiotics Following Primary and Secondary Breast Augmentation

Summary

Postoperative antibiotics are routinely used for implant-based breast augmentation at the investigators' institution. From 2017-2019, the investigators' institution has conducted approximately 270 primary and secondary breast augmentation procedures. Current plastic surgery literature does not provide recommendations for antibiotic prophylaxis following implant-based breast procedures. Despite controversy surrounding their utility during the postoperative course, postoperative antibiotics have become commonplace for many plastic surgeons. To date, strong scientific evidence supporting this practice is minimal and based largely on anecdotal evidence and limited studies, including poorly controlled retrospective and non-blinded prospective series. The goal of this study is to conduct a prospective randomized trial to assess whether extended antibiotic prophylaxis is necessary to prevent infection and long-term complications (e.g. capsular contracture) in patients undergoing augmentation mammoplasty with implants. The investigators' anticipate that extended antibiotic prophylaxis is not required. The rationale for discontinuing postoperative antibiotics is based on the following: (1) a single dose of preoperative intravenous antibiotics has been demonstrated to be sufficient prophylaxis for most breast surgeries and (2) there are patient safety concerns associated with prolonged antimicrobial use such as the development of resistant bacterial strains and clostridium-related infections. Concrete evidence that extended antibiotic prophylaxis is not required would encourage plastic surgeons to practice better antibiotic stewardship and help stymie the rise of drug-resistant organisms.

Timeline

Start

2021-04-01

Primary completion

2024-05-30

Completion

2024-07-30

Publications

• Background Chopra K, Gowda AU, McNichols CHL, Brown EN, Slezak S, Rasko Y. Antimicrobial Prophylaxis Practice Patterns in Breast Augmentation: A National Survey of Current Practice. Ann Plast Surg. 2017 Jun;78(6):629-632. doi: 10.1097/SAP.0000000000000942.
• Background Hardwicke JT, Bechar J, Skillman JM. Are systemic antibiotics indicated in aesthetic breast surgery? A systematic review of the literature. Plast Reconstr Surg. 2013 Jun;131(6):1395-1403. doi: 10.1097/PRS.0b013e31828bd752.
• Background Keramidas E, Lymperopoulos NS, Rodopoulou S. Is antibiotic prophylaxis in breast augmentation necessary? A prospective study. Plast Surg (Oakv). 2016 Fall;24(3):195-198. doi: 10.4172/plastic-surgery.1000976. Epub 2016 Aug 19.
• Background LeRoy J, Given KS. Wound infection in breast augmentation: the role of prophylactic perioperative antibiotics. Aesthetic Plast Surg. 1991 Fall;15(4):303-5. doi: 10.1007/BF02273877.
• Background Mirzabeigi MN, Mericli AF, Ortlip T, Tuma GA, Copit SE, Fox JW 4th, Moore JH Jr. Evaluating the role of postoperative prophylactic antibiotics in primary and secondary breast augmentation: a retrospective review. Aesthet Surg J. 2012 Jan;32(1):61-8. doi: 10.1177/1090820X11430830.
• Background Gylbert L, Asplund O, Berggren A, Jurell G, Ransjo U, Ostrup L. Preoperative antibiotics and capsular contracture in augmentation mammaplasty. Plast Reconstr Surg. 1990 Aug;86(2):260-7; discussion 268-9.

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