BACKGROUND: It is well known that a single pre-operative dose of intravenous antibiotics reduces the incidence of surgical site infections. However, the use of post-operative antibiotic prophylaxis following cosmetic breast surgery remains a controversial topic among plastic surgeons. Many surgeons routinely prescribe post-operative antibiotics despite the lack of proven efficacy. The purpose of this study is to determine the incidence of post-operative complications with and without the use of post-operative prophylactic antibiotics for patients undergoing cosmetic breast surgery.
METHODS: A retrospective chart review was performed on all patients undergoing cosmetic breast augmentation with silicone or saline implants at a single plastic surgery practice between January 2005 to December 2008. The use of post-operative antibiotics differed among the four plastic surgeons in the practice. Patient data was retrieved from hospital and office records, with special focus on patient demographics, details of the operative procedures, post-operative antibiotic regimen, and incidence of post-operative complications. Statistical analysis was performed using Fisher’s exact test.
RESULTS: A total of 209 patients undergoing breast augmentation were identified. The mean age of patients was 37.1 years (range 17-67). Forty-nine (23.4%) of patients were smokers. Saline implants were used in 65.5% (n=137) of patients while silicone was used in 34.5% (n=72). All patients received a single peri-operative dose of intravenous systemic antibiotic prophylaxis. A total of 55.5% (n=116) patients received post-operative antibiotics while 44.5% (n=93) did not receive post-operative antibiotics. The antibiotic regimen varied with 85.3% (n=99) receiving Cephalexin, 7.8% (n=9) receiving Clindamycin, 2.6% (n=3) receiving Ciprofloxacin, 2.6% (n=3) receiving Azithromycin, and 1.7% (n=2) receiving Levofloxacin. The duration of antibiotics ranged from 3 to 5 days depending on surgeon preference. Mean follow up was 3.36 months (range 1-24). There were a total of 27 complications reported with 14 occurring in patients who received antibiotics and 13 in those who did not. Complications included capsular contracture (n=16), hematoma formation (n=3), implant rupture (n=3), Mondor’s thrombophlebitis (n=2), infection (n=1), galactocele (n=1), and dermolysis (n=1). Seventeen of these complications required re-operation. There was no statistically significant difference in the total complication rate between patients receiving post-operative antibiotics (12.1%, 14/116) and those who did not (14%, 13/93; p=0.678). The surgical site infection (SSI) rates did not differ significantly between the group that did (0%, 0/116) and did not (1.1%, 1/93) receive antibiotics (p=0.445). There was also no statistically significant difference in the rate of capsular contracture in patients receiving antibiotics (7.8%, 9/116) and those not receiving them (7.5%, 7/93; p=1.0).
CONCLUSIONS: The results of this study demonstrate that there is no reduction in overall complications, SSI or capsular contracture when post-operative prophylactic antibiotics are used. Antibiotic use carries the risk of adverse events for the patient and the greater population. Given the potential risk for harm and the lack of proven efficacy, we do not recommend the routine use of prophylactic post-operative antibiotics for cosmetic breast surgery. Further evaluation with a randomized prospective trial is needed in order establish optimal practice guidelines