Post-Operative Antibiotic Prophylaxis for Implant-Based Breast Reconstruction with Acellular Dermal Matrix

Background and Purpose:

Tissue expander and implant based breast reconstruction remains one of the most common forms of post-mastectomy breast reconstruction in the United States. Acellular dermal matrix has been described for improving inferolateral prosthesis coverage and support and inframammary fold reconstruction.¹

Recommended guidelines for infection prophylaxis in breast reconstruction with acellular dermal matrix and tissue expanders remains that of a clean procedure, specifically antibiotic administration only prior to surgery. Previous studies demonstrate increased post-operative rates of infection and seroma associated with allogenic acellular dermal matrix use.^2,3,4  Prior experience with post-operative prophylaxis in breast reconstruction with acellular dermal matrix indicates decreased rate of infection. The purpose of this study was to evaluate the impact of post-operative antibiotic prophylaxis on infection rates in post-mastectomy expander based breast reconstruction with acellular dermal matrix.

Methods:

A retrospective study reviewed collected data of 96 patients (n=132 breasts) who underwent either immediate or delayed expander based breast reconstruction using acellular dermal matrix, specifically AlloDerm (Lifecell Corp., Branchburg, N.J.). Infection rates were analyzed after patients received post-operative antibiotic prophylaxis for 48 hours (Group B=6/18/07 - 9/30/09; n=83), greater than 48 hours (Group C=11/19/09 – 8/30/10; n=30), or no post-operative antibiotics (Group A=10/1/09 –11/18/09; n=19). The senior author (J.C.O.) solely performed all breast reconstructions.

Results:

Infection rates for breast reconstructions with post-operative antibiotic course were 8.4% (48 hours) and 3.3% (> 48 hours). Patients with no antibiotic course had an infection rate of 31.6%. Overall infection rates among the groups were significantly different (p=0.004). Infections were defined and confirmed by fluid culture, and treated with oral or IV antibiotics with possible surgery.  Patient demographics and comorbidities, previous chemotherapy, previous radiation, expander size, intraoperative fill volume, and length of indwelling Jackson-Pratt drains were recorded.  Uncontrolled variables were time course between mastectomy and reconstruction, node dissection, prior operations, and whether reconstruction was unilateral or bilateral. 

Conclusion:

This study demonstrates significant differences in the rate of infection between the groups of patients undergoing breast reconstruction who received post-operative antibiotic prophylaxis and the group that did not. Correlating recorded parameters provides further support for the use of post-operative antibiotics with tissue expander and implant based breast reconstruction with acellular dermal matrix.  Our study strongly suggests optimal duration of post-operative antibiotic prophylaxis is at least 48 hours.