October #PRSJournalClub Recap – Antibiotic Prophylaxis following Implant-Based Breast Reconstruction: What Is the Evidence?

by Jordan Frey (@JordanFreyMD)

Each month, Plastic and Reconstructive Surgery brings us an interactive forum to discuss new and innovative plastic surgery articles with the article’s authors themselves. October certainly did not disappoint as the article “Antibiotic Prophylaxis following Implant-Based Breast Reconstruction: What Is the Evidence?” was discussed with authors Dr. Brett Phillips (@mdbphillips) and Dr. Eric Halvorson (@erichalvorsonmd). This article examined a question that every plastic surgery resident has contemplated: what antibiotics should I give my breast reconstruction patient and for how long?

Infections after breast reconstruction, especially implant-based breast reconstruction, may often lead to implant loss and reconstructive failure, which is catastrophic.  Common practice is therefore often to provide patients antibiotics after these procedures for 5 to 7 days or until drains are removed in an effort to minimize infection. However, prolonged antibiotic courses carry risk as well, such as selecting for more resistant bacterial strains. In their article, Dr. Phillips and Dr. Halvorson review all eligible articles in the plastic surgery literature examining infection after breast reconstruction. Their primary focus was examining outcomes in implant-based breast reconstruction, but they also examined autologous reconstructions.

The articles included in the study often had diverse definitions of infection as well as varied outcomes. The authors ultimately conclude that 24 hours of antibiotic prophylaxis is all that is warranted or necessary after breast reconstruction, whether implant- or autologous-based. They also make a very important point that a risk assessment model in breast reconstruction based on more high-quality evidence is required to identify patients at high risk for infection and facilitate patient-centered antibiotic prophylaxis.

The article was also supplemented by a PRS Journal Club podcast featuring Drs. Devinder Singh, Sammy Sinno (@sammysinnoMD), Raj Sawh-Martinez (@docrfsm), and Amanda Silva (@AmandaKSilvaMD), which helped to launch the discussion on Twitter.

 

As you can imagine, this excellent paper fostered an excellent online, live Twitter dialogue between the authors and #PRSJournalClub followers from around the world! Check out below for just a sample of this fantastic discussion!

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