Routine Perioperative Antibiotic Use in Reduction Mammoplasty



Routine Perioperative Antibiotic Use in Reduction Mammoplasty

Joseph J. Thornton, MD, Debbie A. Kennedy, MD, and Susan Gannon, MD.

Introduction: Reduction Mammoplasty is a procedure commonly performed by plastic surgeons, and much effort has been placed on the refinement of operative technique (1-4). On the contrary, perioperative management is often taken for granted; including the role of prophylactic antibiotics. While there have been attempts to quantify it’s utility, the data are conflicting and far from conclusive(5-9). In general, antibiotic use is safe; and if demonstrated to decrease the complication rate in reduction mammoplasty, e.g. infection, wound healing, or scarring; then its use is warranted. Widespread use of antibiotics exposes patients to increased risk of allergic reactions, superinfection, c. dificile diarrhea and continues to pressure antibiotic resistance(10-12). We set out to evaluate a single surgeon’s extensive breast reduction practice and how a change in protocol to routine perioperative antibiotics affected wound healing complications and clinically evident infections.

Patients: All patients undergoing bilateral inferior pedicle reduction mammoplasty by a single surgeon from June 2001 until March 2006 are included, numbering 173 consecutive surgeries. Unilateral reductions, short scar reductions and free nipple reductions are excluded to ensure a similar cohort of patients. Institution, technique, and both pre and post operative care remained unchanged with the exception of a transition to the routine use of perioperative antibiotics. The standard inferior pedicle Wise pattern is used for all reductions followed by an overnight stay in the hospital, with routine follow up in the office. No drains are used, and an ace wrap over fluffed gauze is the dressing which remains intact until the 4th day postoperative. Initially only patients felt to be high risk for wound healing complications (immunosuppresion, diabetics, or smokers) were given antibiotics; whereas the later patients all received antibiotics. Cefazolin (1g IV q8 hours) and cephalexin (250mg PO qid) were utilized in the vast majority, with clindamycin (600mg IV q6 hours, and 300mg PO q8 hours) reserved for those noted to be penicillin allergic. Antibiotics were dosed intravenously both preoperatively and while in hospital and transitioned to oral at home for a total of five days.

Methods: Retrospective chart review of office and hospital charts documenting the use of perioperative antibiotics, patient demographics, co morbid conditions, reduction size, operative time, wound complications and clinical wound infections which required further treatment was undertaken. Infections are defined clinically only; fevers, erythema, drainage were all indicators which led to further treatment with antibiotics. Wound healing complications cover any area of breakdown, from small skin edge blistering to wound dehiscence and or necrosis. A total of 173 charts were reviewed with follow up for all patients.

Results: Of the 173 patients reviewed, 90 received perioperative antibiotics and 83 did not receive antibiotics. It was found that patient populations, operative times and volumes removed were similar as were overall wound complications, from 37% to 32% (odds ratio 0.8 [0.45-1.41]); however, there is a significant reduction in clinical infections from 32% to 17% with antibiotic use (odds ratio 0.39 [0.19-0.67]).

Conclusions: Even though antibiotic use has potential morbidity, in this series, its use in routine reduction mammoplasty has reduced the clinical infection rate by nearly one half from 32% to 17%. Therefore we recommend its use and continue to do so routinely in our busy breast reduction practice.

References:

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