Are systemic antibiotics indicated in aesthetic breast surgery? A systematic review of the literature.

[BACKGROUND] The use of systemic prophylactic antibiotics to reduce surgical-site infection in aesthetic breast surgery remains controversial. The aim of this review is to weigh the available evidence with respect to reducing surgical-site infection.

[METHODS] Two literature searches were performed to analyze the available data for studies involving either reduction or augmentation mammaplasty and the results of different antibiotics regimens. Outcome measures included surgical-site infection and capsular contracture.

[RESULTS] A total of 2971 patients (5891 breasts) were included. A meta-analysis of surgical-site infection incidence after aesthetic breast surgery revealed a significant reduction in infections overall with antibiotic prophylaxis compared with controls (p=0.02). This was most significant with a single preoperative antibiotic dose (p=0.02). In cases of reduction mammaplasty, when antibiotics are administered as a single preoperative dose, the risk of developing surgical-site infection is halved. With augmentation mammaplasty, there was no effect on infection rates with any antibiotic regimen. Data concerning the incidence of capsular contracture were insufficient for meta-analysis.

[CONCLUSIONS] For cases of reduction mammaplasty, the authors recommend a single intravenous perioperative dose of antibiotic with action against Staphylococcus species. For augmentation mammaplasty, there is no evidence to refute current guidelines, based on recommendations obtained from other forms of implant surgery.

[CLINICAL QUESTION/LEVEL OF EVIDENCE] Therapeutic, II.