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Rampino Cordaro et al. Breast reconstruction, antibiotics and drains

INTRODUCTION University Hospital between May 2013 and May 2014.
The guidelines in use at the Udine S. Maria della All study patients signed informed consent and gave
Misericordia University hospital, which conform to the their permission for publication of their pictures and
recommendations published by the Italian National samples analysis for research purpose; 86 patients
Guidelines System (SNLG) and adopted by the Friuli- (92.5%) of the 96 considered.
Venezia-Giulia Regional Health Authority, recommend
short-term pre-operative antibiotic prophylaxis via 2 g of Inclusion criteria consisted of all women undergoing
cephazolin for breast implant patients, plus 1 g for breast implant surgery, comprising: (1) post-
operations scheduled to last more than 3.5 h. The mastectomy breast reconstruction via tissue expander/
guidelines specify that antibiotic prophylaxis must be implant or Becker expander; (2) expander/implant
administered immediately before (in this case 30 min) replacement surgery; and (3) breast augmentation to
surgery, and be limited to the peri-operative period. correct asymmetry.

The literature indirectly confirms the efficacy of the The patient sample also included 3 cases of corrective
short-term prophylaxis proposed in the guidelines, surgery secondary to complications arising in the
and published evidence supporting the superiority of post-operative period, in particular: (1) 1 implant
prolonged prophylaxis is notably absent. [1-3] Hence, replacement with contralateral mastopexy following
based on the current evidence, extending prophylaxis Becker expander rupture; (2) 1 implant replacement
to cover the first 24 h of the post-operative period can with latissimus dorsi myocutaneous flap following
only be justified if there are major risk factors for post- implant exposure; and (3) 1 latissimus dorsi
surgical infection, and the reasons behind any decision myocutaneous flap reconstruction implant with breast
to prolong prophylaxis beyond the recommended limit implant and contralateral mastopexy following breast
must be noted in the patient’s medical records. [4,5] cancer relapse.

Although we can assume that most, if not all, specialists A total of 96 women who had undergone prosthetic
in the sector adhere to such guidelines, the duration of breast reconstruction surgery were considered. In 50
antibiotic prophylaxis is nonetheless often the object of patients, reconstruction was performed immediately
much discussion. Aside from the fear of peri-prosthetic after mastectomy (modified radical, nipple-sparing
infections, major concerns are also raised by the or skin-sparing) following a diagnosis of breast
sequelae of infections, in particular implant loss, delays cancer. Surgery was performed to fit either a tissue
in neo-adjuvant therapy administration, unsatisfactory expander or a permanent implant, accompanied or
aesthetic outcomes and the need for further corrective not by contralateral mastopexy. In an additional 12
surgery, not to mention potential medico-legal issues. [6,7] patients, deferred post-mastectomy reconstruction
via expander or permanent implant positioning, with
Indeed, peri-prosthetic pocket infections tend to or without latissimus dorsi flap reconstruction and/or
develop subclinically, leading to capsular contracture contralateral mastopexy, was performed. In another
and other post-implant complications without overt group of 31 patients, expanders were replaced with
signs or symptoms. However, peri-prosthetic discharge permanent implants, with or without contralateral
may represent an effective marker of even subclinical mastopexy and/or lipofilling. The remaining three
peri-prosthetic infection, and can be easily obtained patients underwent corrective surgery secondary
from post-operative surgical drains. to post-implant complications, specifically implant
rupture, implant exposure, and breast cancer relapse,
Hence, in order to make a contribution, however minor, respectively.
to this debate, the authors conducted a microbiological
analysis of the peri-prosthetic discharge of breasts All patients received the recommended short-term
treated at Udine University Hospital. The aim was to antibiotic prophylaxis, i.e. 2 g cephazolin (plus 1 g
establish objectively whether the short-term prophylaxis eventually given after 3.5 h of surgery) 30 min before
recommended in the guidelines is able to sterilize the surgery.
peri-prosthetic pocket.
Records pertaining to each patient were kept in a
METHODS specific study chart, the first part comprising the
patient’s personal information, diagnosis, lesion site,
Patients were recruited from the Plastic Surgery Clinic, and type of surgery received. The second part of the
Gemona, and the Surgery Clinic, Udine, both affiliated study chart was used to compile data pertaining to
with the Udine “Santa Maria della Misericordia” the patient’s “unnecessary” habits (smoking, drinking,
Plastic and Aesthetic Research ¦ Volume 4 ¦ February 28, 2017 25