Title: A Prospective Randomized Study of Antibiotic Efficacy in
Preventing Infection in Reduction Mammaplasty
Authors:
Ahmad H. Ahmadi, MD, Benjamin E. Cohen, MD, Payam Shayani, MD
Introduction: The role of prophylactic antibiotics in reduction
mammaplasty remains controversial. However, most surgeons choose to
use antibiotics.1 In addition to cost and potential allergic reactions,
unnecessary administration of antibiotics can suppress host natural
flora and produce resistant organisms.2 We conducted a prospective
randomized study to determine the efficacy of various antibiotic
regimens in preventing infection among patients undergoing reduction
mammaplasty.
Method: Fifty patients were sequentially assigned to one of three
study limbs: (1) no antibiotics, (2) preoperative antibiotics only, (3)
preoperative and postoperative antibiotics. Demographic, operative and
postoperative data were recorded and analyzed. The study was
terminated when statistical power was reached. The antibiotic regimens
are shown in table 1. An alternative antibiotic regimen was used if
the patient was allergic to cephalosporins. Preoperative data
collected on patients included age, body mass index (BMI)3, history of
diabetes (DM), peripheral vascular disease (PVD), previous breast
surgery, steroid therapy and tobacco use (table 2). Operative data
included specimen weight, operative time, blood loss (EBL), prolonged
hypotension, adjunctive axillary and breast tail liposuction and
intraoperative breast tissue culture (table 3). Infection was defined
as cellulitis, purulent drainage, infected hematoma/seroma or abscess.
Delayed wound healing was defined as stitch abscess, minor dehiscence
or necrosis. Postoperatively, the operating surgeons saw the patients
for at least three postoperative visits over six weeks.
Results: The patient population in the three limbs of study was
similar. Thus, there was no significant difference among the groups
insofar as the preoperative data was concerned (p < 0.01): age, body
mass index, history of diabetes, peripheral vascular disease, previous
breast surgery, steroid or tobacco use (table 2).
Furthermore, no
significant difference (p < 0.01) was noted among intraoperative data
in the three groups: specimen weight, operative time, blood loss,
prolonged hypotension, adjunctive breast liposuction and positive
bacterial culture from intraoperative breast tissue samples (table 3).
Among the intraoperative breast tissue samples, S. epidermidis was the
most commonly isolated organism (90%).4 Using strict criteria,
infection rate ranged from 19% to 20%. There was no significant
difference (p < 0.01) in rate of infection among the study limbs
(figure 1). There was, however, a significant reduction (p < 0.005) in
delayed wound healing in the group that received preoperative
antibiotics only. Among the studied risk factors for infection only
positive intraoperative culture of breast tissue was significant (p <
0.008) for development of infection. Delayed wound healing also
contributed to development of infection (p < 0.003).
Conclusion: This prospective randomized study shows that prophylactic
antibiotics in reduction mammaplasty do not affect infection; however,
a single preoperative dose significantly improves wound healing. Our
results should help surgeons in choosing prophylactic antibiotics
appropriately for patients undergoing reduction mammaplasty.
Table 1. Antibiotic Regimens
Study Group
Antibiotic Regimen
Alternative Antibiotic
Regimen for Cephalosporin
Allergy
No Antibiotics
-
-
Preoperative Antibiotics
Only
Preoperative &
Postoperative Antibiotics
cefazolin 1 gm IV
levofloxacin 500 mg IV
Preop: cefazolin 1
gm IV
Postop: cefazolin 1
gm q8 x 2 doses then
cephalexin 500 mg PO
qid x 3 days
Preop: levofloxacin 500
mg IV
Postop: levofloxacin 500
mg PO qd x 3 days
Table 2. Preoperative Data
Antibiotics Regimens
Average Age
Average BMI (kg/m2)
DM (N)
PVD (N)
Previous Breast Surgery (N)
Steroid Use (N)
Smoking (N)
Table 3. Operative Data
Antibiotic Regimens
Average Specimen (gm/breast)
Average Operative time (min)
Average EBL (ml)
Breast Tail Liposuction (N)
Hypotension (N)
Positive Intraoperative
Bacterial Culture (%)
None
(N=17)
Preop Only
(N=17)
Pre & Postop
(N=16)
32
31
1
0
1
1
3
34
33
0
0
0
0
1
36
33
2
0
0
1
0
None
Preop Only
962
215
173
2
0
58%
794
204
161
3
0
50%
Pre &
Postop
1235
235
216
3
2
57%
p
0.7
0.5
1
0.8
1
0.2
1
p
0.13
0.39
0.25
0.90
0.32
1.00
Patients
16
14
12
10
8
6
4
2
0
83%
53%
29%
No Abx
19% 25%*
23%
Preop Only
Infection
Pre &
Postop
Delayed Wound Healing
Figure 1. Rates of Infection and delayed wound healing.
reduction in delayed wound healing (p < 0.005).
* Significant
References
1. Perrott JA, Caster SA, Perez PC, Zins JE: Antibiotic Use in
Aesthetic Surgery: A National Survey and Literature Review. Plast
Reconstr Surg. 2002; 109:1685-1693.
2. Monroe S, Polk R: Antimicrobial use and bacterial resistance. Curr
Opin Microbiol. 2000 Oct;3(5):496-501. Review.
3. de Jong RH: Body Mass Index: Risk Predictor for Cosmetic Day Surgery
Plastic and Reconstructive Surgery 2001;108:556-561
4. Ransjo U, Asplund OA, Gylbert L, Jurell G: Bacteria in the female
breast. Scand J Plast Reconstr Surg. 1985;19(1):87-9.
5. Thornton JW, Argenta LC, McClatchey KD, Marks MW: Studies on the
endogenous flora of the human breast. Ann Plast Surg. 1988
Jan;20(1):39-42.