From the Guidelines

Prophylactic antibiotic use significantly reduces the risk of surgical site infection in patients undergoing breast reconstruction surgery.

The use of preprocedural systemic antimicrobials has been shown to significantly reduce the rate of infection in breast reconstruction surgery 1.
Patients at high risk for infection, such as those with a body mass index >25 kg/m2 or prior breast implant infection, should consider proceeding with an autologous flap reconstruction instead of an implant-based reconstruction due to the lower rate of infection with the former procedure 1.
Perioperative antimicrobials should be based on the surgical procedure and most common pathogens encountered at the surgical site, with efforts made to confirm a patient’s reported penicillin allergy to minimize the use of second-line antibiotics 1.
Additional infection preventive measures, such as antimicrobial irrigation of the pocket and implant immersion, as well as the use of bioabsorbable films that elute antibiotics locally, have shown promise in reducing infection rates 1.
Best practices for reducing infection rates include avoiding extended postoperative antimicrobial use, allowing adequate incisional healing before initiating adjuvant therapy, and using techniques such as chlorhexidine-impregnated dressings and antiseptic solutions to decrease bacterial colonization 1.

The most common bacteria causing tissue expander infections are methicillin-resistant staphylococci and gram-negative pathogens, including Pseudomonas and Klebsiella spp. 1.
Acellular dermal matrices have been associated with increased incidence of seroma and hematoma, and extended durations of surgical drains, which can serve as microbial conduits for pathogens to migrate from the skin to the implant 1.

From the Research

The use of prophylactic antibiotics in breast reconstruction surgery is a topic of debate, with some studies suggesting that it may not reduce the risk of surgical site infection (SSI) 2, 3.
A study published in 2016 found that the administration of oral antibiotics at discharge did not reduce the risk of SSI in patients undergoing immediate tissue expander breast reconstruction 2.
Another study published in 2020 found that extended prophylactic antibiotics did not reduce the incidence of SSI after immediate breast reconstruction 3.
However, a systematic review published in 2012 found that prophylactic antibiotics administered preoperatively significantly reduced the incidence of SSI for patients undergoing breast cancer surgery without reconstruction 4.
A retrospective analysis published in 2016 found that the administration of a single dose of preoperative antibiotic did not decrease the SSI rate in patients undergoing elective, nonreconstructive breast operations 5.
A systematic review published in 2023 found that antibiotic prophylaxis up to a maximum of 24 hours is useful in lowering infection rates in autologous breast reconstructions, but the quality of evidence is limited due to the small number of available studies 6.

The risk of SSI in breast reconstruction surgery is higher than average for a clean surgical procedure, with rates ranging from 3% to 15% 4.
The use of prophylactic antibiotics may influence antibiotic resistance patterns when infections occur 2.
Methicillin-resistant Staphylococcus aureus is a common cause of SSI in breast reconstruction surgery 2, 5.
Patient factors such as BMI > 25 kg/m2 may increase the risk of SSI 5.

There is no consensus on the best prophylactic antibiotic regimen for breast reconstruction surgery 6.
The choice of antimicrobial agent and the duration of antibiotic treatment are not well established 6.
Further research is needed to determine the optimal antibiotic prophylaxis regimen for breast reconstruction surgery 3, 6.