Perioperative Antibiotic Prophylaxis And Surgical Site Infections In Implant-based Breast Reconstruction

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Main Authors: Aryan Gupta, Natalia Mejia, Alexander Chang, Adam Walchak, Sameer Patel, LKSOM Temple University Hospital / Fox Chase Cancer Center, Philadelphia
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Published: Zenodo 2026
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author Aryan Gupta
Natalia Mejia
Alexander Chang
Adam Walchak
Sameer Patel
LKSOM Temple University Hospital / Fox Chase Cancer Center
Philadelphia
author_facet Aryan Gupta
Natalia Mejia
Alexander Chang
Adam Walchak
Sameer Patel
LKSOM Temple University Hospital / Fox Chase Cancer Center
Philadelphia
contents PURPOSE: Surgical site infections (SSIs) significantly impact morbidity and reconstructive outcomes following implant-based breast reconstruction after mastectomy. Perioperative antibiotic prophylaxis is central to infection prevention, with cefazolin commonly used as the first-line agent. Although true β-lactam allergy is uncommon and cross-reactivity with cefazolin is rare, penicillin allergy labels frequently lead to the use of second or third-line antibiotics. We evaluated perioperative antibiotic prophylaxis patterns and SSI rates among patients with reported penicillin allergies undergoing implant-based breast reconstruction. METHODS: A single-center retrospective chart review was conducted of adult patients who underwent implant-based breast reconstruction between July 2016 and December 2025. Data regarding reported penicillin allergy status and perioperative antibiotic prophylaxis were collected. Primary outcomes included SSI rates among penicillin-allergic and non-penicillin-allergic patients, as well as the incidence of anaphylactic reactions. RESULTS: The study included 614 patients who underwent a total of 923 implant-based reconstruction procedures. All patients were women, with a mean age of 58.1 years and a mean body mass index of 28.2. A total of 94 patients (15.3%) carried a documented penicillin allergy label. Among these, 6 patients (1.0%) reported a history of anaphylaxis, 3 patients (0.5%) had a documented drug-induced hepatotoxicity reaction, and 85 patients (13.8%) reported a nonanaphylactic reaction or had no documented reaction type. SSI rates were significantly higher among patients who received alternative prophylactic antibiotics compared with those who received standard cefazolin prophylaxis (8.8% vs 3.8%, P = 0.023). No anaphylactic reactions to perioperative antibiotic prophylaxis were observed in either group. CONCLUSION: Use of alternative perioperative antibiotic prophylaxis was associated with increased SSI rates. First-generation cephalosporins remain appropriate first-line agents for implant-based breast reconstruction, while alternative antibiotics may be best reserved for patients with clearly documented severe hypersensitivity reactions. *Source: https://ps-rc.org/meeting/Program/2026/EP127.cgi*
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spellingShingle Perioperative Antibiotic Prophylaxis And Surgical Site Infections In Implant-based Breast Reconstruction
Aryan Gupta
Natalia Mejia
Alexander Chang
Adam Walchak
Sameer Patel
LKSOM Temple University Hospital / Fox Chase Cancer Center
Philadelphia
plastic surgery
reconstructive surgery
conference abstract
PSRC 2026
PURPOSE: Surgical site infections (SSIs) significantly impact morbidity and reconstructive outcomes following implant-based breast reconstruction after mastectomy. Perioperative antibiotic prophylaxis is central to infection prevention, with cefazolin commonly used as the first-line agent. Although true β-lactam allergy is uncommon and cross-reactivity with cefazolin is rare, penicillin allergy labels frequently lead to the use of second or third-line antibiotics. We evaluated perioperative antibiotic prophylaxis patterns and SSI rates among patients with reported penicillin allergies undergoing implant-based breast reconstruction. METHODS: A single-center retrospective chart review was conducted of adult patients who underwent implant-based breast reconstruction between July 2016 and December 2025. Data regarding reported penicillin allergy status and perioperative antibiotic prophylaxis were collected. Primary outcomes included SSI rates among penicillin-allergic and non-penicillin-allergic patients, as well as the incidence of anaphylactic reactions. RESULTS: The study included 614 patients who underwent a total of 923 implant-based reconstruction procedures. All patients were women, with a mean age of 58.1 years and a mean body mass index of 28.2. A total of 94 patients (15.3%) carried a documented penicillin allergy label. Among these, 6 patients (1.0%) reported a history of anaphylaxis, 3 patients (0.5%) had a documented drug-induced hepatotoxicity reaction, and 85 patients (13.8%) reported a nonanaphylactic reaction or had no documented reaction type. SSI rates were significantly higher among patients who received alternative prophylactic antibiotics compared with those who received standard cefazolin prophylaxis (8.8% vs 3.8%, P = 0.023). No anaphylactic reactions to perioperative antibiotic prophylaxis were observed in either group. CONCLUSION: Use of alternative perioperative antibiotic prophylaxis was associated with increased SSI rates. First-generation cephalosporins remain appropriate first-line agents for implant-based breast reconstruction, while alternative antibiotics may be best reserved for patients with clearly documented severe hypersensitivity reactions. *Source: https://ps-rc.org/meeting/Program/2026/EP127.cgi*
title Perioperative Antibiotic Prophylaxis And Surgical Site Infections In Implant-based Breast Reconstruction
topic plastic surgery
reconstructive surgery
conference abstract
PSRC 2026
url https://doi.org/10.5281/zenodo.20064719