Risk Assessment and Antibiotic Administration Model
We read the interesting article on antibiotic prophylaxis following implant-based breast reconstruction by Phillips and Halvorson.1 Implant-based reconstruction accounts for approximately 75 percent of all reconstructions performed in the United States and 40 to 60 percent of those performed in the United Kingdom. It is clearly evident that there is a lack of high-quality level I evidence in the literature to address the role of antibiotics in patients undergoing breast reconstruction or to support the routine use of postoperative antibiotics after breast surgery with or without drains.2 In the United Kingdom as in the United States, there is wide variation in practice in relation to administration of antibiotics, including the type, mode, and duration.3
It is known that surgical-site infection after breast surgery can lead to delay in adjuvant treatments and poorer cosmetic outcomes, and can have a detrimental effect on health economics. Thus, it is important for a global/national study to address the question and generate a consensus guideline for the use of antibiotics, particularly in reconstructive breast surgery. Until then, I have suggested a risk assessment model (Fig. 1) to guide the administration of antibiotics following implant/breast reconstructive surgery. The comorbidities that may increase the risk of postoperative infection are listed in Table 1.