Extended Antibiotic Prophylaxis in Implant-based Breast Reconstruction: A Systematic Review and Meta-analysis

Extended prophylactic antibiotic (EPA) regimens are commonly used following implant- or tissue expander (TE)-based breast reconstruction, though their efficacy in preventing infection-related complications remains unclear. This systematic review and meta-analysis evaluated whether EPA use (>48 hours postoperatively) reduces surgical site infections (SSIs), explantation, or reoperation events compared to short-course antibiotic regimens (≤48 hours). A comprehensive search of four databases was conducted through May 2025, following PRISMA guidelines. Sixteen studies were included, comprising 8,173 patients in the EPA group and 2,676 in the non-EPA group. Outcomes assessed included overall, minor, and major infections, as well as explantation and reoperation rates. Risk ratios (RR) with 95% confidence intervals (CI) were calculated, and study quality was evaluated using the Downs and Black checklist. No statistically significant differences were found between groups for overall infection (RR 0.90, 95% CI: 0.75-1.06), minor infection (RR 0.62, 95% CI: 0.28-1.33), major infection (RR 0.83, 95% CI: 0.50-1.38), explantation (RR 0.77, 95% CI: 0.46-1.30), or reoperation (RR 1.17, 95% CI: 0.78-1.78). These findings suggest that EPA does not confer additional clinical benefit in reducing postoperative complications following implant-based breast reconstruction. In light of the known risks associated with prolonged antibiotic use-including gastrointestinal disturbances, Clostridium difficile infection, and antibiotic resistance-these results support more judicious, evidence-based prescribing practices. This study provides updated evidence to inform antibiotic stewardship efforts and standardize care in breast reconstruction.