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Article Abstract
Background: The practice of systemic antibiotic prophylaxis to prevent surgical site infection (SSI) in breast surgery remains debated. The aim of this review is to provide a comprehensive overview of the literature evaluating the current evidence on the efficacy of antibiotic prophylaxis in nononcologic breast surgery, including risk-reducing mastectomy, gender-affirming mastectomy, augmentation, and reduction.
Methods: A literature search of PubMed and Cochrane databases of 1990-2025 was conducted to identify studies evaluating antibiotic prophylaxis and SSI outcomes in nononcologic breast surgery. Included studies were screened and analyzed by procedure type, study design, and outcomes.
Results: The impact of antibiotic prophylaxis varied by procedure type. For risk-reducing mastectomy, the results were mixed. Multiple clinical trials indicated no significant reduction in SSI with antibiotic prophylaxis, while one meta-analysis and one cohort study suggested that antibiotics may decrease the risk of SSI. Additionally, one randomized controlled trial in overweight or obese patients indicated that antibiotic prophylaxis significantly decreased SSI in risk reducing mastectomy. In gender-affirming mastectomy, infection rates were low (approximately 3%-5%), and evidence supports single-dose preoperative prophylaxis. For breast reduction, multiple systematic reviews and clinical trials indicated a significant reduction in SSI with prophylactic treatment. Two randomized controlled trials indicated that extending antibiotic prophylaxis into the postoperative period had no significant impact on SSI. For breast augmentation, systematic reviews and clinical studies found no significant reduction in SSI with prophylactic antibiotic treatment. While one systematic review suggested SSI reduction in implant-based reconstruction, this was not observed in breast augmentation.
Conclusions: The use of antibiotic prophylaxis within nononcologic breast surgery remains poorly defined, with reported effectiveness varying depending on the type of surgery, duration of treatment, and risk factors of the patient. Further high-quality clinical trials are warranted to fully evaluate the role of prophylactic antibiotic use in nononcologic breast surgery.
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