Please select the eligibility criteria that correspond to the clinical trial below.
Title: Postoperative Antibiotic Requirements Following Immediate Breast Reconstruction
Brief Summary: Antibiotics are used routinely in postoperative tissue expander based breast reconstruction (TE) and autologous flap (AF) breast reconstruction procedures. Closed suction drains are also used routinely in immediate breast reconstruction to prevent fluid accumulation and seroma formation at the surgical sites. Antibiotics are most often prescribed as a precaution since drains can be a source for infection by creating open channels to outside contaminants. Plastic surgery patients without closed suction drainage devices are usually not placed on prolonged postoperative antibiotics. Current preoperative surgical antibiotic prophylaxis is recommended for up to 24 hours only. These recommendations do not take into account the increased risk of indwelling closed suction drains. A recent survey of plastic surgeons, conducted by SBUMC investigators, (IRB# 129415) found that Plastic Surgeons are divided as to extended outpatient administration following TE breast reconstruction.

The study plans to prospectively enroll patients who will undergo immediate breast reconstruction with TE or AF based breast reconstruction. Using the above data and the current protocol, the investigators will investigate the optimal antibiotic discontinuation period for these patients. The investigators hypothesize that the use of 24-hour perioperative antibiotics in TE or AF based immediate breast reconstruction with closed suction drainage, does not result in an increased infection rate compared to prolonged postoperative antibiotic administration.


Options:
A: Inclusion Criteria:

* Women with histologically diagnosed breast cancer of age group 18-80 years old, ECOG 0-1, clinical stage I to IIIB, admitted to the surgery ward, who were scheduled for elective MRM.

Exclusion Criteria:

* Women with significant co-morbid factors (diabetes mellitus, severe malnutrition, corticosteroid therapy), those scheduled for simultaneous breast reconstruction or bilateral oophorectomy, with intake of antibiotics within one week prior to surgery, with known allergy to cephalosporins, and those with local infection.
B: Inclusion Criteria:

* Women at any age with early stage breast cancer (stage I-II) and American Society of Anesthesiologists (ASA) score of I-II.

Exclusion Criteria:

* Ductal carcinoma in situ (DCIS; stage 0 cancer),
* Advanced or distant metastatic stage,
* Receiving any neoadjuvant therapy,
* History of receiving any antibiotics within prior 3 months,
* History of immunodeficiency,
* Having a remote infection,
* History of reaction to study antibiotics,
* Denial of signing the consent form.
C: Inclusion Criteria:

* All patients presenting to Stony Brook University Medical Center Plastic Surgery clinic for immediate breast reconstruction using a tissue expander.
* Age 18 years or older

Exclusion Criteria

* Delayed or revision implant reconstruction
* Refusal or inability to consent
* Contraindications to surgery as determined by attending physician
* Contraindications to both penicillin/cephalosporin and clindamycin antibiotics (significant allergies)
* Patients with serious existing systemic infection, defined as 2 or more of the following:

Peripheral body temperature \>38 degrees Celsius CRP \>5g/L Leukocytes \> 12,000/microliter
D: Inclusion Criteria:

* diagnosis of mammary neoplasms and plans to undergo an elective ALND of Berg´s levels I and II due to axillary metastasis determined preoperatively by core biopsy or evidence of metastasis in the SLNB in the intraoperative or in the differed analysis.

Exclusion Criteria:

* chronic renal failure due to possible toxicity of gentamicin
* patients undergoing a modified radical mastectomy.

Answer: C