Single Versus Extended-dose Antibiotic Prophylaxis Regimens in Reduction Mammaplasty: A Systematic Review and Meta-analysis

Extended postoperative antibiotic regimens remain widely prescribed in reduction mammaplasty, despite variability in practice and insufficient evidence to support their superiority over single-dose preoperative prophylaxis. This divergence in clinical practice carries significant implications for antimicrobial stewardship, healthcare costs, and patient safety. We aimed to synthesize contemporary evidence comparing single-dose preoperative versus extended postoperative antibiotic prophylaxis in reducing surgical site infection (SSI) and postoperative morbidity in reduction mammaplasty. PubMed, Embase, Scopus, Web of Science, Medline (EBSCO), CENTRAL, and Google Scholar were searched from database inception through December 2025. Studies comparing single-dose preoperative versus extended-dose postoperative antibiotic (≥24 hours) prophylaxis in adult females undergoing reduction mammaplasty were included. The primary outcome was SSI, and secondary outcomes included wound complications and operative time. Random-effects models were employed, and risk of bias was assessed with RoB 2.0 and ROBINS-I. Six studies (3 RCTs; 3 observational), including 5,020 patients (2,496 extended-dose; 2,524 single-dose), found no significant difference in SSI rates (OR = 0.66; 95% CI [0.28, 1.60]; p = 0.36). Similarly, secondary outcomes showed no difference in operative time (SMD = 0.19; 95% CI [-0.04, 0.41]; p = 0.11), wound dehiscence (OR = 0.29; 95% CI [0.06, 1.49]; p = 0.14), or delayed wound healing (OR = 2.00; 95% CI [0.65, 6.15]; p = 0.23). This study provides evidence that single-dose preoperative antibiotic prophylaxis is equivalent to extended postoperative courses in preventing infectious and wound-related complications. These findings support antimicrobial stewardship principles and may inform the development of standardized prophylaxis protocols for reduction mammaplasty.