***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Epidemiologic data on local complications after breast augmentation  are scarce . In particular , few prospect ively collected data are available on modern breast implants on this issue . Using data from the Danish Registry for Plastic Surgery of the Breast , the authors examined determinants of surgery-requiring complications and capsular contracture grade s III to IV among 2277 women who underwent cosmetic breast implantation from June 1999 through April 2003 . During an average follow-up period of 1.6 years after implantation , 4.3 % of these women ( 3 % of implants ) required secondary surgery as a result of short-term complications . The most frequent clinical indications for surgery were displacement of the implant ( 38 % ) , capsular contracture grade s III to IV ( 16 % ) , ptosis ( 13 % ) , and hematoma ( 11 % ) . Overall , the authors found that inframammary incision and subgl and ular placement were associated with decreased risks of developing complications requiring surgical intervention , whereas implants larger than 350 mL increased the risk of such complications ( relative risk [ RR ] , 2.3 ; 95 % confidence interval [ CI ] , 1.3–4.0 ) . Thirty-nine Baker III to IV capsular contractures were identified , of which 22 were treated surgically within the study period . Submuscular placement of the implant decreased the risk of capsular contracture grade s III to IV ( RR , 0.3 ; 95 % CI , 0.2–0.8 ) , whereas surgical routes other than inframammary and drainage of implant cavity were associated with increased risk of capsular contracture . Current surgical practice s and modern implants used for breast augmentation produce fewer short-term complications than procedures and devices of the past . This prospect i ve study indicates that surgical procedures are more important predictors for local ( short-term ) complications than implant or patient characteristics Background : The role of prophylactic antibiotics in reduction mammaplasty remains controversial . However , most surgeons choose to use antibiotics . In addition to cost and potential allergic reactions , unnecessary administration of antibiotics can suppress host natural flora and produce resistant organisms . Methods : Fifty patients were sequentially assigned to one of three study limbs : ( 1 ) no antibiotics , ( 2 ) preoperative antibiotics only , or ( 3 ) preoperative and postoperative antibiotics . The study was design ed to include approximately 17 patients in each group .  Cephalosporin antibiotics were used unless there was any question of allergy , in which case an alternative antibiotic regimen was used . Preoperative data collected on patients included age , body mass index , history of diabetes mellitus , peripheral vascular disease , previous breast surgery , steroid therapy , and tobacco use . Operative data included specimen weight , operative time , estimated blood loss , prolonged intraoperative hypotension , adjunctive axillary and breast tail liposuction , and intraoperative breast tissue culture . Results : The patient population in the three limbs of the study was similar . Thus , there was no significant difference among the groups insofar as the preoperative data were concerned ( p > 0.20 ) : age , body mass index , diabetes mellitus , peripheral vascular disease , previous breast surgery , and steroid or tobacco use . Furthermore , no significant difference ( p > 0.12 ) was noted among intraoperative data in the three groups : specimen weight , operative time , estimated blood loss , prolonged hypotension , adjunctive breast liposuction , and positive bacterial culture from intraoperative breast tissue sample s. Ninety percent of positive intraoperative breast tissue cultures revealed Staphylococcus epidermidis . Using strict criteria , the infection rate ranged from 19 to 20 percent . There was no significant difference ( p > 0.91 ) in rate of infection among the three study limbs . There was , however , a significant reduction ( p = 0.002 ) in delayed wound healing in the group that received preoperative antibiotics only . Among the studied risk factors for infection , only positive intraoperative culture of breast tissue was significant ( p = 0.008 ) for development of infection . There was a significant association between delayed wound healing and infection ( p = 0.003 ) . Conclusions : This prospect i ve study did not find that prophylactic antibiotics in reduction mammaplasty have an effect on infection ; however , a single preoperative dose significantly improved wound healing Over a 9-month period from September of 1991 to May of 1992 , 339 patients were included in a r and omized , double-blind , placebo-controlled study using azithromycin as the prophylactic agent to determine whether it effects a clinical ly meaningful reduction in postoperative surgical infections in plastic surgery .  Azithromycin was given as prophylaxis in 171 patients and placebo in 168 patients . The study medication was a single oral dose taken at 8 P.M. the day before surgery . The patients were followed up for a minimum of 4 weeks after surgery . The patients who received wound infection prophylaxis had 5.1 percent infections compared with 20.5 percent in the placebo group ( p = 0.00009 ) . Eighty percent of all wound infections were first seen after discharge , explaining why plastic surgeons might overlook their infectious complications . There was a significant reduction in postoperative complications ( p = 0.04 ) and in the additional use of antibiotics postoperatively ( p = 0.007 ) in the prophylaxis group . Subgroup analysis showed a significant reduction in surgical infections in breast surgery ( p < 0.05 ) and reconstructive surgery with flaps ( p < 0.05 ) . No effect of the prophylactic regime was demonstrated in patients undergoing secondary surgery for cleft lip and palate disease This prospect i ve study was conducted to assess the influence of antibiotics use on surgical site infections ( SSI ) rates  after reduction mammaplasty . Patients undergoing reduction mammaplasty were assigned to group 1 ( n = 50 ) , which received intravenous cephalotin pre- and postoperatively , besides oral cephalexin for 6 days after discharge , or to group 2 ( n = 50 ) , which received no antibiotics . Patients were followed up weekly for 30 days , regarding to SSI , by a blinded surgeon . The Centers for Disease Control and Prevention definitions and classification of SSI were adopted . There was no statistical difference between the groups in regard to age , body mass index , duration of operation , and total resection weight . SSI rates were 2 % and 14 % in groups 1 and 2 , respectively ( P = 0.03 ) . In group 2 , older patients and those with higher resection weight had significant higher SSI rates ( P = 0.02 and P = 0.04 , respectively ) . We observed that antibiotics use decreased SSI rates after reduction mammaplasty The use of prophylactic antibiotics in reduction mammoplasty has been r and om and its efficacy unproven . This study review ed 106 consecutive inferior pedicle technique reduction mammoplasties . Two groups were identified ; 47 patients received prophylactic antibiotics  and 59 patients did not . The decision of who received prophylactic antibiotics was r and om based on resident rotation and resident preoperative orders . The demographics were equal between the antibiotic group and the control group . The wound infection rate and the rate of delayed healing were examined in both groups . There were no statistically significant differences in the infection rate or the rate of delayed wound healing in either the antibiotic group or the control group . Individual risk factors were also studied in each group . These risk factors included obesity , older age , smoking history , and large reductions . The use of prophylactic antibiotics did not reduce the infection rate in any of these high-risk groups . Comparing the individual risk factors for the remainder of the patient population showed that the infection rate was higher in obese patients but was unaffected by prophylactic antibiotics .  Delayed healing was also higher in larger reductions but also was unaffected by the use of prophylactic antibiotics . We conclude that the use of prophylactic antibiotics in reduction mammoplasty is not efficacious in reducing the rate of wound infection or delayed healing The main drawback with augmentation mammaplasty using implants is capsular contracture . The cause of this complication is still unknown . Silicone particles , hematoma , and bacterial contamination are some of the etiologic factors discussed . In this r and omized , double-blind study on 76 breast-augmented women , 50 percent of the patients had preoperative prophylaxis with benzylpeni-cillin and dicloxacillin . Bacteria sample s were taken intra-operatively . The number of negative cultures increased significantly with antibiotic prophylaxis . In four follow-ups during the first postoperative year , the rate of contractures was evaluated by subjective and objective methods . The results showed no statistically significant difference between the placebo and the antibiotic group with respect to the incidence of capsular contracture In a prospect i ve , r and om , double-blind , and concurrently controlled clinical study of 124 patients having augmentation mammaplasty , using multiple independent subjective judges as well as objective compressibility measurements , the use of a variety of local antibacterials in or around inflatable retromammary prosthetic implants reduced the early postoperative onset of class III to IV capsular contracture by sevenfold ( 85 percent ) and the final incidence by more than half ( 50 percent ) ( p < 0.01 ) . We believe this study provides the most unequivocal evidence to date that the cause of capsular contracture in retromammary augmentation is periprosthetic bacterial contamination . Irrigation with a 5 percent povidone-iodine ( 50 percent Betadine ) solution was as effective as other techniques and is currently our procedure of choice We assessed the efficacy of perioperative antibiotic prophylaxis for surgery in a r and omized , double-blind trial of 1218 patients undergoing herniorrhaphy or surgery involving the breast , including excision of a breast mass , mastectomy , reduction mammoplasty , and axillary-node dissection . The prophylactic regimen was a single dose of cefonicid ( 1 g intravenously ) administered approximately half an hour before surgery . The patients were followed up for four to six weeks after surgery . Blinding was maintained until the last patient completed the follow-up and all diagnoses of infection had been made . The patients who received prophylaxis had 48 percent fewer probable or definite infections than those who did not ( Mantel-Haenszel risk ratio , 0.52 ; 95 percent confidence interval , 0.32 to 0.84 ; P = 0.01 ) . For patients undergoing a procedure involving the breast , infection occurred in 6.6 percent of the cefonicid recipients ( 20 of 303 ) and 12.2 percent of the placebo recipients ( 37 of 303 ) ; for those undergoing herniorrhaphy , infection occurred in 2.3 percent of the cefonicid recipients ( 7 of 301 ) and 4.2 percent of the placebo recipients ( 13 of 311 ) . There were comparable reductions in the numbers of definite wound infections ( Mantel-Haenszel risk ratio , 0.49 ) , wounds that drained pus ( risk ratio , 0.43 ) , Staphylococcus aureus wound isolates ( risk ratio , 0.49 ) , and urinary tract infections ( risk ratio , 0.40 ) . There were also comparable reductions in the need for postoperative antibiotic therapy , non-routine visits to a physician for problems involving wound healing , incision and drainage procedures , and readmission because of problems with wound healing . We conclude that perioperative antibiotic prophylaxis with cefonicid is useful for herniorrhaphy and certain types of breast surgery The aim of this r and omized clinical trial was to determine whether a single intravenous dose of 2 g flucloxacillin could prevent wound infection after primary non‐reconstructive breast surgery 
    Output:
    
In cases of reduction mammaplasty , when antibiotics are administered as a single preoperative dose , the risk of developing surgical-site infection is halved .
With augmentation mammaplasty , there was no effect on infection rates with any antibiotic regimen .
For augmentation mammaplasty , there is no evidence to refute current guidelines , based on recommendations obtained from other forms of implant surgery .