Implants and Breast Pocket Irrigation: Outcomes of Antibiotic, Antiseptic, and Saline Irrigation

Abstract

Background Breast implant-associated infection and capsular contracture are challenging complications that can result in poor outcomes following implant-based breast surgery. Antimicrobial irrigation of the breast pocket or implant is a widely accepted strategy to prevent these complications, but the literature lacks an evidence-based consensus on the optimal irrigation solution. Objectives The objective of this systematic review is to compare clinical outcomes, specifically capsular contracture, infection, and reoperation rates, associated with the use of antibiotic, antiseptic, and saline irrigation. Methods A systematic review was performed in March 2020 using the following search terms: “breast implant,” “irrigation,” “antibiotic,” “bacitracin,” “antiseptic,” “povidone iodine,” “betadine,” “low concentration chlorhexidine,” and “hypochlorous acid.” Capsular contracture, infection, and reoperation rates were compared using forest plots. Results Out of the 104 articles were screened, 14 met inclusion criteria. There was no significant difference in capsular contracture rates between antibiotic and povidone iodine irrigation, although the data comparing these two groups was limited and confounded by the concurrent use of steroids. Antibiotic irrigation showed a significantly lower rate of capsular contracture compared to saline irrigation and a lower rate of capsular contracture and reoperation compared to no irrigation at all.. Povidone iodine was associated with lower rates of capsular contracture and reoperation compared to saline irrigation but there was no data on infection rates specific to povidone iodine irrigation. Conclusions Our study supports the use of antibiotic or povidone iodine use for breast implant irrigation. Further research is required to better determine which of these two irrigation types is superior.

Does Antibiotic Irrigation Really Reduce the Risk of Capsular Contracture of the Breast?

“…In contrast to the findings of this review by Awad et al, [ 1 ] 3 recently published systematic reviews, [ 9 , 20 , 25 ] including a meta-analysis [ 20 ] find no benefit for antibiotic irrigation or povidone-iodine irrigation. Swanson discontinued any form of antibiotic irrigation in favor of sterile saline irrigation without a change in capsular contracture rate (6%) [ 10 , 26 ].…”

“…Awad et al [ 1 ] report a systematic review comparing capsular contracture rates with the type of pocket irrigation. The authors conclude that antibiotic irrigation leads to significantly fewer capsular contractures than saline irrigation.…”

“…Drinane et al [ 4 ] reported 2 capsular contractures among 27 women (54 breasts) receiving antibiotic irrigation and 2 capsular contractures among 28 women (56 breasts) treated with saline irrigation. The difference in risk for both studies, whether considered individually or combined, is nonsignificant [ 1 ].…”

“…Awad et al [ 1 ] also compared antibiotic irrigation with no irrigation [ 1 ]. Only two studies included such a comparison [ 7 , 8 ].…”

Pharmacological Approaches for the Prevention of Breast Implant Capsular Contracture

“…Irrigation of the breast implant pocket, and/or the implants themselves, with various sterile or drug solutions is both widely reported and practised as part of efforts to reduce the rate of CC and for mitigating the risk of BIA-ALCL. 117,164,118,[169][170][171][172] Commonly administered solutions include sterile saline, 115,173 a triple antibiotic solutions (such as bacitracin, neomycin and polymyxin b), 115 and triamcinolone acetonide (Table ). 139 The results to date have been mixed.…”