A Meta-analysis of Breast Implant Irrigation Solutions' Effect on Infection and Capsular Contracture Frequencies

In implant-based breast surgery, use of implant irrigation to reduce biofilm, thus reducing infection and capsular contracture, is standard practice. However, it is unclear which irrigation is superior.

The aim of this systematic review was to evaluate the most commonly cultured bacteria from infected implants and the efficacy of different irrigation solutions in reducing the risk of implant infection and capsular contracture.

Using Covidence, 808 studies published in the last 30 years in relation to implant irrigation use during implant-based breast augmentation and reconstruction surgery were identified. These studies were screened based on the eligibility criteria, and 27 studies were included as a part of the systematic review. The primary outcome measures of interest were implant infection and capsular contracture frequencies. Saline, povidone-iodine, chlorhexidine, triple antibiotic solution (TAS), and other antibiotics (eg, biodegradable antibiotic beads, bacitracin, and continuous vancomycin), were the different types of irrigation solutions identified in these studies. Descriptive analysis of the different species of bacteria cultured from all infected implants was conducted. A meta-analysis was performed to generate a summary proportion of the primary outcomes for implant irrigations.

Staphylococcus aureus (25.5%), coagulase-negative Staphylococcus (19.8%), and Pseudomonas aeruginosa (9.1%) were the most frequently cultured bacteria from infected implants. Gram-positive bacteria (62.6%) were more commonly cultured from infected implants than gram-negative (16.1%) bacteria. Povidone-iodine showed the lowest infection frequency, while saline and TAS showed the highest infection frequencies. Additionally, TAS showed the lowest capsular contracture frequency, while saline and povidone-iodine showed higher capsular contracture frequency.

Povidone-iodine was the most effective in reducing infection frequency while TAS was the most effective in reducing capsular contracture frequency. As the TAS in these studies include cefazolin, gentamycin, and bacitracin (which is no longer available as a solution), further research to determine efficacy of antibiotic solution without bacitracin is required. To potentially reduce the risk of implant infection and capsular contracture, plastic surgeons should consider which implant irrigation solutions are most effective against common bacterial pathogens.