Background: In implant-based breast surgery, use of implant irrigation to reduce biofilm thus reducing implant infection and capsular contraction is standard practice. However, it is unclear which irrigation is superior. Our study aims to evaluate which implant irrigation is more effective.
Methods: Four databases were used to search for studies published in the last 30 years containing data related to the use of implant irrigation during implant-based breast augmentation and reconstruction surgery. Our primary outcome measures were infection and capsular contraction frequencies (IF and CCF). Specific search terms were used to gather appropriate literature. From the search terms, 808 articles were identified that were eligible for review. Inclusion criteria consisted of irrigation solution names in the article title and discussion of implant irrigation and associated IFs and/or CCFs in the abstract. Exclusion criteria consisted of article titles and abstracts that did not discuss implant irrigation use with breast augmentation and reconstruction surgeries. Two independent screeners identified 3 randomized control trials, 7 prospective studies, and 17 retrospective studies. A meta-analysis was performed to generate a summary proportion of the primary outcomes (IF and CCF) for implant irrigations. Cochran’s Q-test of Homogeneity was performed to identify the type of effects model to be used, with a p-value of 0.1 employed as the measure of significance.
Results: Povidone-iodine (PI) showed the lowest IFs, while oxychlorosense sodium and saline showed the highest IFs. Likewise, triple antibiotic solution (TAS) showed the lowest CCF, while saline and PI showed higher CCF.
Conclusions: Weighted analysis shows the use of PI to be the most effective in reducing IF while TAS is the most effective in reducing CCF. 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.
