Albany Medical College, Albany, NY, USA.
Division of Plastic Surgery, Albany Medical Center, Albany, NY, USA.
Aesthet Surg J. 2022 Jan 12;42(2):NP102-NP111. doi: 10.1093/asj/sjab181.
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.
The objective of this systematic review was to compare clinical outcomes, specifically capsular contracture, infection, and reoperation rates, associated with the use of antibiotic, antiseptic, and saline irrigation.
A systematic review was performed in March 2020 based on 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 by analysis of forest plots.
Out of the 104 articles screened, 14 met the inclusion criteria. There was no significant difference in capsular contracture rates between antibiotic and povidone-iodine irrigation, although the data comparing these 2 groups were limited and confounded by the concurrent use of steroids. Antibiotic irrigation showed a significantly lower rate of capsular contracture compared with saline irrigation and a lower rate of capsular contracture and reoperation compared with no irrigation at all. Povidone-iodine was associated with lower rates of capsular contracture and reoperation compared with saline irrigation but there were no data on infection rates specific to povidone-iodine irrigation.
Our study supports the use of antibiotics or povidone-iodine for breast implant irrigation. Further research is required to better determine which of these 2 irrigation types is superior.
乳房植入物相关感染和包膜挛缩是具有挑战性的并发症，可导致乳房植入术后的不良结局。对乳房袋或植入物进行抗菌冲洗是预防这些并发症的广泛接受的策略，但文献中缺乏关于最佳冲洗溶液的循证共识。
本系统评价的目的是比较使用抗生素、防腐剂和生理盐水冲洗时与临床结果（特别是包膜挛缩、感染和再次手术率）相关的结果。
2020 年 3 月进行了系统评价，使用了以下搜索词：“乳房植入物”、“冲洗”、“抗生素”、“杆菌肽”、“防腐剂”、“聚维酮碘”、“洗必泰”、“低浓度氯己定”和“次氯酸”。通过森林图分析比较包膜挛缩、感染和再次手术率。
在筛选出的 104 篇文章中，有 14 篇符合纳入标准。抗生素和聚维酮碘冲洗的包膜挛缩发生率没有显著差异，尽管比较这两组数据的数量有限且受到类固醇的影响。与生理盐水冲洗相比，抗生素冲洗的包膜挛缩发生率显著降低，与完全不冲洗相比，包膜挛缩和再次手术的发生率也较低。与生理盐水冲洗相比，聚维酮碘冲洗的包膜挛缩和再次手术发生率较低，但没有关于聚维酮碘冲洗感染率的具体数据。
我们的研究支持使用抗生素或聚维酮碘进行乳房植入物冲洗。需要进一步的研究来更好地确定这两种冲洗类型中哪一种更优越。
