Does antimicrobial irrigation of breast implant pockets reduce capsular contracture? A systematic review and meta-analysis
James J. Drinane, D.O1; Tayseer H Chowdhry, M.D.1; W. Benjamin Smisson, M.D.1; Edmond Ritter, M.D., Professor of Plastic Surgery2;
1. Department of Surgery, Medical College of Georgia at Georgia Regents University 2. Department of Surgery, Division of Plastic Surgery, Medical College of Georgia at Georgia Regents University
Purpose: The purpose of this study was to conduct a meta-analysis to determine if irrigation of breast implant pockets with antimicrobial agents reduces the rate of capsular contracture. Capsular contracture is the most common complication following primary augmentation mammoplasty, yet its etiology remains cryptogenic.
Methods: PubMed was searched for publications from January 1 of 2000 through October of 2015. Studies with the following criteria were included: primary breast augmentation with implants, use of antimicrobial irrigation, and documentation of capsular contracture. Our primary outcome was incidence of capsular contracture. The quality of included studies was assessed independently. Studies were meta-analyzed to obtain a pooled odds ratio describing the effect of antimicrobial irrigation on capsular contracture.
Results: The meta-analysis included eight studies and totaled 8538 patients. 5255 patients received antimicrobial irrigation and 3544 patients did not. Analysis revealed that combined antimicrobial irrigation, the antibiotic irrigation subgroup, and iodine subgroup, were associated with an increased incidence of capsular contracture (OR 2.60; 95% CI, 2.3–2.94; OR 1.41; 95% CI, 1.17–1.70; OR 3.19; 95% CI,2.23–4.56; p<0.00001; I2=99.9) respectively.
Conclusions: Antimicrobial irrigation of implant pockets does not reduce the incidence of capsular contracture. The authors recommend that further prospective multicenter trials be conducted to further elucidate the role of antibiotic irrigation in capsular contracture.
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