The role of hydroxyethyl starch in preventing surgical-site infections and nipple necrosis in patients undergoing reduction mammaplasty: a prospective case-control study of 334 patients

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

BACKGROUND

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.

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Outcomes and Outcome Measures in Breast Reduction Mammaplasty: A Systematic Review

BACKGROUND

Reduction mammaplasty remains critical to the treatment of breast hypertrophy. No technique has been shown to be superior; however, comparison between studies is difficult due to variation in outcome reporting.

OBJECTIVES

The authors sought to identify a comprehensive list of outcomes and outcome measures in reduction mammaplasty.

METHODS

A comprehensive computerized search was performed. Included studies were randomized or nonrandomized controlled trials involving at least 100 cases of female breast hypertrophy and patients of all ages who underwent 1 or more defined reduction mammaplasty technique. Outcomes and outcome measures were extracted and tabulated.

RESULTS

A total 106 articles were eligible for inclusion; 57 unique outcomes and 16 outcome measures were identified. Frequency of patient-reported and author-reported outcomes were 44% and 88%, respectively. Postoperative complications were the most frequently reported outcome (82.2%). Quality-of-life outcomes were accounted for in 37.7% of studies. Outcome measures were either condition-specific or generic; frequencies were as low as 1% and as high as 5.6%. Five scales were formally assessed in the breast reduction populations. Clinical measures were defined in 15.1% of studies.

CONCLUSIONS

There is marked heterogeneity in reporting of outcomes and outcome measures in the literature. A standardized outcome set is needed to compare outcomes of various reduction mammaplasty techniques.

LEVEL OF EVIDENCE: 4