Abstract P20. Does Antimicrobial Irrigation Of Breast Implant Pockets Reduce Capsular Contracture? A Systematic Review and Meta-analysis

Abstract Aim This systematic review and meta-analysis aims to synthesize the current evidence and establish the efficacy of the various managements of infected breast implants. Method A comprehensive search in the MEDLINE, EMBASE and CENTRAL databases was conducted for primary clinical studies reporting on the management of infected breast implants from 1946 to September 2019. The primary outcome measure was the proportion of patients with successful treatment. Results Nineteen articles involving 1044 patients were included. Mild infections seen in 29.00%(95%CI=11.51% to 50.58%) of the patients were treated exclusively with antibiotics, of which, 81.41%(95%CI=57.82% to 96.63%) were successfully treated without the need for surgical intervention. Overall, 39.01%(95%CI=21.41% to 58.23%) of the patients underwent surgical salvage of the infected breast implants, of which 84.56% (95%CI= 74.92% to 92.20%) successfully retained the salvaged implants without infection recurrence. Meanwhile, 35.01%(95%CI=27.01% to 43.57%) of the patients underwent explantation of the infected breast implant, of which, only 39.02%(95%CI=23.93% to 55.28%) had re-insertion of a new implant on a later date, and 4.99% (95%CI=1.66% to 9.99%) of these patients had recurrence of infection requiring removal of the infected implant. The commonest complication was capsular contracture, which was reported in 10.78%(95%CI=4.41% to 19.49%) of the patients. Changes in the quality of life and cost implications were not reported. Conclusions This study consolidates current available evidence on the management of infected breast implants, which could assist decision making and improve patient education, however current data is limited by the lack of level-1 evidence.

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Risk factors for developing capsular contracture in women after breast implant surgery: A systematic review of the literature

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2018.08.010 ◽

2018 ◽

Vol 71 (11) ◽

pp. e68 ◽

Cited By ~ 2

Author(s):

Yara Bachour ◽

Marco J.P.F. Ritt

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Breast Implant ◽

Capsular Contracture ◽

Review Of The Literature ◽

Implant Surgery

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Nonsurgical treatment of capsular contracture: Review of clinical studies

Journal of International Medical Research ◽

10.1177/0300060520927873 ◽

2020 ◽

Vol 48 (6) ◽

pp. 030006052092787

Author(s):

Anthony Papaconstantinou ◽

Triantafyllia Koletsa ◽

Efterpi Demiri ◽

Kostantinos Gasteratos ◽

Sofia-Eleni Tzorakoleftheraki ◽

...

Keyword(s):

Systematic Review ◽

Plastic Surgery ◽

Clinical Studies ◽

Breast Implant ◽

Capsular Contracture ◽

Nonsurgical Treatment ◽

Reconstructive Plastic Surgery ◽

Reconstructive Plastic

Capsular contracture is one of the most distressing complications of breast implant use in both aesthetic and reconstructive plastic surgery procedures. This systematic review was performed to assess the effectiveness of all nonsurgical treatments for established capsular contracture.

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Comprehensive Comparison Between Shaped Versus Round Implants for Breast Reconstruction: A Systematic Review and Meta-Analysis

Aesthetic Surgery Journal ◽

10.1093/asj/sjaa128 ◽

2020 ◽

Vol 41 (1) ◽

pp. 34-44 ◽

Cited By ~ 1

Author(s):

So-Eun Han ◽

Kyeong-Tae Lee ◽

Saik Bang

Keyword(s):

Breast Reconstruction ◽

Meta Analysis ◽

Breast Implant ◽

Capsular Contracture ◽

Complication Rates ◽

Level Of Evidence ◽

Relative Risks ◽

Patient Reported ◽

Aesthetic Results ◽

Retrospective Cohort Studies

Abstract Background Prosthetic breast reconstruction has been gaining popularity and a variety of implant options are currently available. Therefore, it is important to evaluate the safety and efficacy of newly developed shaped implants compared with those of conventional round implants. To date, few studies have investigated the outcomes of breast reconstruction with shaped versus round implants. Objectives The present study aimed to comprehensively compare, via meta-analytic methodology, shaped and round breast implant reconstruction in terms of complication profiles and aesthetic satisfaction. Methods PubMed/MEDLINE, Ovid, and Cochrane databases were searched to identify relevant studies presenting the complication rates for shaped and round implant groups. The relative risks of the following complications between the groups were calculated: infection, seroma, capsular contracture, rupture, rippling, reconstruction failure, and implant exchange or removal. Outcomes of aesthetic satisfaction included aesthetic results and patient-reported outcomes. Results Meta-analysis of 8 retrospective cohort studies, representing 2490 cases of implant-based breast reconstruction, was performed. There were no significant differences in the risks of infection, seroma, capsular contracture, and reconstruction failure between the 2 groups. The risks of implant rupture and rippling were significantly reduced with shaped implants. In a subgroup analysis of shaped/textured and round/smooth implants, the risk of infection was significantly enhanced in the former, whereas incidences of other complications, including capsular contracture and reconstruction failure, were similar. Aesthetic satisfaction analysis of the 2 groups demonstrated similar outcome scores with favorable overall results. Conclusions Our results suggest that both shaped and round implants might provide favorable breast reconstruction outcomes with similarly low complication rates and aesthetic results. Level of Evidence: 4

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Accuracy of Ultrasonography in Breast Implant Rupture Diagnosis: Systematic Review and Meta-Analysis

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000008408 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Ana C. M. Lacerda ◽

George Carvalho ◽

Maria L. R. Uggioni ◽

Daniela V. Bavaresco ◽

Carla S. Simon ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Breast Implant ◽

Implant Rupture ◽

Breast Implant Rupture

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Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Systematic Review of the Literature and Mini-Meta Analysis

Current Hematologic Malignancy Reports ◽

10.1007/s11899-013-0164-3 ◽

2013 ◽

Vol 8 (3) ◽

pp. 196-210 ◽

Cited By ~ 49

Author(s):

Philip A. Thompson ◽

H. Miles Prince

Keyword(s):

Systematic Review ◽

Anaplastic Large Cell Lymphoma ◽

Cell Lymphoma ◽

Meta Analysis ◽

Breast Implant ◽

Large Cell ◽

Review Of The Literature ◽

Large Cell Lymphoma

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Microtexture and the Cell/Biomaterial Interface: A Systematic Review and Meta-Analysis of Capsular Contracture and Prosthetic Breast Implants

Aesthetic Surgery Journal ◽

10.1093/asj/sjy178 ◽

2018 ◽

Vol 39 (6) ◽

pp. 603-614 ◽

Cited By ~ 4

Author(s):

Orr Shauly ◽

Daniel J Gould ◽

Ketan M Patel

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Capsular Contracture ◽

Breast Implants

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1443 Comparison of Outcomes Between Immediate Direct-to-Implant Breast Reconstruction versus Two-Stage Implant Breast Reconstruction; a Systematic Review and Meta-analysis

British Journal of Surgery ◽

10.1093/bjs/znab259.225 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

O Kelly ◽

I Balasubramanian ◽

C Cullinane ◽

R Prichard

Keyword(s):

Systematic Review ◽

Breast Reconstruction ◽

Meta Analysis ◽

Capsular Contracture ◽

Tissue Expander ◽

Immediate Breast Reconstruction ◽

Two Stage ◽

Significant Difference ◽

Implant Reconstruction ◽

Implant Breast Reconstruction

Abstract Background Direct-to-implant (DTI) breast reconstruction is increasingly performed as the preferred method of immediate breast reconstruction following mastectomy. The proposed advantages of DTI over two-stage tissue expander (TE)/implant reconstruction relate to fewer surgical procedures. This systematic review and meta-analysis aims to evaluate the safety and efficacy of DTI versus conventional TE/implant breast reconstruction. Method A systematic review was performed (PubMed, Embase, Scopus) to identify relevant studies that compared outcomes between DTI and TE/Implant reconstructions. Publications up to October 2020 were included. The primary outcome was overall complication rate. Secondary outcomes included infection rate and implant loss. Results Nineteen studies, including 32,971 implant-based breast reconstructions, were analysed. Median age was 48 years. Mean BMI was 25.9. There was no statistically significant difference between the two groups. Duration of follow up ranged from 1-60 months. Overall complications were significantly more likely to occur in the DTI group (OR 1.81 [1.17-2.79]). Overall complications refers to all reported complications including seroma, haematoma, would dehiscence, infection, skin necrosis and capsular contracture. Implant loss was also significantly higher in the DTI cohort (OR 1.31 [1.12-1.78]). There was no significant difference in infection rates between the two groups. Subgroup analyses, focusing on high-powered multicentre studies showed that the risks of overall complications were significantly higher in the DTI group (OR 1.51 [1.06-2.14]). Conclusions This meta-analysis demonstrates significantly greater risk of complications and implant loss in the DTI breast reconstruction group. These findings serve to aid both patients and clinicians in the decision-making process regarding implant reconstruction following mastectomy

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Implants and Breast Pocket Irrigation: Outcomes of Antibiotic, Antiseptic, and Saline Irrigation

Aesthetic Surgery Journal ◽

10.1093/asj/sjab181 ◽

2021 ◽

Author(s):

Amanda N Awad ◽

Adee J Heiman ◽

Ashit Patel

Keyword(s):

Systematic Review ◽

Hypochlorous Acid ◽

Povidone Iodine ◽

Breast Implant ◽

Capsular Contracture ◽

Saline Irrigation ◽

Concurrent Use ◽

Significant Difference ◽

Poor Outcomes ◽

Reoperation Rates

Abstract Background 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. Objectives The objective of this systematic review is to compare clinical outcomes, specifically capsular contracture, infection, and reoperation rates, associated with the use of antibiotic, antiseptic, and saline irrigation. Methods A systematic review was performed in March 2020 using 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 using forest plots. Results Out of the 104 articles were screened, 14 met inclusion criteria. There was no significant difference in capsular contracture rates between antibiotic and povidone iodine irrigation, although the data comparing these two groups was limited and confounded by the concurrent use of steroids. Antibiotic irrigation showed a significantly lower rate of capsular contracture compared to saline irrigation and a lower rate of capsular contracture and reoperation compared to no irrigation at all.. Povidone iodine was associated with lower rates of capsular contracture and reoperation compared to saline irrigation but there was no data on infection rates specific to povidone iodine irrigation. Conclusions Our study supports the use of antibiotic or povidone iodine use for breast implant irrigation. Further research is required to better determine which of these two irrigation types is superior.

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