Efficacy and Safety of Povidone-Iodine Irrigation in Reducing the Risk of Capsular Contracture in Aesthetic Breast Augmentation: A Systematic Review and Meta-Analysis.

[BACKGROUND] Capsular contracture is common and distressing after aesthetic breast augmentation. The precise cause of capsular contracture is not well established. This systematic review investigates current available evidence regarding perioperative povidone-iodine irrigation safety and efficacy in reducing capsular contracture.

[METHODS] PubMed/MEDLINE, Embase, and Scopus databases were searched for publications through December of 2014. Studies with the following criteria were included: (1) primary breast augmentation with implants; (2) perioperative povidone-iodine use; and (3) documentation of capsular contracture. Our primary outcome was incidence of Baker class III/IV capsular contracture. The methodologic quality of included studies was assessed independently. Trials were meta-analyzed to obtain a pooled odds ratio describing the effect of povidone-iodine irrigation on Baker class III/IV capsular contracture.

[RESULTS] Nine studies with a total of 5153 patients undergoing aesthetic breast augmentation with implants were included. Only three comparative studies achieved high methodologic quality. The meta-analysis included four studies, with 1191 patients receiving povidone-iodine irrigation and 595 patients receiving saline irrigation. The meta-analysis favored povidone-iodine irrigation for decreasing Baker class III/IV capsular contracture (2.7 percent versus 8.9 percent; OR, 0.30; 95 percent CI, 0.18 to 0.50; p < 0.00001; I = 0 percent). The reported implant rupture rates for both saline implants and silicone implants were less than 1 percent.

[CONCLUSIONS] Perioperative povidone-iodine irrigation reduces Baker class III/IV capsular contracture and is not associated with implant rupture. Low methodologic quality of included studies limits recommendations for perioperative povidone-iodine irrigation as the standard of practice. Additional high-quality trials are warranted to corroborate the findings of this meta-analysis.

[CLINICAL QUESTION/LEVEL OF EVIDENCE] Therapeutic, II.