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Methods: We systematically searched MEDLINE, EMBASE and CENTRAL from inception to January 2016 by two independent reviewers. We included in vivo studies with the following criteria (1) breast augmentation with implants in adult female; (2) the use of intraoperative irrigation with antibiotic. Our primary outcome was postoperative rate of capsular contracture (Baker III and IV). We assessed the methodologic quality of included studies using MINORS and JADAD scoring system. GRADE tool was utilized in assessing the quality of clinical recommendations merging from this systematic review. Pooled random effects estimates and 95% confidence intervals for complication and capsular contracture rates were derived. Comparisons were performed for breast augmentation with or without the use of intraoperative antibiotic irrigation using a pooled odds ratio and 95% CI.
Results:A total of 12 studies were ultimately included in the review. Most of the studies were level 4 evidence. The most common antibiotic agents used were gentamicin and bacitracin. The pooled estimates were 2.5% (95% CI, 1.2 - 4.2%) for capsular contracture, 4.8% (95% CI, 0.9-11.6%) for reoperation rate, 1.4% (95% CI, 0.5-2.8%) for infection, 2.4% (95% CI, 0.8-4.7%) for seroma and 1.5% (95% CI, 1.2-2.0%) for hematoma. The fixed effects pooled OR of four observational studies (level III evidence) was 0.33 (95% CI: 0.19, 0.57) indicating a protective effect for intraoperative antibiotic irrigation over saline control.
Conclusions: The result of the available evidence suggests that the use of antibiotics irrigation is associated with lower risk of capsular contracture. However, lack of adjustment of other clinical factors and the weak quality of the current evidence are potential limitations of this result. This analysis illustrates the need for better designed studies to definitely answer the question.