Negative-Pressure Wound Therapy in the Prevention and Management of Complications from Prosthetic Breast Reconstruction: A Systematic Review

Aim: To analyze the outcomes from the use of negative-pressure wound therapy (NPWT) in the prevention and management of complications from prosthetic breast reconstruction.

Method: A systematic review of literature was conducted by using PubMed-MEDLINE for key words: negative pressure wound therapy, breast reconstruction, and prosthesis (including breast implants and tissue expanders).

Results / Discussion: Eight studies with a total of 72 patients undergoing prosthetic breast reconstruction with breast implants or tissue expanders were included. In preventing breast wound complications, there is one case control study using Incisional NPWT (-125 mmHg) after immediate expander-based breast reconstruction for 3 days. The overall mastectomy flap necrosis rate was lower (8.9% vs 23.5%) compared to the conventional dressing group. Another case series also demonstrated good outcome with 24/25 (96%) breasts achieved healing. In the management of nipple-areolar complex (NAC) venous congestion, one case report demonstrated 85% rescue of NAC after using NPWT (- 75 mmHg) for a total of 12 days. In the management of peri-prosthetic infections, two case series used NPWT with instillation. It accelerated the treatment of the infections and maintained the breast cavity for future reconstruction. Conventional NPWT also showed good salvage outcome in three case reports.

Conclusion: NPTW in prosthetic breast reconstruction may be a promising management showing beneficial results with low risk of complications. However, low methodologic quality of included studies limits recommendations for NPWT as the standard of practice. Additional high-quality trials are warranted to corroborate the findings of this systematic review.