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

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. 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. 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. 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. Therapeutic, II.