Concentration of Povidone-Iodine Pocket Irrigation in Implant-Based Breast Surgery: A Scoping Review

Abstract

Background: In implant-based breast surgery, microbial contamination of implant surfaces predisposes complications such as overt periprosthetic infection and has been linked to capsular contracture (CC). Anti-microbial practices, including povidone-iodine (PVP-I) breast pocket irrigation, are routinely employed to minimise these risks. No standardised protocol for using this antiseptic exists, particularly concerning the ideal concentration. This review investigates how PVP-I concentration affects outcomes in these procedures while highlighting research gaps.

Methods: Using PRISMA-ScR guidelines, a systematic search was conducted across MEDLINE, Embase, Scopus, and PubMed databases from their inception to June 2024. Studies were screened using pre-determined criteria for inclusion. The methodological quality of relevant studies was assessed using the MINORS tool. Data regarding basic characteristics, PVP-I irrigation implementation, and outcomes (primarily periprosthetic infection and CC) were extracted for analysis.

Results: Nine articles, primarily observational studies, and retrospective analyses were included. These mainly focused on breast augmentation with a few including reconstruction. There was considerable heterogeneity in surgical techniques, and reported PVP-I concentrations ranged from 4 to 20%. This was further confounded by frequent mixing of irrigation solution with antibiotics. Although infection and CC rates were frequently reported, most studies did not specify outcome data for patients receiving PVP-I irrigation.

Conclusions: While PVP-I irrigation is extensively used in implant surgeries, the current evidence base is insufficient to determine the optimal concentration and application techniques. This review underscores the need for further detailed research to establish evidence-based guidelines for PVP-I use, aiming to improve patient care and surgical outcomes in breast surgery.

Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Betadine; Breast augmentation; Breast implant; Breast reconstruction; Capsular contracture; Povidone-iodine.

Fig. 1

PRISMA flowchart illustrating the identification and screening process of studies for inclusion. Reporting checklist: The authors have completed the PRISMA-ScR reporting checklist