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Review
. 2025 May 20:22925503251336253.
doi: 10.1177/22925503251336253. Online ahead of print.

The Use of Negative Pressure Wound Therapy for Breast Surgeries: A Systematic Review and Meta-Analysis

Tal Levit  1   2 , Oluwatobi Olaiya  2 , Declan C T Lavoie  1 , Ronen Avram  2 , Christopher J Coroneos  2   3
Affiliations
Review

The Use of Negative Pressure Wound Therapy for Breast Surgeries: A Systematic Review and Meta-Analysis

Tal Levit et al. Plast Surg (Oakv). .

Abstract
in English, French

Background: Negative pressure wound therapy (NPWT) following breast surgery has emerged as a promising intervention theorized to reduce complication rates, improve patient-important outcomes, and enhance cost-effectiveness. This systematic review and meta-analysis aims to determine outcomes of NPWT following breast surgery. Methods: MEDLINE, Embase, CINAHL, Web of Science, and CENTRAL were searched to include all English-language, peer-reviewed observational and randomized controlled trials (RCTs) investigating NPWT on the breast or donor site among patients undergoing breast surgery. Studies evaluated at least one of the following outcomes: wound dehiscence, surgical site infection (SSI), implant loss, re-operation, re-admission, hematoma, seroma, and skin/wound necrosis. Quality of evidence was assessed with GRADE methodology. Results: This review includes 31 studies (eight RCTs, 23 observational) analyzing 3320 patients (4326 breasts). High certainty of evidence indicates decreased risk of wound dehiscence among NPWT patients in RCTs for all NPWT application sites (donor: 0.40; 95%CI 0.21, 0.79; breast: 0.59; 95%CI 0.41, 0.84) and observational trials where NPWT was placed on donor sites (0.64; 95%CI 0.42, 0.98). Some evidence indicates NPWT may reduce SSI, hematoma, seroma, and skin/wound necrosis incidence, however results are uncertain and varied in statistical significance. No effect was identified on rates of breast implant loss, re-operation, and re-admission, although this certainty of evidence is very low. Conclusions: Our findings suggest NPWT following breast surgery reduces the risk of wound dehiscence, may have some effect on SSIs, hematoma, seroma, and skin/wound necrosis; and does not demonstrate an effect on rates of implant loss, re-operation or re-admission.

Historique: Le traitement des plaies par pression négative (TPN) après chirurgie du sein est devenu une intervention prometteuse qui, en théorie, peut réduire les taux de complications, améliorer des résultats importants pour les patientes et s’avérer plus rentable. Cette revue systématique avec méta-analyse vise à établir les résultats de la TPN après une chirurgie du sein. Méthodologie: Une recherche de tous les essais contrôlés randomisés et observationnels, revus par les pairs et en langue anglaise, portant sur la TPN du sein ou d’un site donneur et impliquant des patientes ayant subi une chirurgie du sein a été menée dans les bases de données MEDLINE, Embase, CINAHL, Web of Science et CENTRAL. Les études évaluaient au moins l’un des résultats suivants : déhiscence de la plaie, infection du site chirurgical (ISC), perte de l’implant, réintervention, réhospitalisation, hématome, sérome et nécrose de la peau/plaie. La qualité de la preuve a été évaluée au moyen de la méthodologie GRADE. Résultats: Cette revue a inclus 31 études (8 ECR, 23 essais observationnels) portant sur 3320 patients (4326 seins). Une forte certitude de la preuve indique un moindre risque de déhiscence de la plaie parmi les patientes TPN dans les ECR pour tous les sites d’application de la TPN (donneur : 0,40; IC à 95 % : 0,21 à 0,79; sein : 0,59; IC à 95 % : 0,41 à 0,84) et dans les études observationnelles quand la TPN a été placée sur les sites donneurs (0,64; IC à 95 % : 0,42 à 0,98). Certaines données probantes indiquent que la TPN pourrait réduire l’incidence des ISC, hématomes, séromes et de la nécrose cutanée/de la plaie. Toutefois, ces résultats ne sont pas certains et ont une significativité statistique variable. Aucun effet n’a été identifié sur les taux de perte des implants, de réintervention et réhospitalisation, bien que le degré de certitude de cette preuve soit très faible. Conclusions: Nos constatations suggèrent que la TPN après chirurgie du sein réduit le risque de déhiscence de la plaie et peut avoir un certain effet sur les ISC, les hématomes, les séromes et la nécrose cutanée/de la plaie; en revanche, elles ne font pas apparaître d’effet sur les taux de perte d’implant, de réintervention ou de réhospitalisation.

Keywords: breast; negative-Pressure dressings; negative-Pressure wound therapy; vacuum-Assisted closure.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
A figure of the PRISMA (preferred reporting items for systematic reviews and meta-analyses) 2020 flow diagram.
Figure 2
Figure 2
A: A forest plot displaying meta-analysis results for wound dehiscence among included randomized controlled trials. (NPWT: Negative pressure wound therapy. RCT: Randomized controlled trial. IV: Inverse variance. CI: Confidence interval). B: A forest plot displaying meta-analysis results for wound dehiscence among included observational trials. (NPWT: Negative pressure wound therapy. IV: Inverse variance. CI: Confidence interval).
Figure 3
Figure 3
A: A forest plot displaying meta-analysis results for surgical site infection among included randomized controlled trials. (NPWT: Negative pressure wound therapy. RCT: Randomized controlled trial. IV: Inverse variance. CI: Confidence interval). B: A forest plot displaying meta-analysis results for surgical site infection among included observational trials. (NPWT: Negative pressure wound therapy. IV: Inverse variance. CI: Confidence interval).
Figure 4
Figure 4
A: A forest plot displaying meta-analysis results for breast implant loss among included randomized controlled trials. (NPWT: Negative pressure wound therapy. RCT: Randomized controlled trial. IV: Inverse variance. CI: Confidence interval). B: A forest plot displaying meta-analysis results for breast implant loss among included observational trials. (NPWT: Negative pressure wound therapy. IV: Inverse variance. CI: Confidence interval).
Figure 5
Figure 5
A: A forest plot displaying meta-analysis results for re-operation among included randomized controlled trials. (NPWT: Negative pressure wound therapy. RCT: Randomized controlled trial. IV: Inverse variance. CI: Confidence interval). B: A forest plot displaying meta-analysis results for re-operation among included observational trials. (NPWT: Negative pressure wound therapy. IV: Inverse variance. CI: Confidence interval).
Figure 6
Figure 6
A: A forest plot displaying meta-analysis results for re-admission among included randomized controlled trials. (NPWT: Negative pressure wound therapy. RCT: Randomized controlled trial. IV: Inverse variance. CI: Confidence interval). B: A forest plot displaying meta-analysis results for re-admission among included observational trials. (NPWT: Negative pressure wound therapy. IV: Inverse variance. CI: Confidence interval).
Figure 7
Figure 7
A: A forest plot displaying meta-analysis results for hematoma among included randomized controlled trials. (NPWT: Negative pressure wound therapy. RCT: Randomized controlled trial. IV: Inverse variance. CI: Confidence interval). B: A forest plot displaying meta-analysis results for hematoma among included observational trials. (NPWT: Negative pressure wound therapy. IV: Inverse variance. CI: Confidence interval).
Figure 8
Figure 8
A: A forest plot displaying meta-analysis results for seroma among included randomized controlled trials. (NPWT: Negative pressure wound therapy. RCT: Randomized controlled trial. IV: Inverse variance. CI: Confidence interval). B: A forest plot displaying meta-analysis results for seroma among included observational trials. (NPWT: Negative pressure wound therapy. IV: Inverse variance. CI: Confidence interval).
Figure 9
Figure 9
A: A forest plot displaying meta-analysis results for skin/wound necrosis among included randomized controlled trials. (NPWT: Negative pressure wound therapy. RCT: Randomized controlled trial. IV: Inverse variance. CI: Confidence interval). B: A forest plot displaying meta-analysis results for skin/wound necrosis among included observational trials. (NPWT: Negative pressure wound therapy. IV: Inverse variance. CI: Confidence interval).
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