Preliminary Outcomes of Hypochlorous Acid As an Adjunct for Pocket Irrigation in Revision Aesthetic Breast Surgery
Capsular contracture is a challenging problem for patients and plastic surgeons despite advances in surgical technique and breast implants. Breast pocket irrigation has been shown to play an important role in decreasing bacterial bioburden. Recent studies have shown 0.025% stable hypochlorous acid (PhaseOne) to effectively penetrate and disrupt biofilms; however, there is limited data on clinical outcomes of this irrigation when used in breast augmentation. Our study investigates the safety and efficacy of hypochlorous acid pocket irrigation in revision breast augmentation by evaluating rates of capsular contracture recurrence, infection, and allergic reactions.
Methods/Technique:
After IRB approval, a retrospective chart review of patients who underwent bilateral revision breast augmentation for Baker grade III or IV capsular contractures was performed. Data was obtained from three board-certified plastic surgeons. Triple-antibiotic solution with or without betadine was used at the time of primary breast augmentation. 0.025% stable hypochlorous acid was used during revision breast augmentation.
All surgeons used similar preoperative practices and surgical technique, adhering to the principles of Tebbetts and the following modified 14-point plan:
1- Single dose of preoperative antibiotics
2- Inframammary incisions
3- Nipple shields
4- Capsulectomy and removal of old implant
5- Meticulous hemostasis
6- Maintain submuscular plane
7- Breast sizers placed in pocket
8- Irrigation with normal saline; evacuation
9- Irrigation with hypochlorous acid; evacuation
10- 60 cc hypochlorous acid placed in pocket; tension on retractor is released to allow contact with all pocket surfaces for a minimum of 5 minutes
11- Surgeon gloves changed
12- Implant is delivered into pocket with “no-touch” technique
13- Layered closure
14- One of the three surgeons gives post-operative antibiotics
Patient factors recorded included the following:
1) Presence of infection within 30 days as evidenced by breast redness, painful swelling, positive culture or incisional drainage
2) Capsular contracture Baker grade
3) Timing of contracture recurrence
4) Allergic reactions including rash, itching, hives, anaphylaxis
5) Follow-up duration
6) Irrigation used
Results/Complications:
There were 135 breasts in 71 patients included in the study. Patient age range was 27-77 years. Follow-up duration ranged from 12-41 months, with a mean of 20.2 months. There were 3 major complications from two unilateral Baker grade III/IV recurrences after 12 months and one bilateral Baker grade II recurrence at 3 months post-op. There was one reoperation for a recurrence. There were no infections or allergic reactions. The overall capsular contracture Baker grade III/IV recurrence rate was zero at 3 and 12 months and 1.5% at 15 months.
Conclusion:
Breast pocket irrigation is a key factor in controlling bioburden which may influence capsular contracture recurrence rates. Our study evaluated three varied applications of .025% stable hypochlorous acid in revision aesthetic breast surgery and found that it is a safe and effective adjunct to pocket irrigation. Hypochlorous acid has no allergic potential and it is non-toxic to native tissue. We plan to report our findings with hypochlorous acid in primary breast augmentation in the future as well as other studies being conducted on the efficacy of hypochlorous acid in aesthetic surgery.