SUMMARY
Background
Improved patient safety (PS) in cosmetic breast surgery relies upon high-quality evidence.
The objective of this study was to systematically review the existing evidence for
PS and quality improvement (QI) in cosmetic breast surgery.
Methods
A systematic review of published plastic surgery literature from 1965 to 2021 was
undertaken through a computerized search following PRISMA guidelines. Publication
descriptors, methodological details, and overall results were extracted. Articles
were assessed for methodological quality using either the MINORS, Cochrane ROB2, or
AMSTAR 2 instrument depending on the type of study.
Results
Sixty studies were included. Most studies were retrospective, and 43.3 percent were
from the 3rd level of evidence. Overall, the scientific quality was moderate, with
randomized controlled trials and non-comparative non-randomized studies generally
being rated of higher quality. Studies investigating approaches to antisepsis (38.3
percent) in cosmetic breast surgery indicated conflicting opinions on prophylactic
antibiotics. Studies focusing on risk factor assessment tools (8.3 percent) held possible
utility in identifying high-risk patients for cosmetic surgery. Studies assessing
anesthesia in cosmetic breast surgery (5 percent) demonstrated a significant benefit
to tumescent local anesthesia. Drains for decreasing hematoma and seroma (8.3 percent)
largely showed no benefit.
Conclusions
Overall, PS and QI studies were of moderate quality and investigated numerous interventions.
Our review identified a need for additional studies to decrease infection and other
breast implant morbidities, specifically breast implant-associated anaplastic large
cell lymphoma and capsular contracture.
Keywords
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Article info
Publication history
Published online: June 27, 2022
Accepted:
June 21,
2022
Received:
December 21,
2021
Footnotes
Authorship:
Neetin Prabhu: Contributed to study design, data acquisition, data extraction, analysis of results, drafting of the manuscript, final approval of the manuscript, and agrees to be held accountable for all aspects of the work.
Connor McGuire: Contributed to study design, data acquisition, data extraction, analysis of results, drafting of the manuscript, final approval of the manuscript, and agrees to be held accountable for all aspects of the work.
Paul Hong: Contributed to study design, drafting of the manuscript, final approval of the manuscript, and agrees to be held accountable for all aspects of the work.
Michael Bezuhly: Contributed to study design, data acquisition, analysis of results, drafting of the manuscript, final approval of the manuscript, and agrees to be held accountable for all aspects of the work.
Identification
Copyright
© 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
