Efficacy and Safety of Povidone-Iodine Irrigation in Reducing the Risk of Capsular Contracture in Aesthetic Breast Augmentation: A Systematic Review and Meta-Analysis
2016; Lippincott Williams & Wilkins; Volume: 138; Issue: 2 Linguagem: Inglês
10.1097/prs.0000000000002376
ISSN1529-4242
AutoresSonia Gaucher, David Maladry, Alexandre Martin, Intissar Benachour, Henri‐Jean Philippe, Sophie Grabar,
Tópico(s)Body Image and Dysmorphia Studies
ResumoSir: Yalanis et al.1 recently published an article entitled “Efficacy and Safety of Povidone-Iodine Irrigation in Reducing the Risk of Capsular Contracture in Aesthetic Breast Augmentation: A Systematic Review and Meta-Analysis.” Meta-analysis is a very helpful tool used by clinicians for making decisions, and we appreciate their methodology (Patients and Methods section), which adequately followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Nevertheless, we would like to discuss some points raised by the selection of the four studies2–5 included for this meta-analysis. First, although the authors explained well the criteria of selection in the Patients and Methods section, they did not enforce them. Indeed, two of the four selected studies (one retrospective study2 and one randomized controlled trial4) have a low methodologic quality according to the scales the authors chose to use. This is against the principle of conducting meta-analysis to select studies of poor quality; otherwise, its results would suffer from the “garbage-in, garbage-out” phenomenon. In line with this, it is unclear why the flowchart indicated that nine studies were selected, whereas the meta-analysis reported only four studies. In fact, only two studies should have been selected for this meta-analysis. Second, regarding the forest plot (Fig. 2 of Yalanis et al.1), it is not clear whether the results are reported by implants or by patients. Indeed, for Burkhardt et al.4 and Burkhardt and Eades,5 results are reported by implants (i.e., for the povidone-iodine group versus the saline group, 71 versus 37 and 52 versus 52, respectively). By contrast, for Giordano et al.,3 patient number are reported (n = 165 in both groups), although Giordano et al.3 reviewed 165 patients and 330 implants by group; for Wiener,2 who reported results by patients, the total for the povidone-iodine group is incorrect (953 versus 903). Moreover, the text of the section “Synthesis of Results” indicates that “1191 patients were allocated to povidone-iodine group and 595 patients were allocated to the saline group,” whereas a total of 1241 for povidone-iodine irrigation and a total of 595 for saline irrigation are reported in Figure 2. These figures are misleading. Third, in the Discussion section, the authors should have discussed in more detail their own study. In particular, the selection of the studies used for the meta-analysis is not discussed, and especially the reason to have kept two studies2,4 of low methodologic quality (see above). They should be more precise, too. For example, they wrote that their “meta-analysis incorporates two randomized controlled trials and two case-control studies,” whereas Burkhardt et al.4 and Burkhardt and Eades5 are two retrospective studies but not case-control studies. Furthermore, there is no discussion about the impact of the application of local antibiotic in addition to the povidone-iodine, with or without prophylactic antibiotics. How does one discriminate between the effect of local antibiotics and povidone-iodine? Nevertheless, the study by Yalanis et al.1 should encourage further investigation in the field of capsular contracture and povidone-iodine irrigation. We fully agree with their statement that “additional high-quality trials are warranted to corroborate the findings of this meta-analysis.” DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Sonia Gaucher, M.D., Ph.D.Université Paris DescartesParis Sorbonne Cité, andService de Chirurgie Générale, Plastique, et AmbulatoireAP-HP, HUPCHôpital Cochin David Maladry, M.D.Service de Chirurgie Générale, Plastique, et AmbulatoireAP-HP, HUPCHôpital Cochin Alexandre Martin, M.D.Université Paris DescartesParis Sorbonne Cité, andService de Chirurgie Générale, Plastique, et AmbulatoireAP-HP, HUPCHôpital Cochin Intissar Benachour, M.D.Service de Chirurgie Générale, Plastique, et AmbulatoireAP-HP, HUPCHôpital Cochin Henri-Jean Philippe, M.D.Université Paris DescartesParis Sorbonne Cité, andService de Chirurgie Générale, Plastique, et AmbulatoireAP-HP, HUPCHôpital Cochin Sophie Grabar, M.D., Ph.D.Université Paris DescartesParis Sorbonne Cité, andUnité de Biostatistique et EpidémiologieAP-HP, HUPCHôpital Hôtel-DieuParis, France
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