Research Summary

Hypochlorous Acid Reduces Surgical Site Infections in Immediate Implant-Based Breast Reconstruction

Anthony Calabro, MA

Key Highlights

  • Hypochlorous acid irrigation reduced surgical site infection (SSI) rates compared with double antibiotic solution alone and betadine alone.
  • SSI rates were lowest with hypochlorous acid (1.3%) and comparable to double antibiotic solution with betadine (4.6%).
  • Hypochlorous acid may be a safer alternative for patients with antibiotic sensitivities.

In a multicenter retrospective cohort study, irrigation with 0.033% hypochlorous acid was associated with lower surgical site infection (SSI) rates in immediate implant-based breast reconstruction compared with other commonly used irrigation solutions. The lowest infection rate (1.3%) was seen in the hypochlorous acid group, suggesting it may be a preferable alternative to more traditional formulations.

Irrigation practices during implant-based breast reconstruction lack consensus on the most effective solution for reducing postoperative infection. While antibiotic-based and povidone-iodine solutions are commonly used, concerns about tissue cytotoxicity and antibiotic resistance have spurred interest in alternative agents. Hypochlorous acid, with its antimicrobial efficacy and minimal cytotoxicity, represents a potential option for surgical irrigation.

The study included patients who underwent immediate implant-based reconstruction following mastectomy between January 2023 and July 2024, excluding those who received delayed or autologous reconstruction. The primary outcome was defined as SSI requiring hospitalization for IV antibiotics, operative wash-out, or explant.

A total of 301 reconstructions were analyzed across 182 patients treated by 17 surgeons. Patients received one of four irrigation regimens: hypochlorous acid (25.6%), double antibiotic with betadine (35.9%), double antibiotic alone (27.3%), or betadine alone (11.2%).

Among the cohort, the mean patient age was 49.5 years, and the mean BMI was 27.3 kg/m². Most patients underwent nipple-sparing mastectomy (75.4%) and received reconstruction in the prepectoral plane (81.4%) using a biologic matrix (98.3%). Surgical site infections occurred in 1.3% of the hypochlorous acid group, compared with 8.5% in the double antibiotic group (P < .0349), 8.8% in the betadine group (P = .0189), and 4.6% in the combination antibiotic and betadine group (P = .2067).

The retrospective nature of the study and the short follow-up period (average 6 months) limit the ability to assess long-term outcomes, such as capsular contracture or late-onset infections.

“Irrigation with 0.033% hypochlorous acid may reduce the risk of SSI in implant-based breast reconstruction while limiting the inflammatory reaction commonly seen with traditional antibiotic irrigation,” the authors concluded.

Reference
DePamphilis MA, Remy K, Austen WG Jr., Carruthers KH. 181. Does irrigation solution influence surgical site infection rates in immediate implant-based breast reconstruction? Plast Reconstr Surg Glob Open. 2025;13(Suppl 1):124-125. doi:10.1097/01.GOX.0001112672.66827.6f