Effect of Hypochlorous Acid Irrigation on Recurrent Capsular Contracture

Document Type

Conference Proceeding

Publication Date

9-2026

Publication Title

Plastic and Reconstructive Surgery. Global Open

Abstract

Objective: Capsular contracture (CC) continues to be the most common complication occurring after breast augmentation. Despite a multitude of different treatment strategies, the incidence of recurrent CC has remained somewhat stable at up to 54%. It is postulated that CC is the physiologic reaction to the “colonization” of the breast pocket with bacteria. Hypochlorous acid (HOCL) is a new addition to the group of potential irrigating solutions. Previous work has documented that HOCL can kill bacteria on contact and even penetrate an existing biofilm, making it a potentially attractive option for pocket irrigation. The goal of this study was to report the use of a unique pocket irrigation strategy performed postoperatively through the drain, utilizing HOCL to interrupt biofilm formation and theoretically then, the development of CC in a cohort of patients with recurrent CC.

Methods: A cohort of patients presenting with severe CC was gathered through the senior author’s clinic. At the time of surgery, all pockets were irrigated with either HOCL or half strength betadine. Post-op washout treatments were performed on consecutive days following the index procedure when feasible beginning on the first post op day. Each treatment was performed by instilling sterile saline until clear effluent was returned, then instilling 40 cc of HOCl into the pocket, letting it sit for 10 minutes, then reactivating the drain. Many patients were maintained post-operatively on oral antibiotics, a mild steroid taper, and a 6-week course of Montelukast (Singulair). Clinical evaluation was done by the senior author at post operative appointments.

Results: In total, 19 patients (13 bilateral, 6 unilateral) representing 32 breasts underwent postoperative pocket irrigation. Of these, 13 were aesthetic breast patients and 6 were reconstructive. Four of the patients presented with CC after their initial implant procedure, while 15 presented after 2-8 (average 3.6) previous revisionary breast procedures. The number of irrigations utilized for each patient ranged from 1-7 (average 3.4) with the irrigations performed 1 to 14 days postoperatively. Of the 32 breasts treated with this protocol who presented with pre-operative Baker grade 3 or 4 or a Hammond grade 2-3 CC, 20 breasts were graded as Baker grade 1 or Hammond grade 0-1 postoperatively. Overall, a 62.5% success rate and a recurrence rate of 37.5%.

Conclusion: Pocket irrigation with saline followed by HOCL performed after capsulotomy or capsulectomy may be an effective adjunct strategy for treatment of patients who present with recurrent capsular contracture.

Volume

14

Issue

Suppl 4

First Page

11

Last Page

12

Comments

Michigan Academy of Plastic Surgeons 34th Biennial Scientific Meeting, July 12-15, 2026, Mackinac Island, MI

DOI

10.1097/01.GOX.0001276720.87843.84

ISSN

2169-7574

Link to Full Text

Share

COinS