Abstract
Background:
Prophylactic closed-incision negative pressure wound therapy (ciNPWT) may reduce risk of postoperative wound complications, but its use in breast surgery remains uncertain due to lack of breast-specific recommendations in guidelines. This meta-analysis addresses this gap by evaluating the efficacy of ciNPWT versus standard dressings in non-autologous breast surgery.
Methods:
A meta-analysis of RCTs and observational studies comparing ciNPWT versus standard dressings in patients undergoing mastectomy, implant-based breast reconstruction, or mammoplasty was conducted following PRISMA (from inception to September 2025). Outcomes were total wound complications, surgical site infection, wound dehiscence, necrosis, seroma, haematoma, re-operation, and implant loss. Risk of bias (RoB2, ROBINS-I) and certainty (GRADE) were assessed, and data pooled (RStudio). Registered with PROSPERO (CRD420251002005).
Results:
Twenty studies (6 RCTs, 14 observational) involving 2287 patients (3376 breasts) were included. ciNPWT significantly reduced total wound complications (RR 0.56, 95%CI 0.42–0.74; p0.20).
Conclusion:
Moderate-certainty evidence indicates that ciNPWT reduces postoperative wound complications—particularly dehiscence and necrosis—with a clinically meaningful ARR of 14% for total wound complications. Refining patient selection and device configuration may further enhance its applicability.