D27. Does Irrigation Solution Influence Surgical Site Infection Rates in Immediate Implant-based Breast Reconstruction?

PURPOSE: There is no universally accepted best practice for type of irrigation agent used at the time of implant-based breast reconstruction. Hypochlorous acid has been proposed as an alternative to traditional formulations due to its robust antimicrobial characteristics with minimal inflammatory properties. This study aims to compare the effect of irrigation formulations on surgical site infection following implant-based breast reconstruction. METHODS: A multicenter retrospective cohort study was conducted on patients who underwent immediate implant-based breast reconstruction after mastectomy from January 2023 through July 2024. The primary outcome assessed was surgical-site infection, which was defined as infections requiring either hospitalization for IV antibiotic management or operative wash-out and explant. RESULTS: Of 301 breast reconstructions, irrigation with 0.033% hypochlorous acid was performed in 77 (25.6%) breasts, double antibiotic (Ancef and Gentamycin) solution with betadine (5% povidone-iodine) in 108 (35.9%) breasts, double antibiotic solution alone in 82 (27.3%) breasts, and betadine solution alone in 34 (11.2%) breasts. Hypochlorous acid was associated with significant reduction in surgical site infection compared to double antibiotic solution alone (1.3% vs 8.5%, p<0.0349) and betadine solution alone (1.3% vs 8.8%, p=0.0189) but similar to double antibiotic solution with betadine (1.3% vs 4.6%, p=0.2067). The average follow-up was 6 months. CONCLUSION: Irrigation with hypochlorous acid may reduce the risk of surgical site infection in implant-based breast reconstruction while limiting the inflammatory reaction commonly seen with antibiotic irrigation. Knowing this, surgeons may choose to utilize hypochlorous acid during implant-based reconstructive procedures, particularly in patients with a history of antibiotic sensitivity.