Hypochlorous acid versus povidone-iodine containing irrigants: Which antiseptic is more effective for breast implant pocket irrigation?

Background: Capsular contracture induced by chronic subclinical infection is a major cause of poor outcomes and reoperation in breast implant surgery. The use of pocket irrigation with antiseptic/antibiotic has been shown to reduce the incidence of contracture. A new formulation of hypochlorous acid solution PhaseOne has been proposed as potential agent for irrigation. Objectives: This study aimed to test the efficacy of hypochlorous acid solution PhaseOne for use in breast pocket irrigation as an alternative to povidone iodine solution Betadine. Methods: The efficacy of PhaseOne, a hypochlorous acid formulated wound and skin cleanser, was tested in vitro against planktonic and biofilm Staphylococcus aureus with or without biological soil and in an implant attachment assay. Its activity was compared with Betadine containing 10% povidone iodine. Results: Our findings showed that PhaseOne was unable to eradicate planktonic and/or biofilm S. aureus in the presence of either tryptone soy broth or bovine calf serum (protein soil) in a variety of in vitro assays. Conclusions: We advise that povidone iodine containing irrigants are superior to hypochlorous acid containing irrigants in the clinical setting and should remain the recommended solution for pocket irrigation to reduce bacterial contamination at breast implants surgery.