Effectiveness of Closed-Incision Negative Pressure Wound Therapy in Non-Autologous Breast Surgery: A Systematic Review and Meta-Analysis

Why clinicians should know about it

• Picked for Breast and Endocrine Surgery (paper of the day, 8 October 2026).
• Picked for Plastic and Reconstructive Surgery (paper of the day, 8 October 2026): Closed‑incision NPWT reduces wound complications in non‑autologous breast surgery

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; p<0.0001; I²=71.9%; moderate certainty), corresponding to an absolute risk reduction (ARR) of 14% (31.8% to 17.8%). Wound dehiscence (RR 0.48, 95%CI 0.29-0.79; p=0.0037; I²=33.4%) and necrosis (RR 0.67, 95%CI 0.48-0.94; p=0.0187; I²=7.5%) were also significantly reduced. Subgroup analyses suggested stronger effects in BMI ≥30 (RR 0.41 vs 0.61 for BMI <30) and with -125 mmHg settings (RR 0.46 vs 0.65 for -80 mmHg), though differences were not statistically significant (p>0.20). 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.

Abstract as published, via PubMed.