To Örebro University

Introduction: Wound-related complications following breast surgery are common and may delay adjuvant treatment, prolong healing time ,and increase morbidity. Incisional negative pressure wound therapy (iNPWT) has been proposed as a strategy to reduce postoperative complications across various surgical procedures. However, its effectiveness in breast surgery remains uncertain.

Method: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Studies comparing iNPWT with standard dressings in closed breast surgery incisions were included if they reported at least one wound-related outcome. Comprehensive searches were conducted in MEDLINE, EMBASE, and CENTRAL up to March 2025. A random-effects model using the Hartung-Knapp-Sidik-Jonkman method was applied. Heterogeneity, publication bias, and study quality were assessed using the RoB2 and ROBINS-I tools. The certainty of evidence was evaluated according to the GRADE approach.

Result: Twenty-nine studies involving 4,904 patients were included. iNPWT had a modest but significant effect in reducing the risk o fwound dehiscence (RR: 1.07; 95% CI: 1.03–1.12; p < 0.001; I² = 81.6%) and surgical site infection (RR: 1.05; 95% CI: 1.01–1.09; p = 0.02; I² = 84.13%), despite the substantial heterogeneity. Prediction intervals highlighted the substantial between-study variability. Findings for seroma, skin necrosis, heamatoma, and nipple-areolar complex necrosis were inconclusive. Meta-regression identified low BMI and younger age as potential protective factors for skin necrosis, although no predictors were found for other complications.

Discussion: iNPWT may reduce specific wound complications in breast surgery, but heterogeneity and methodological limitations constrain conclusions. Further high-quality randomized trials with standardized outcomes are needed.