Effectiveness of incisional negative pressure wound therapy vs. standard dressings in breast surgery: a systematic review and meta-analysis

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 of wound 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.