A Review of Breast Implant Pocket Irrigation With Hypochlorous Acid to Reduce Capsular Contracture Risk

Background: Plastic surgeons commonly irrigate breast implant pockets with antimicrobial solutions to reduce the risk of capsular contracture. Since its introduction ∼ a decade ago, 0.025% hypochlorous acid irrigation has been adopted in many practices. However, a review of this method has not been published. Methods: A literature review was conducted to identify publications that evaluated hypochlorous acid for breast implant pocket irrigation. Results: The literature search produced 13 publications, all appearing in the Aesthetic Surgery Journal, including 3 laboratory studies and 2 clinical chart reviews. The first study, published in 2021, evaluated 71 breast augmentation patients undergoing revision for capsular contracture. The authors reported 3 recurrences (4.2%). The second study, published in 2026 by the same senior author, evaluated patients undergoing primary breast augmentation who were treated with various irrigation solutions, including 40 women who received hypochlorous acid irrigation. The inclusion rate was 62.6%. No capsular contractures were reported for this subset of patients. Most publications included authors with financial conflicts of interest, such as equity ownership, employment, or medical advisory positions with the product's manufacturer. One laboratory study by unconflicted investigators was not supportive. Discussion: No microorganism has been linked to this common complication. The 2 clinical studies are affected by selection bias and conflict of interest, undermining reliability. No independent researchers have corroborated a reduced capsular contracture rate. Conclusions: Both clinical studies have limitations that undermine the reliability of the authors’ conclusions. Without knowledge of a responsible microbe to target and of a change in the breast microenvironment, the scientific rationale for antimicrobial breast pocket irrigation remains unclear.