In your experiences have you seen a decrease in capsular contraction incidents after using the keller funnel on areola incisions. Thanks for your time.
Has the Keller Funnel Caused a Decrease in Chance for Capsular Contraction?
Doctor Answers (18)
The Keller Funnel insertion sleeve reduces capsular contracture
Capsular contracture has been the number one complication of breast augmentation. Nationally this has occurred in up to 30% of breast augmentation surgeries. This is a complicated process with many factors to consider. The best current theory is that trace bacterial contamination of the implant stimulates white blood cells to release factors that over time can cause the capsule to contract. This can cause the implant to feel hard and look round and elevated. Other factors such as bleeding around the implant can also cause capsular contracture, but this is a minority of the cases. The current standard of practice is to make every attempt to reduce the chance of bacterial contamination of the implant during surgery. Even after a surgical prep, there are still bacteria on the skin and there are normally bacteria in the milk ducts. To minimize the risks of contamination, intravenous antibiotics are given at surgery. The implant and surgical field are irrigated with a combination of several antibiotics. The Keller funnel is a device much like a pastry bag that allows the implant to be inserted without contacting the skin or breast tissue. Since the milk ducts are normally colonized with bacteria, I recommend avoiding the peri areolar incision and use an inframammary crease incision to reduce the chance of contamination. Using these techniques, the incidence of capsular contracture has been reduced to less than 5%. If you are adamant about a periareolar incision, I think you may have a higher risk of capsular contracture but it would still make sense to use an insertion sleeve such as the Keller funnel. Him
Does The Keller Funnel Reduce The Risk Of Capsular Contraction?
Dear Rosy81, The Keller Funnel is a wonderful device that has many benefits already listed by my colleagues. They include: smaller incision size, less trauma to the implant, less trauma to the incision itself, ease of use for the surgeon and reduced risk of implant contamination. I use this device on ALL of my silicone implants and I am able to place the implant into the pocket with a no touch technique. As you have read, most of us believe that this will lead to less capsular contractures. Studies are under way to confirm this belief. I would whole-heartedly recommend using this device.
The Keller Funnel should be used in all breast enhancement procedures
The Keller Funnel is a wonderful device. The idea is simple, yet genius. I wish I had thought of it. I use it on every single silicone breast implant that I place because it certainly does several things:
1) minimize incision size
2) minimize pressure on the implant shell and thus likely extend life of the implant
3) reduce potential bacterial contamination and infection and/or capsular contracture.
To me, it is a no brainer. Why not use it? Well, it costs about $125 per funnel list price. Is it expensive? Absolutely. Is it worth it? It is worth every penny....
Capsular contracture is miserable to deal with. The funnel is a simple and easy way to minimize risk and while it is impossible to do a study where one side has the funnel and one doesn't to see if it really reduces capsular contracture, the downside is so minimal that I believe it should be used.
Ask your surgeon about the device, and if he does not use it, ask why not?
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Keller funnel and capsular contracture
great question!!!! current theories suggest that capsular contracture may be due to contamination with biofilm. an interesting study with the keller funel on cadavers suggest that the funnel is very effective in reducing contamination of the implant. we are currently involved in a study to look at capsular contracture rates with the funnel. so far we think it reduces the risk.
please note that i was asked by one of the implant companies to evaluate the funnel before it became available. i liked it so much i invested in the company and am currently on their advisory board!!! i have used it in every silicone implant case since they became available.
Keller Funnel and Capsular Contraction
One of the thoughts behind capsular contracture is that the implant has some small amount of bacteria on the implant that causes the body to have a reaction and form the capsular scar tissue.
I do believe that the funnel decreases the chance that the implant will have any contaminant on it. The funnel keeps the implant from ever touching the skin.
The other benefits of the Keller funnel is that you can place the implant through a much smaller incision than can be placed with the traditional method. The funnel also avoids unnecessary trauma to the implant or the skin. This is especially important when used for larger implants or through a trans-axillary augmentation.
the funnel has no effect on capsular contracture. It however does reduce the size of the incisions for access and facilitates surgery
Thank You from Dr. Keller (Inventor of the Keller Funnel)
Thank you for your question regarding the Keller Funnel. Please watch the video I have provided below that should hopefully answer your questions thoroughly. If you have any more questions about my funnel, please feel free to ask.
Has the Keller Funnel Caused a Decrease in Chance for Capsular Contraction?
The funnel helps in the insertion of Silicone implants by reducing the push and pull on the implant during insertion and reducing the "touching" of the implant during insertion...But we really don't know if it in fact helps reduce the Capsular Contracture...We are looking for studies to tell us that...And we still continue to "touch" saline implants when we insert them!...so...right now...not sure.
Keller Funnel allows a true "NO-touch" technique for breast augmentation. No touch means less contamination.
Used properly, the Keller Funnel can completely eliminate the surgeon or nurse touching the sterile implant from manufacturer packaging to the actual breast pocket. Bacterial contamination from skin bacteria or intraductal breast bacteria causing a biofilm are the primary causes of capsular contracture, so it makes perfectly good sense that anything which reduces (even minimal) contamination SHOULD reduce the risk of capsular contracture.
My partner and I perform several hundred breast augmentations per year, and we have noted a very low (3-5%) overall incidence of capsular contracture in our own patients for years. We previously utilized "minimal-touch" technique, careful and precise dissection, meticulous hemostasis, Betadine irrigation, and mostly submuscular pocket placement, and our patients benefitted from this with low capsular contracture rates. We (and our patients) benefitted with fewer re-operations!
Many of our colleagues who utilize similar techniques enjoy similarly low capsular contracture rates, and we would anticipate their skepticism that a simple device like a cake frosting cone could make a worthwhile difference (especially at $100 per funnel) in an already-low capsular contracture rate. We were equally skeptical.
Until we tried the device!
It allows more rapid insertion, less force on the implant shell (less inadvertent rupture or shell weakening leading to later rupture), smaller incision, faster closure and a true No-touch technique. If we each reduce our capsular contracture rate by one patient per year, costs for the Keller Funnel are more than covered by elimination of the time and cost of re-operation for capsular contracture. And the re-operations don't always work!
Prevention is truly worth more than a ton of "cure," so we do believe the Keller Funnel is an advance that all breast augmentation surgeons should use. My partner and I have no financial inducements or affiliations with Keller, so I am an unbiased objective user, but I feel so strongly about the potential benefits of this device I recently gave a talk at an international plastic surgery conference about this device.
Until the scientific studies conclusively prove its benefit, I will continue to use and endorse this product. I really don't need a scientific study to show me that wearing a seatbelt is a good idea, and having someone tell me that they never wear a seatbelt and have not had a problem will not persuade me to abandon mine!
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.