Strattice & Keller Funnel Consideration for my Capsule Contractor Breast?
Doctor Answers (12)
Most plastic surgeons who perform reconstructions have experience with acellular dermal matrix which strattice is one of many on the market. These are really good for reconstructing the pocket when there is a lot of tissue atrophy and thinning
Using strattice propery does take experience. If the surgeon tells you he has never used strattice and it is your idea, find someone with experience using it if that is indeed what you want. However, strattice may not be the cure-all that you think it is. Despite encouraging experience using it in the early going, many surgeons are seeing patients with strattice develop recurrent capsules, which is no surprise. As far as the Keller funnel is concerned, it's benefit in reducing capsules is purely hypothetical.
Treating capsular contracture
With a removal of all the scar tissue (complete capsulectomy), new implants, and using the under the breast incision, capsular contracture can usually be treated without anything fancy.
Textured implants only have an advantage in reducing capsular contracture when the implants are in front of the muscle, but anyone with contracture should be thinking about putting the implants behind the muscle.
The Keller funnel is but a means of avoiding contamination with the skin, and there is not one iota of proof that it helps with capsular contracture.
Strattice is not FDA approved for prevention of capsular contracture, but I and many others are using it enthusiastically for that purpose (off label.) I usually don't do it after a first time contracture, especially when there are things to do that reduce the chances of contracture which had not been done during the previous operation(s). But when contracture is recurrent and when everything has already been done properly, then i am very much in favor of it.
I have taught a number of surgeons how to use Strattice. There is some information on my website, which is listed below.
Good luck. Oh - one more thing - don't tell your surgeon to use strattice, the keller funnel, or anything else. pick a surgeon in whom you have total confidence.
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Smaller implants retro-pectoral to minimize contracture
Unfortunately, you have not provided any photographs, your bra size or whether your implants were placed in front or behind the muscle. There is a new technique called Implant Exchange with Mini Ultimate Breast Lift. Using only a circumareola incision it is possible to exchange the implants, reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage. Aligning the areola, breast tissue and implant over the bony prominence of the chest wall gives maximum anterior projection with a minimal size implant. I always recommend silicone gel implants placed retro-pectoral since they look and feel more natural and are less likely to ripple. Smaller implants are more stable long term, are less likely to have complications and need revisions. You would be an excellent candidate for this new technique, which does not require a strattice, which is quite expensive.
Gary Horndeski, M.D.
Experience is the Best Teacher
The Kenner funnel is used for primary augmentation where there is a small incision. In a revision your incision may include a lift or just a larger incision where there would be plenty of room to place the implant. STRATTICE ® is typically indicated to help reposition poorly positioned implants (internal bra) and not for capsular contracture. The typical way to treat capsular contracture would be to remove the capsule and change the site of the implant. Trust your doctors 18 years of experience.
Use of the Keller final during breast augmentation to decrease capsular contracture is controversial.
Use of the Keller final when inserting a breast implant has theoretical merit but has not been established as a means of eliminating capsular contracture. The use of acellular dermal matrix to decrease capsular contracture is also controversial in you must be familiar with the downside before signing a consent.
Capsular contracture treatment and prevention
Capsular contracture can be a very frustrating problem. There are many things that we do to help prevent the problem but we do not always know the exact cause. I believe that the use of the Keller funnel helps to reduce any surface contamination of the implant. Strattice is an option but is very expensive and I would only consider it in a case that has failed every other possibility. There is currently no long term data > than 5 years, demonstrating that Strattice is a long term solution for capsular contracture. I wish that this was not the case or we would use it every time. Some surgeons will have more experience with the material than others.
Capsular contracture issues
No one thing will prevent a capsular contracture. While I know how to use a Keller funnel, I have not incorporated that into my practice. Strattice can help with recurrent capsules. But there are many variables that may impact capsular formation.
Capsular contracture prevention
I am sorry to "muddy the waters" by giving you conflicting information, but if you trust your surgeon to do the procedure, let him (or her) decide how best to accomplish this. none of the surgeons on this website have examined you or know you. You should trust your surgeon. Strattice is not a sure way to prevent recurrent capsular contracture although it may help lower the risk of recurrence. Same thing goes for the funnel. In fact, the most important thing is to try to identify what happened and prevent it from happening again. This is where trust of your surgeon comes into play.