Should I reconsider a plastic surgeon if they do not use the keller funnel when placing implant?

I would recommend the use of a Keller funnel with any silicone gel augmentation.  It allows a much smaller incision size and possibly less stress on the cohesive gel as it is being inserted.   It is not as necessary for saline implants.  The capsular contracture rate reduction with use of this funnel is not supported by any studies in the literature so thus far it would be theoretical. 

This is a great question.
The Keller funnel has become a very common part of my practice for
several reasons.



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.



Whether a surgeon uses a Keller funnel or not should only be
a small part of your decision making process.
While I do like the funnel a routinely use it, I don’t think this is the
most important part of the operation.



I hope this helps.
Good Luck!

Dear Exited4boobs,   The Keller funnel device  is a plastic cone that is suppose to help the passage of the silicone gel implants into the pocket. I use almost exclusively saline implants where the issue of implants insertion is not an issue, because the implants are inserted empty into the pocket and than filled up. The saline implants have multiple advantages : 1. Small incision at the subareola line which is scar friendly as oppose to long submammary incision that is necessary for gel implants. That area is not scar friendly and can be quite noticeable. 2. The subareola insertion , due to the mobility of the breasts, allows for disection of the cleavage area under direct vision and digital feel which helps to create a beautiful and precise cleavage. This apply also to the creation of the submammary fold. 3. 1/3 of the cost of gel implants. 4. When leakage or rapture of implants ocurre, the saline implants replacement is very simple while the gel implants replacement is complex. In any event, choose a surgeon and not a device. Consult with board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures to make sure that they are numerous, consistent and attractive. Check also the'realself' reviews for positive patients experience which provides important information on the surgeons.                    Best of luck,                                   Dr Widder

While in most silicone cases I use this device it is not a standard of care. In my opinion if I can reduce the risk of contamination and speed up placement of the implant it is worth the price of the funnel.  If the funnel cost less it would be great. I think a product similar to it will come out and be better and cheaper. Pick your surgeon on other factors in my opinion. Good Luck!

I would not use the criteria of used a Keller Funnel to choose a surgeon.  The funnel has nothing to do with the implant volume.  It is used just to facilitate placement of the implant.

The Keller funnel allows insertion of the implant without the implant dragging against the skin, which many surgeons including myself believe increases the risk of small numbers of skin bacteria to adhere to the breast implant.   There is considerable evidence that an important cause of capsular contracture is due to biofilm contamination from skin flora which does not cause clinical infection, but does cause inflammation.  That being said, their are other less expensive strategies to avoid skin coming into contact with the implant.  I do think your surgeon should have some strategy for inserting the implant with a "no skin touch" technique or other techniques to minimize bacteria from adhering to the implant, but the Keller funnel is not the only technique.   Capsular contracture has decreased significantly over the years due to a variety of improvements in technique. 

It is important for you to pick the surgeon that you have good relationship with, good results by photo and reputation, and who is trying to achieve your goals. I feel the keller funnel is a minor technique difference. Good luck.

Thanks for your question.I use the Keller Funnel for my silicone augmentation patients. I find that it makes insertion of the gel implants cleaner, easier and more streamlined. Without stressing the implant incisions can be smaller too. There is not enough information to prove that it can diminish capsular contracture, but intuitively, and in my practice I think it does. Unfortunately, this disposable funnel shaped piece of plastic costs over $100 each. I think that's why many surgeons have not adopted it. I wish I had invented it. You should be able to ask your plastic surgeon any question you wish. Discuss the Funnel as well, you may be doing your PS a favor by showing that it is an important consideration for you.He or she may not have exact statistics at the ready but most can give an honest ball park about the rate of capsular contracture. All plastic surgeons who do breast augmentation will have a small percent of patients that develop capsular contracture. Capsular contraction is not something that surgeons or patients have control over so a frank discussion of it should be embraced and it must be weighed in any patient who is considering breast implants silicone or saline.Best of luck to you in choosing the right surgeon.

A plastic surgeon should know their own capsular contracture rate.  I do not believe the keller funnel decreases its rate. With submuscular placement, apropriate intraoperative antibiotics, and meticulous technique, the rate should be quite small.Good luck,Ary Krau MD FACS

Thank you for the question. In my practice, I use the funnel for all breast augmentation procedures involving silicone gel breast implants of all sizes. I believe that the use of the funnel allows for the use of a smaller incision and for easier breast implant insertion ( allowing for a “no touch technique” and no contact of the breast implant with the patient's skin). Hopefully, in the longer term, it will be shown to decrease the incidence of encapsulation as well. Best wishes with your upcoming surgery.