Pros and cons of Keller Funnel in capsular contractures removal and cohesive gel implants?

Question

Is the Keller Funnel a wise choice for a patient who had capsular contractures 3 times with saline implants and removal 3 times who currently desires replacement with cohesive gel implants.

Christian Subbio, MD · Answer

At this point, you need to be taking every measure possible to ensure you don't have yet another operation for revision.  The Keller Funnel is one of those measures.  I would1-discuss using textured implants which have been proven to lower contracture rate2-use a submuscular pocket3- potentially use dermal matrix which also shows lower contracture rates, though this is expensive4- use a Keller funnel5- use supersterile technique and minimize implant handling6- utilize postoperative massage7- prescribe Singulair which may slightly help with contracture rates8- Discuss warrantees which cover revisions due to contracture
And other things.  Discuss all of these options with your plastic surgeon.Best of luck!
Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

Shlomo Widder, MD · Answer

Dear Dollie,   Sorry about your problem. You did not provide details of the treatment that you received for the capsule contracture. Severe capsule contracture, requires capsulectomy (scar excision) and replacement of the implant due to 'Biofilm' - bacteria on the implants and in the capsule.   I have been in practice for 30 years and never used the Keller funnel. I never replaced saline implants with silicone implants because of capsule contracture. Moreover, silicone implants have , statistically, higher rate of capsule contracture.   The appropriate procedure for severe capsule contracture  is as mentioned above and should be done by an experienced board certified plastic surgeon who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures of redo breasts augmentation in the photo gallery, to make sure that they are numerous, consistent  and attractive with nice cleavage, perky, symmetrical and natural looking.                                Best of luck,                                             Dr Widder

Farhad Rafizadeh, MD · Answer

It is believed that capsular contraction is caused by bacterial contamination. Therefore a Keller funnel and a no touch technique is very helpful to avoid contact with the skin and the bacteria that live in the skin. In your case with recurring capsular contractions, I would recommend removing the the implants and the capsules and waiting 3 to 6 months and then reinserting the new implant using a no touch technique and the Keller funnel. Keller funnel can be used with anatomic textured cohesive implants. I don't think that these kinds of implants, by themselves can avoid another capsular contraction.

Urmen Desai, MD, MPH, FACS · Answer

Kelly funnel can reduce the incidence of capsular contracture.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified Beverly Hills Plastic Surgeon

Gregory Baum, MD · Answer

Thanks for your question. The answer is it may help but we don't know for sure yet. The latest thinking about capsular contracture is that a biofilm(low-grade bacterial contamination) may play a part in causing this problem. This is why some surgeons change gloves before putting the implants in the pocket and some also use the Keller funnel to try to have a "no touch" technique of putting in the implants to avoid or minimize the chance for skin bacteria contamination of the pocket/implant. Sometimes despite all these maneuvers, you still can get capsular contracture so we don't have all the answers yet. The two stage approach of removing the implants and capsules and then coming back at a later time to put in the implants would also be a wise decision. I would also use textured implants as some reports seem to indicate that textured implants have a slightly lower risk of capsular contracture. Good luck!!

Gregory T. Lynam, MD · Answer

The device is great and at least 2 studies show lower CC rates. you may have biofilm in the pocket and so only solution is to take implants out and put in a new pocket. I may be able to be done the same time or in a staged approach where implants come out first for a period of time. The funnel alone will not fix you and doing the same operation over and over a bad idea. Good Luck!

Tom J. Pousti, MD · Answer

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.

Evan Sorokin, MD · Answer

The Keller Funnel is a genius adjunct to breast surgery but is not a cure in and all of itself.  There are many steps that plastic surgeons will take to reduce the risk of capsular contracture.  The funnel is one of them.  It should be used on all gel breast surgeries in my opinion.  There are no real downsides except cost.  At $125 per funnel some docs simply choose not to use it but that is not an acceptable reason in my opinion.  They use reasons like "I don't need it" or "it's unproven" but no real good reasons.  Many facilities simply won't pay for it.  The hospital I operate won't pay for them so when I operate there I need to bring them myself.  In my own surgical center I use them without even thinking twice about it.  So, capsular contracture is hard to beat.  Make sure you find a surgeon who is going to give you every possible advantage that you can get!

Steven Wallach, MD · Answer

A keller funnel is used by some to insert the implant into the pocket.  I think more importantly is to remove the entire capsule and put a new implant in as well as possible using an ADM if a CC has occurred multiple times.

Pros and cons of Keller Funnel in capsular contractures removal and cohesive gel implants?

Answers (9)

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