How is the subfascial breast augmentation with Keller funnel technique?

Question

Hi, i was Reading about subfascial BA with the use of the Keller funnel and wanted to know your thoughts.

Daniel Barrett, MD · Answer

Dear Easygoing303343,

I almost always place implants submuscularly. This significantly lowers the rate of capsular contracture. In addition, it looks much more natural because the muscle covers the implant, so it's not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle. I use a Keller funnel to reduce the chance of capsular contracture.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

James M. Economides, MD, FACS · Answer

Subfascial breast augmentation (BA) combined with the use of the Keller Funnel is an interesting approach that offers several advantages. Let me break down both components for you and explain how they might benefit your surgery.

Subfascial Breast Augmentation:
This technique involves placing the implant under the fascia, which is a thin layer of connective tissue that covers the chest muscle, rather than directly under the muscle or over it (subglandular). Here's what you might want to know about this placement:

Pros:
Less Muscle Interference: Since the implant isn’t placed directly under the chest muscle, this technique can be better for those who are very active or lift weights (like yourself), as it avoids issues with muscle distortion when flexing or engaging the chest.

Faster Recovery: Subfascial placement typically has a faster recovery period compared to submuscular implants, with less post-op pain since the muscle isn’t being manipulated or cut.

More Natural Movement: Implants placed under the fascia have a more natural movement than subglandular implants but without the pronounced muscle flex distortion seen with submuscular placement. This makes it a middle ground between both techniques.

Tissue Coverage: The fascia provides an additional layer of tissue over the implant, which can improve the overall appearance, especially in individuals with thinner skin or less breast tissue. This extra layer helps reduce implant visibility and rippling, which can be a concern with subglandular placement.

Cons:
Higher Risk of Capsular Contracture: Subfascial placement carries a slightly higher risk of capsular contracture than submuscular placement because the implant isn’t as shielded from the breast tissue and its natural bacteria. However, this risk is often managed through meticulous surgical techniques and post-op care.

Less Soft Tissue Coverage: Compared to submuscular placement, the implant may be more palpable if you don’t have much natural breast tissue. The fascia is a thin layer, so while it adds some coverage, it’s not as thick as the chest muscle.

Keller Funnel:
The Keller Funnel is a device used by surgeons to insert implants more easily and with less trauma. It has gained popularity because of its benefits in breast augmentation procedures.

How It Works:
The Keller Funnel is a sterile, cone-shaped tool that allows surgeons to insert the implant directly into the breast pocket without needing to touch the implant itself. The implant is placed into the funnel, which is then squeezed to deliver the implant into the surgical site.
Pros of Using the Keller Funnel:
Reduced Infection Risk: Since the surgeon doesn’t need to touch the implant, the risk of contamination is significantly reduced. This is particularly important for reducing the risk of complications like capsular contracture, which can occur when bacteria enter the surgical area.

Minimized Incision Size: The Keller Funnel allows for smaller incisions because the implant can be squeezed through the funnel into the breast pocket, even if the implant is larger. This can result in less scarring, which is something you’ve mentioned being concerned about.

Less Trauma to Tissue: By using the funnel, the implant slides more easily into place, which can reduce the amount of force and trauma to the breast tissue during insertion. This can lead to less bruising, faster recovery, and less discomfort post-op.

Efficiency and Precision: Surgeons often find that the Keller Funnel makes the procedure more efficient and precise, reducing the time the implant spends outside of the sterile field.

Cons of the Keller Funnel:
There aren’t many downsides to using the Keller Funnel. It’s widely seen as a positive advancement in surgical technique, but it’s important to ensure your surgeon has experience using it, as technique and familiarity with the tool play a significant role in its success.

Conclusion:
The combination of subfascial implant placement with the use of the Keller Funnel seems like a strong option, especially for someone like you who is active and interested in minimizing scarring and recovery time. The subfascial approach provides the advantages of avoiding muscle distortion during exercise, and the Keller Funnel enhances the safety and precision of the procedure.

If you’re considering this method, it would be good to discuss with your surgeon how experienced they are with both techniques. Each patient’s anatomy is different, and they’ll be able to advise whether this combination aligns with your goals and concerns, particularly regarding implant size, tissue coverage, and scarring.

Richard Baxter, MD · Answer

I have been doing subfascial for many years and it is a great option for most patients. The main benefit is that it avoids distortion of the breasts with muscle activity (animation deformity) while providing a secure pocket. A Keller funnel (or something similar, there are others now) should be routine regardless of whether the implant is under or over the muscle.

Zoran Potparic, MD · Answer

It is very difficult to claim that subfascial augmentation is very different from subglandular since integrity of fascia is so variable. In both cases implant is placed on top of the muscle underneath the breast tissue. This technique preserves muscle insertion and full function which may be important in selective patients (body builders, etc. ). Use of funnel to place an implant, without touching it with gloved hand and implant touching the skin surface,  to avoid bacterial contamination of the implant capsule, is one of the measures to decrease capsular contracture. After many years of studies of cause and nature of capsular contracture around breast implants we still do not have a clear answer whether sub facial/subglandular implant placement vs submuscular is producing better result, more natural looking breasts, lower incidence of capsular contracture. The same can be said for funnel vs gloved hand implant insertion. Hope this helps.

Ram Kalus, MD, FACS · Answer

Thank you for your question. This is in fact my preferred technique and implant placement in over 90% of my breast augmentations. The only patient who is possibly not an ideal candidate for subfascial placement is the woman with extremely small or flat breasts in whom there is little or no breast envelope to adequately camouflage the implant, in which case dual plane or sub pectoral (submuscular) would probably be advisable.

The subfascial placement essentially eliminates the risk of animation deformity, allows for a faster and almost painless recovery, and is anatomically more correct placement for a breast implant so ALL breast tissue naturally exists above the muscle.

Please consult with an experienced board certified plastic surgeon whose results, aesthetics, and reviews resonate with you. Best of luck to you.

Matthew S. Kilgo, MD · Answer

Hello. Subfascial breast augmentation potentially shares some of the advantages of submuscular placement, including reduced implant visibility and capsular contracture rates without the increase in post operative pain associated with muscle elevation. However, in thin patients Implant visibility (rippling) can be a problem. I utilize the Keller funnel with all breast augmentations to minimize implant contamination and possibly reduce rates of capsular contracture.

Sean Fisher, MD · Answer

subfascial breast augmentation refers to the plane the implant is being placed in. This can be done either above or below the pectoralis muscle. The decision on plane is through discussion with your surgeon- assessing patient goals combined with anatomy. Subfascial augmentation has the benefit of no potential for animation deformity, however it requires more native breast tissue to camouflage the implant. I can give a more full appearance to the upper portion of the breast, which can be good or bad depending on goals. It also can run the risk of having a visible implant or issues with rippling when done in thinner patients with little breast tissue. A keller funnel is a device used to place implants without physically touching them intra-operatively with the goal of decreasing the risk of contact with the skin/contamination that may contribute to biofilm on the implants.
Sean FisherAesthetic Plastic Surgeon Seattle, WA

Hilton Becker, MD · Answer

The subfascial breast augmentation with Keller funnel ,when performed  with a small implant under local anesthetic is often called the injectable implant technique 
It is an excellent technique
  See

Michael J. Denk, MD, FACS · Answer

Using a Keller funnel for implant placement in a subfascial BA has several advantages: 1- The incision to place the implant is shorter, hence your scar is shorter. 2- Less trauma to the implant while placing it. 3- Implants will have less (little to no) contact with breast tissue or skin, which reduces contamination and infection. 4- Implants have less contact with the surgeon’s and assistants’ gloves, which also reduces contamination and infection. Hope this is helpful.

Connie Hiers, MD, FACS · Answer

The Keller Funnel is a tool to insert the implant very sterilely which many plastic surgeons utilize. The end results will be the same whether the funnel is used or not. Subfascial placement works well in some women who need more coverage of their implants but do not want the muscle involvement. there is less coverage than placing the implant behind the muscle.

How is the subfascial breast augmentation with Keller funnel technique?

Answers (11)

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