How is the subfascial breast augmentation with Keller funnel technique?

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

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.

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.