Capsular contracture remains a dreaded complication of breast augmentation and reconstructive surgeries. A new study published in the Aesthetic Surgery Journal suggests the Keller Funnel (Keller Medical) can reduce those rates by more than 50%.
“The Keller Funnel is a device used to insert silicone breast implants in a way that eliminates contact with the skin. So, it really facilitates what we think of as a no-touch technique,” study co-author Richard A. Baxter, M.D., a plastic surgeon, Seattle, Wash., tells Cosmetic Surgery Times. “The reason for doing that is that capsular contracture, which is a hardening of the scar capsule, is thought to relate in many cases to what are called biofilms, which originate from bacteria. The idea of the funnel I think appeals to a lot of us who do a high volume of breast implant surgery.”
Study Details, Results, Implications
Plastic surgeon researchers compared 1,177 breast augmentations performed without the insertion funnel to 1,620 breast augmentations performed with the insertion funnel. In the study, seven centers retrospectively reviewed their surgical records from March 2006 to December 2012 for female patients who had undergone primary breast augmentation with silicone gel implants. In group 1, consecutive augmentations were performed without the insertion funnel. In group 2, consecutive augmentations were performed with the insertion funnel. The researchers looked for the development of grade III or IV capsular contracture that led to reoperation within 12 months.
They found that the insertion funnel group had a significantly lower incidence of reoperations performed due to capsular contracture within 12 months of primary breast augmentation with silicone gel implants. The rate of reoperation due to capsular contracture was 1.49% without the funnel and 0.68% with it, which is a 54% reduction in grades III and IV capsule detection.
“All of the practices going in had a low level of capsular contracture to begin with, but averaged together the incidence dropped by about half,” Dr. Baxter says.
The study suggests to plastic and cosmetic surgeons that there’s significant benefit to using the Keller Funnel, according to Dr. Baxter.
“It does add cost — about $100 for each case,” he says. “We’re balancing that against the cost of having to re-operate on patients. And reoperation for capsular contracture is not a trivial situation. It usually requires a capsulectomy, which involves removing the entire scar capsule and inserting a new implant, so it’s a big recovery for the patient and a significant expense. Even if it’s one patient out of 100 in a year, avoiding having to operate on them justifies use of the funnel.”
Dr. Baxter says the rate of biofilm-related capsular contracture depends on patient type.
“For example, in breast reconstruction there may be other confounding issues like radiation treatment and so forth. But for breast augmentation it’s likely that the majority of patients relate to biofilm,” he says.
Today, Dr. Baxter uses the funnel on all his breast augmentation and reconstruction patients receiving silicone gel-filled implants.
“With the saline implants you probably don’t need it, but we do so few of those now,” he says.
Disclosure: Dr. Baxter reports no relevant disclosures.