Who would have thought that the surgical equivalent of a chef’s pastry bag might reduce infection and capsular contracture from silicone breast implants? Surgeons are calling the disposable Keller Funnel (see photo below) “innovative,” “revolutionary,” and “exciting.” That’s impressive, because surgeons are a group that is not easily impressed. (The funnel isn’t used with saline implants, which are inserted empty and filled once they are positioned in the chest.)
Capsular contracture is a hardening of the scar surrounding the implant. It is a risk for any woman who has silicone implants for augmentation or reconstruction, and in fact, is the most common reason these women need reoperation. This scar tissue isn’t unusual and it’s not harmful; the body responds in the same way to pacemakers, implanted orthopedic devices and any foreign object within. Many women with breast implants are unaware that they even have capsular contracture, but it can become problematic when it thickens and hardens sufficiently to distort implant shape or position and/or cause pain. Experts use the Baker scale to classify capsular contracture:
Grade I: The breast remains soft and looks normal.
Grade II: The breast appears normal but feels hard.
Grade III: The breast is hard, visibly distorted, and may cause discomfort.
Grade IV: This is similar to Grade III, but the breast is much harder and may be painful.
Grades I and II often require no action; Grades III and IV are sometimes treated with medication, ultrasound, massage or capsulectomy, a surgical procedure to remove the scar tissue surrounding the implant. In most cases, however, the implant and scar tissue are removed, and the implant is replaced (if that’s what the patient wants).
No one knows for sure what triggers capsular contracture, but experts think it might occur when bacteria from a surgeon’s gloves or the chest pocket is transferred to the surface of the implant. The Keller Funnel allows surgeons to follow a “no-touch” procedure, meaning they minimize bacteria by pouring the implant, which has been soaked in antibiotic fluid, into the funnel and then propelling it gently into the pocket; just as you would squeeze frosting from a pastry bag onto a cake. The implant never comes in contact with the surgeon’s hands or the patient’s skin, so any bacteria is minimized. That means less chance of infection, and hopefully, less capsular contracture. Anecdotal evidence shows that the funnel does reduce the incidence of infection and capsular contracture; formal studies aren't yet available for the device that was introduced in 2009.
Using the funnel produces other benefits too. It allows for a smaller incision (that’s always good news) and shaves about 15 minutes from the procedure. It may minimize ruptures as well, because surgeons no longer need to tug and push on the implant with their fingers, which may weaken the implant shell and encourage rupture.
If you’re having surgery involving silicone breast implants—whether it is augmentation or reconstruction—ask if your plastic surgeon uses the Keller Funnel. Or visit http://www.kellerfunnel.com for a list of surgeons who use it.