The basics of breast augmentation, my most common operation, have not really changed in the last three or four decades. Certainly, there have been significant advances in the designs of the implants themselves, but how the implants are placed in the body is basically the same. However, there is an important advance recently which I have adopted that is aimed at achieving the best, most natural result: enter the Keller Funnel.
The Keller Funnel is a sterile plastic sleeve which a silicone breast implant is put in prior to being placed in the body. The sleeve, which has a special coating which allows the implant to slide through it, eliminates all contact between the implant and the patient’s skin.
Additionally, it may allow a slightly smaller incision to be used, and it makes placing the implant easier for me. The Keller Funnel is mainly used with silicone implants because they are fully filled by the manufacturer, whereas saline implants are filled after they are placed in the body.
The goal of using the Keller Funnel is to affect the formation of the capsule – the layer of (scar) tissue which surrounds the implants. You want to have a supple layer of tissue that will allow the implant to move naturally like a normal breast would, and to feel soft. If the capsule become thickened (a capsular contracture) the breast can feel firm.
Our understanding of things that affect the formation of the capsule has increased a lot over the past decade or so. We know that anything that might increase scar formation is to be avoided. One such thing might be exceedingly small amounts of contamination from the skin (such as bacteria) through which the implants must be placed. This is this is why the Keller Funnel was developed.
I am not sure that we can as of yet scientifically prove that using the funnel has an impact on how the capsule forms, and thus the rate of capsular contracture, but it seems to make sense. As such, this has become a part of my routine for the placement of silicone breast implants.
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