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BACKGROUND: Breast augmentation is the most common procedure performed among plastic surgeons, with national data reflecting 279,143 augmentation mammaplasties performed in 2015 alone, a 31% increase from 2000. Despite variable high rates of complications (1-15%), the popularity and satisfaction remains high. Capsular contracture remains an elusive and feared complication. The exact etiology is multifactorial; however minimizing implant contamination secondary to skin contact can lower these rates. The rate of capsular contracture for primary augmentation-mastopexy is 2.97% and for primary augmentation alone of 1.8 to 9.8%. The Keller funnel was designed to allow for a “no touch technique” as well as for smaller incisions and ease implant insertion. We aim to highlight a low rate of capsular contracture with experience with the Keller funnel in a robust single surgeon experience.
METHODS: A retrospective review of consecutive female patients undergoing primary breast augmentation or combination augmentation-mastopexy performed by a single private practice plastic surgeon over a 13 year period from September, 2003 to February, 2016 was performed. After excluding secondary augmentations, 1584 patient records were reviewed. After 2011, all implants were placed via Keller funnel. Patient demographics, past medical history, procedural details (including fill material and volume, incision, concomitant procedures, and use of Keller funnel) were recorded. Total reoperations, complications and device failures were reviewed. Total reoperations include complications that required reoperation but also voluntary size increase and explantation. Complications are defined as implant related negative outcomes after the primary operation, specifically Baker grade III/IV capsular contracture, need for prolonged antibiotics or return to operating room.
RESULTS: A total of 1584 patients underwent primary breast augmentation including 175 patients undergoing concurrent mastopexy from 2003 to 2016. From 2003 to 2011, 924 primary augmentations were performed with 54.0% silicone implants and 60 with mastopexy. At this time, the Keller funnel was not consistently used (5%). There were only 6 patients with Baker grade III/IV which required reoperation. Of these, 4 were silicone which equates to a 0.8% capsular contracture rate for silicone implants. Only 1 patient developed infection requiring prolonged antibiotics. From 2011 to 2016, there were 660 primary augmentations performed, 590 with silicone. Of these patients, 115 of these underwent combination augmentation-mastopexy, 110 with silicone. Only 2 patients experienced Baker III/IV capsular contracture, 1 with primary augmentation (0.18%) and 1 with combination augmentation mastopexy (0.87%), which resolved in 3 months with monthly injection of Accolate. No patients have required re-operations for capsular contracture. Ten patients have required re-operations for size exchange or silicone. Since 2011, there have been no infections which required re-operation or prolonged antibiotics.
CONCLUSIONS: While associated with a slight cost, the Keller funnel allows for smaller incisions and subjective ease of implant insertion. The use of the Keller funnel was associated with a decreased rate of capsular contracture and infection, compared to the literature. Reoperation for implant exchange remains unchanged. This single surgeon experience with high volume breast augmentation demonstrates a favorable complication profile through the use of the “no touch” technique aided by the Keller funnel.