Breast augmentation continues to be one of the most popular cosmetic body contouring procedures in the United States. Women have a basic choice between saline and silicone gel breast implants for their augmentation. One of the considerations when choosing between these two breast implant types is the size and location of the incision needed for their insertion.
With saline implants very small incisions can be used, even high up in the armpit, as the implant is placed in a deflated state. It can be rolled up like a burrito and slide in through an incredibly small incision. This is not possible with silicone gel implants as they come prefilled. They require a larger incision and this virtually precludes the armpit (axillary) incision if the implant is of any size. I typically place them through a lower breast crease incision which may often need to be 4 to 6 cms in length to get the implant in. While in the Caucasian patient, this incision may heal up well and virtually not be seen, this is much more of an issue in any women with more skin pigmentation including the ethnicities of Hispanics, Asians and Middle Eastern patients. They often will opt for a saline implant because of the scar concern even though they may have really preferred a saline breast implant.
In addition, when putting in a silicone implant there is a lot of manipulation and stress on the containment bag of the implant known as the shell. Using finger poking and pushing, the implant is forced through the incision. One doesn’t have to have a PhD in biomaterials to surmise that this is not the best treatment of a breast implant shell. It is likely, but unproven, that such point stress areas on the implant may contribute to an earlier or more frequent incidence of silicone gel breast implant rupture over the patient’s lifetime. Besides the adverse stress on the implant shell, there is also an increased risk of infection due to bacterial contamination from direct contact of the implant by the skin edges of the incision and the surgeon’s gloves.
A novel delivery device for silicone gel breast implants is now available that obviates all of these concerns. Known as the Keller Funnel, this device allows the implant to be inserted in a very similar manner to that of icing a cake. While the intent and type of material is different, the appearance does look similar. It is a clever use of near equal force distribution along the implant by a funnel device so that the pressure of deformation and stress is distributed more equally. By using a funnel-shaped wrap, the implant is gently squeezed through the smaller funnel hole.
The benefits of this device are multiple but,
most importantly, it allows a silicone gel breast implant to be inserted through a smaller incision while lessening the risk of causing unseen weakening or distortions of the implant’s shell that may lead to an earlier device failure and rupture. This means not only can even large silicone breast implants be put in through smaller lower breast crease and nipple incisions, but they can now routinuely be inserted through an armpit incision as well. This will be of great interest to non-Caucasian breast augmentation patients.
The other reassuring benefit that Funnel Breast Augmentation has is that no human ever touches the implant from packaging to the breast pocket. This removes the most likely source of bacterial contamination. While the national incidence of breast implant is very low (mercifully I have never seen one), this device provides another helpful maneuver that should help to make that risk even lower.
Dr. Barry Eppley
Indianapolis, Indiana