In 2009 the FDA approved the Keller Funnel – a sterile funnel (looks like a pastry funnel) used to insert silicone breasts implants in a“no-touch” technique. I use a Keller Funnel for all my breast augmentation surgeries. The implant goes from it’s sterile container, into the sterile funnel, straight into the pocket without contacting skin or any other surgical instruments. Studies have shown that there is at least half the amount of bacterial contamination from breast tissue when using the funnel.
The reason why this is important is because capsular contracture – scar tissue formation around breast implants is one of the most problematic complications of breast augmentation surgery and it occurs in 10-15% of all women usually resulting in reoperation. Capsular contracture has been in part attributed to a biofilm of bacteria formed around the implant. Therefore minimizing bacterial contamination should help prevent capsular contracture.
Also use of Adam’s solution – a triple antibiotic solution of cefazolin, gentamamicin and bacitracin – has been shown to decrease capsular down to 1.8 % in study groups.2 I use Adam’s solution to clean out the breast pocket, clean all surgical instruments involved in implant placement, clean the breast skin, soak the implant, and also fill the Keller funnel with it. I use it everywhere I can.
It has also been shown that exposed nipples are sources of implant bacterial contamination during breast augmentation.3 The terminal ducts at the nipple and areola are colonized with bacteria. Therefore, I cover the nipples with a Tegederm nipple shield during the surgery to decrease the chance of bacteria from the nipple spilling into the surgery site.
I also make sure the breast pocket is completely free of any blood and minimize any instruments used and don’t put gauze or lap pads into the pocket during surgery even though there haven’t been any good clinical studies to prove that these steps help. I may be excessive and obsessive about all these little things, but as a woman with implants myself – my greatest fear is capsular contracture, which can occur even years after the surgery – so I try to do everything possible to try to prevent it’s occurrence.
- Dr. Catherine Begovic
1. Moyer HR, Ghazi B, Saunders N et al., Contamination in smooth gel breast implant placement: testing a funnel versus digital insertion technique in a cadavar model. Aesthet Surg J. 2012 Feb;32(2):194-9.
2. Adams W, Rios J, Smith S et al. Enhancing Patient Outcomes in Aesthetic and Reconstructive Breast Surgery using Triple Antibiotic Breast Irrigation: Six-Year Prospective Clinical Study. Plast Reconstr Surg. 2006;118(7 Suppl):45S-52S.
3. Wixtrom R, Stutman RL, Burke RM et al., Risk of Breast Implant Bacterial Contamination from Endogenous Breast Flora, Prevention With Nipple Shields, and Implications for Biofil Formation. Aesthetic Surg J. 2012: Sept 10 [epub ahead of print]
The September American Medical Association newsletter reports a study from Canada that compared 4,705 women who miscarried in the first 20 wks of pregnancy to 47,050 controls who had normal pregnancies. All women were aged 15-45. The study found that in the miscarriage group, twice as many women had taken NSAIDS during their pregnancy. NSAIDS stands for non-steroidal anti-inflammatorys and include ibuprofen, Advil, Motrin, and Alieve (naproxen), Diclofenac, Vioxx (rofecoxib) to name a few.
However, the actual percent of patients in both groups who took NSAIDS was low. Only 7.5% of patients in the miscarriage group had taken NSAIDS and 2.6% of the women in the normal group had taken the medications. Therefore there are likely to be other factors that contributed to the miscarriage.
Many of my friends and colleagues are in the process of getting pregnant so I felt that it was important to share this information. Although there is limited data on the connection between NSAIDS and miscarriages, this study suggests that women avoid NSAIDS if possible to avoid a potential problem. NSAIDS already carry warnings against their use late in pregnancy but the recent Canadian study suggests that there could be dangers in taking them early on in the pregnancy as well.
Dr. Catherine Begovic M.D.
The American Medical Association newsletter reported this week that just 15 minutes of exercise daily helps increase life expectancy.
This was based on a study in the medical journal Lancet who evaluated 400,000 people and found that 15 minutes of exercise a day increases life expectancy three years. A study from the National Health Research Institute in Taiwan that evalulated 416,000 adults also found that those who exercised 15 min a day cut their risk of death by 14% compared with those who did not exercise.
Of course, fuller and longer workouts are more beneficial. The Taiwan study also found that each 15 min of exercise reduced the risk of death by an additional 4% – those who exercised the most vigorously had a death reduction as high as 40% compared to those who don’t exercise. So for those of you are who committed work out enthusiasts – your time and efforts pay off.
What do these studies tell us? Even you are very busy, it is worth it still to get some gym time in every day. Everyone has at least 15 min to do some exercise so there’s no excuse! Exercise more and live longer!
Dr. Cat Begovic M.D.
The article is entitled “Liposuction: A temporary fix?” In it, I give my critique on a recent article in Obesity magazine online that claimed that fat moves from the thighs to the abdomen after liposuction, and that fat comes back after liposuction. It addresses many issues concerning diet and exercise and what liposuction can and cannot accomplish.
For those of you who have read my blogs on liposuction – you will know the answers to these questions. For those of you who don’t and are curious – I recommend you get the magazine and read the article!
Dr. Cat Begovic M.D.