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]
Just last week, at least 4 or 5 of my girlfriends who have breast implants asked me this question. I’m not sure how this idea started, but most women think that their breast implants need to be changed routinely. This is not the case – really, implants only need to be removed and replaced if there is a problem. In most cases, the problem involves implant leaks or scar tissue forming around the implant, known as “capsular contracture”. This scar tissue makes the breast feel firm, distorted, or uncomfortable. In the surgery, the scar tissue, or capsule, will also be removed.
Leaks are another reason to replace implants. If a woman has saline implants, it will be obvious if there is a leak. The implant slowly deflates as the saline solution leaks out. If a woman has silicone implants, it is sometimes difficult to detect a leak. This is why the FDA recommends screening for silicone leaks 3 years after implant placement and then every 2 years. Sometimes there are symptoms such as hard lumps, distortion of the breast or implant, swelling, burning, or hardening of the breast. If that happens, the implant should be removed.
Before getting a breast augmentation surgery, ask your doctor about the pros and cons of the procedure. Women who are considering implants should know that they are committing themselves to multiple surgeries over their lifetime. The good news is that if an implant needs to be replaced, the manufactures currently provide new implants for free and often cover part of the surgery fees as well.
Dr. Cat Begovic
Breast augmentation research – Recent publication in the Aesthetic Surgery Journal by Dr. Catherine Huang Begovic
One of the most common and disfiguring complications of breast implants is capsular contracture. This is scar tissue that forms around the implant and causes discomfort or distortion of the breast. No one knows what predisposes certain women to develop this scar tissue. There have been different theories such as a genetic predisposition to inflammation forming scar, a small amount of blood around the implant that causes increased inflammation, or a bacterial film that forms around the implant causing an inflammatory response. In surgery I do everything possible to decrease any of these factors – making sure there is absolutely no bleeding or oozing before placing the implant, washing the implant pocket multiple times with saline, antibiotic solution, and betadine to clear out any debris, bacteria, or blood, and changing to new clean and sterile gloves before touching each implant.
I am committed to research to battle the problem of capsular contracture. My latest research has just been published in the Aesthetic Surgery Journal. I’ve copied the abstract below.
Aesthet Surg J. 2010 May;30(3):404-8.
Effects of Singulair (montelukast) treatment for capsular contracture.
BACKGROUND: Capsular contracture (CC) is one of the most common complications of breast augmentation surgery. Leukotrienes are implicated in the inflammatory cascade and have been postulated to be involved in the formation of CC. Therefore, leukotriene antagonists Accolate and Singulair have been prescribed by plastic surgeons off-label to treat and prevent CC. To date, there are no studies investigating the efficacy of Singulair on CC.
OBJECTIVE: The authors retrospectively review a series of patients treated with Singulair to determine whether it improves CC after breast implant surgery.
METHODS: Nineteen patients treated with Singulair by the senior surgeon (NH) after implant placement from March 2006 to November 2009 were included in this study. Follow-up on Singulair efficacy was obtained by a combination of office chart review and standardized telephone questionnaire. Results were characterized as complete improvement, improvement, no change, or worse.
RESULTS: Seventeen patients presented with CC resulting from a variety of breast operations. Two patients who had a history of recurrent CC were prescribed Singulair prophylactically immediately after surgery. Twenty-one breasts with existing CC were included in the total. Two (11%) patients became worse, three (16%) patients had no change, five (26%) improved, seven (37%) completely improved, and two (11%) were prevented from having CC formation.
CONCLUSION: Our preliminary study shows that Singulair improves CC. Breasts with mild CC (Baker score < III) appeared to have better improvement with Singulair compared to those with more severe contracture (Baker score III and IV). Singulair is well tolerated with minimal side effects and can be administered to patients after breast implant surgery to improve CC.