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Does Implant Insertion with a Funnel Decrease Capsular Contracture? A Preliminary Report
Nicholas A Flugstad1, Jason N Pozner1, Richard A Baxter1
1Dr Flugstad is a fellow in private practice in Huntersville, NC. Dr Pozner is a plastic surgeon in private practice in Boca Raton, FL. Dr Baxter is a plastic surgeon in private practice in Mountlake Terrace, WA. Dr Creasman is a plastic surgeon in private practice in San Jose, CA. Dr Egrari is a plastic surgeon in private practice in Bellevue, WA. Dr Martin is a plastic surgeon in private practice in Las Cruces, NM. Dr Messa III is a plastic surgeon in private practice in Weston, FL. Dr Oliva is a plastic surgeon in private practice in Spokane, WA. Dr Schlesinger is a plastic surgeon in private practice in Honolulu, HI. Dr Kortesis is a plastic surgeon in private practice in Huntersville, NC.
Background:
Capsular contracture remains a common and dreaded complication of breast augmentation. The etiology of capsular contracture is believed to be multi-factorial, and its causes may include biofilm formation due to implant/pocket contamination with skin flora. It has been shown that insertion funnel use reduces skin contact and potential contamination by 27-fold in a cadaver model. After incorporating the funnel into our surgical protocols, we anecdotally believed we were experiencing fewer capsular contractures in our augmentation practices.
Objectives:
The purpose of this study was to test the hypothesis that capsular contracture related reoperation rates decreased after insertion funnel adoption using data from multiple practices.
Methods:
At seven participating centers, we retrospectively reviewed the surgical records from March 2006 to December 2012 for female patients who had undergone primary breast augmentation with silicone gel implants. Group 1 consisted of consecutive augmentations done without the insertion funnel, and Group 2 consisted of consecutive augmentations done with the insertion funnel. The primary outcome variable was development of grade III or IV capsular contracture that led to reoperation within 12 months.
Results:
A total of 1177 breast augmentations met inclusion criteria for Group 1 and 1620 breast augmentations for Group 2. The rate of reoperation due to capsular contracture was higher without use of the insertion funnel (1.49%), compared to Group 2 with funnel use (0.68%), a 54% reduction (P = 0.004).
Conclusions:
The insertion funnel group experienced a statistically significant reduction in the incidence of reoperations performed due to capsular contracture within 12 months of primary breast augmentation.
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