Devil's Advocate: Evidence-Based Recommendation for "One Breast-One Insertion Funnel" Policy.

Area of Science:

• Plastic Surgery
• Surgical Microbiology

Background:

• Insertion funnels significantly reduced capsular contracture rates in breast augmentation.
• Financial constraints often lead to the reuse of a single insertion funnel for both breasts during bilateral procedures.

Purpose of the Study:

• To investigate if using the same insertion funnel for both breasts increases capsular contracture risk for the second breast.
• To determine the microbiological impact of reusing insertion funnels in breast implant surgery.

Main Methods:

• Microbiological cultures of insertion funnel tips were obtained before first use and after insertion of the first breast implant.
• Retrospective analysis of capsular contracture rates in first versus second implanted breasts.
• Samples analyzed for bacterial contamination, including Staphylococcus epidermidis and Cutibacterium acnes.

Main Results:

• No bacterial growth was observed in funnel samples before initial use.
• Significant bacterial contamination (Staphylococcus epidermidis, Cutibacterium acnes) was detected in all funnels after insertion of the first implant.
• Capsular contracture rates were higher in the second implanted breast compared to the first, despite overall reductions with funnel use.

Conclusions:

• Reuse of insertion funnels leads to bacterial contamination, posing a risk for capsular contracture in the second breast.
• Surgeons should consider using separate, sterile insertion funnels for each breast to minimize complication incidence.
• Implementing single-use funnels may offer a marginal but significant reduction in capsular contracture rates.