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Keller Funnel Efficacy in "No Touch" Breast Augmentation and Reconstruction: A Systematic Review. Plast Reconstr Surg Glob Open 2022; 10:e4676. [PMID: 36448016 PMCID: PMC9699649 DOI: 10.1097/gox.0000000000004676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/29/2022] [Indexed: 01/25/2023]
Abstract
UNLABELLED Breast augmentation is one of the most common aesthetic surgical procedures. Tissue expansion followed by permanent implants is the most frequent postmastectomy breast reconstruction method. Implant contamination remains a critical problem with these procedures' resulting in acute infection as well as capsular contracture. To reduce the risk of implant contamination, the "no-touch technique" utilizing the Keller funnel has been adopted by many surgeons. This systematic review aims to investigate the advantages of the Keller funnel method for breast augmentation-reconstruction. METHODS A systematic review of PubMed, Embase, the Cochrane database, and Google Scholar was performed between 2005 and 2021. All clinical-based, retrospective and prospective studies utilizing the Keller funnel method for breast implant insertion were selected. RESULTS Six studies were identified for evaluation: five were retrospective cohorts and one was a prospective trial. No randomized controlled trials were found. Outcomes reported included lower rates of capsular contracture (RR, 0.42; P = 0.0006; 95% CI, 0.25-0.69), shorter incision lengths (35.5 ± 2.1 mm), less insertion time (mean = 6 seconds), and decreased complications, and one paper reported ultimately greater patient satisfaction with outcomes (BREAST-Q Score: 92%). CONCLUSIONS This review suggests that the Keller funnel is a useful method for no-touch breast augmentation and reconstruction surgery. The Keller funnel reduces subsequent capsular contracture rate, surgical time, and incision length and allows for easier insertion. However, our findings support recommendation of a prospective randomized controlled clinical trial with larger population size and follow-up intervals.
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Fernández-Ibarburu B, Díaz-Navarro M, Ibarra G, Rivera A, Hafian R, Irigoyen Ã, Carrillo R, Pérez-Cano R, Muñoz P, García-Ruano Á, Lasso JM, Guembe M. Efficacy of Povidone Iodine Against Microbial Biofilms in Breast Implants With Different Textures: Results From an in vitro Study. Front Microbiol 2022; 13:868347. [PMID: 35422778 PMCID: PMC9002313 DOI: 10.3389/fmicb.2022.868347] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background In the practice of breast augmentation and reconstruction, implant irrigation with various solutions has been widely used to prevent infection and capsular contracture, but to date, there is no consensus on the optimal protocol to use. Recently, application of povidone iodine (PI) for 30 min has shown in vitro to be the most effective irrigating formula in reducing contamination in smooth breast implants. However, as 30 min is not feasible intraoperatively, it is necessary to determine whether shorter times could be equally effective as well as to test it in both smooth and textured implants. Methods We tested the efficacy of 10% PI at 1', 3', and 5' against biofilms of 8 strains (2 ATCC and 6 clinical) of Staphylococcus spp. on silicone disks obtained from Mentor® and Polytech® implants of different textures. We analyzed the percentage reduction of cfu counts, cell viability and bacterial density between treatment (PI) and control (sterile saline, SS) groups for each time of application. We consider clinical significance when > 25% reduction was observed in cell viability or bacterial density. Results All textured implants treated with PI at any of the 3 exposure times reduced 100% bacterial load by culture. However, none of the implants reached enough clinical significance in percentage reduction of living cells. Regarding bacterial density, only 25-50 μm Polytxt® Polytech® implants showed significant reduction at the three PI exposure times. Conclusion PI is able to inhibit bacterial growth applied on the surface of breast implants regardless of the exposure time. However, no significant reduction on living cells or bacterial density was observed. This lack of correlation may be caused by differences in texture that directly affect PI absorption.
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Affiliation(s)
| | - Marta Díaz-Navarro
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gorka Ibarra
- Department of Plastic Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Andrés Rivera
- Department of Plastic Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rama Hafian
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ãlvaro Irigoyen
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Raquel Carrillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rosa Pérez-Cano
- Department of Plastic Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Patricia Muñoz
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Ángela García-Ruano
- Department of Plastic Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José M Lasso
- Department of Plastic Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María Guembe
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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