Posts Tagged "Capsular Contracture"

The no touch breast augmentation is a surgical technique in which the implantation process is done with a Keller Funnel, a device closely resembling that of a baker’s bag. With its tip inserted into a small incision, it is squeezed successively to propel the implant toward its pocket.


While the surgeon holds the Keller Funnel, the nurse pours the implant from the sterile packaging directly into its wide opening. Once the implant is properly loaded, the surgeon squeezes and propels it into place. Simply put, no one actually touches the prosthesis.


no touch breast augmentation

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One of the benefits of the no touch breast augmentation technique is the perceived reduction of capsular contracture rate.


Capsular contracture is a copious formation of scar tissue around the implants. While a thin flexible capsule-shaped scar is a normal part of recovery, implant contamination at the time of surgery is believed to trigger the over production of collagen bundles (scar tissue).


Low-grade infection during the initial healing stage may also cause capsular contracture.


In its late stage, capsular contracture causes breast deformity and pain and thus it requires surgery in which the copious scar tissue is removed together with the implants. Replacement might be done simultaneously, while some doctors recommend waiting for a few months to ensure complete healing of the breast pocket.


Aside from minimizing the risk of capsular contracture, the no touch breast augmentation offers other benefits; hence, it has become a favorite technique of celebrity plastic surgeon Dr. Tarick Smiley who has posted Snapchat videos to demonstrate the method.


The use of Keller Funnel can reduce the length of incision by almost half, making it easier to hide scars at the areola’s border, parallel to the submammary fold, and inside the armpit skin crease, says Dr. Smiley.


Furthermore, the implantation process via Keller Funnel reduces the force by up to 95 percent (the finger insertion method uses about 27 lbs. of force, while the no touch just requires 0.64). This results in less trauma around the skin incision and thus promotes favorable scars, he adds.


And with reduced force, Dr. Smiley says implant stability is preserved as well.


The shorter surgical time is another key benefit of Keller Funnel. According to surveys, more than half of surgeon-respondents reported 10-20 minutes reduction in their procedure time.

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The Keller funnel breast augmentation is a technique that uses a pouch-like disposable device that makes the insertion of silicone breast implants quicker and less “traumatic.” Studies have also suggested it can lower the risk of contamination at the time of surgery, which in turn reduces the capsular contracture rate.


Capsular contracture happens when the usually thin scar capsule around the implants becomes thicker. This complication is closely linked to implant contamination at the time of surgery and low-grade infection during the initial healing phase.


keller funnel breast augmentation

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With this technique, the implantation process is entirely done without touching the implants (their sterile packaging is opened before they are “poured” into the funnel). The tip of the funnel is placed into a small incision and is then squeezed to propel the implant into its pocket.


The implantation process will only take about 20 seconds, significantly shorter compared to the finger-push technique.


Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently demonstrated on his Snapchat account how Keller funnel breast augmentation is performed.


The patient shown in the video received 500 cc high profile implants via peri-areolar incision, also referred to as “through the nipple.” One of the challenges of larger breast implants is the need for longer incisions, which of course result in longer scars. But with the use of Keller funnel, this problem has been easily resolved.


With a short incision (about 3.5 cm) that ran precisely within the areola’s lower border, the scar is expected to blend in with the surrounding skin after 6-12 months, said Dr. Smiley.


In addition, the celebrity plastic surgeon has noted the drastic reduction in the amount of surgical trauma around the skin, which could further promote favorable scars.


With the gamut of benefits provided by Keller funnel breast augmentation, he now uses it in most of his surgeries involving silicone implants, which are always prefilled.


It is important to note that the Keller funnel technique does not apply to saline implants, which are always positioned inside their pockets “empty” before they are gradually inflated by a predetermined amount of saline or sterile saltwater.

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In breast augmentation surgery, it is possible to eliminate some risk factors in order to achieve predictably good results and avoid short- and long-term complications. For this reason, any prudent plastic surgeon will always require his patients to quit smoking at least three weeks prior to surgery.

But for extra conservative doctors, patients are even advised to avoid tobacco products for several months. The idea is to wait for the body to flush out the toxins known to impede healing and increase risk of complications.


Upland plastic surgery expert Dr. Tarick Smaili explains the four main reasons to quit smoking before breast augmentation, or better yet, to kick the nicotine habit for good.

1.  Accelerated aging of the breast. Several studies have already proven the detrimental effects of smoking to skin, particularly how it breaks down collagen and leads to dry, sagging skin. For this reason, heavy smokers are more prone to breast ptosis or drooping even after factoring in other variables.

If sagging occurs after augmentation, the breast will look pendulous and unattractive. While breast lift can give some improvement, the poor skin quality of smokers could impede them to achieve optimal results.

The leading breast augmentation surgeon believes that there is no point of improving one’s appearance through surgery if she is unwilling to kick the nicotine habit or poor lifestyle known to accelerate aging.

2.  Increased risk of infection and capsular contracture. Smoking can significantly increase the risk of general complications and less than optimal results.

Infection is particularly detrimental because it could trigger capsular contracture in which a thin, transparent scar tissue that normally forms around an implanted device becomes too thick. Eventually, the affected breast becomes painful and distorted, thus warranting a revision surgery.

Smokers are also prone to internal bleeding, coughing episodes (which is rather inconvenient during breast augmentation recovery), anesthetic-related complications such as pneumonia, and blood clots.

3.  High incidence of reoperation. Of course, with increased risk of complications comes another problem—i.e., high incidence of reoperation which means additional expenses, emotional distress, and possibly less than optimal results.

4.  Longer recovery. Cigarettes and other tobacco products are considered vasoconstrictors, meaning they cause blood vessels to tighten up, affecting the way the body recovers from surgical trauma.

Usually, quitting smoking just three weeks is enough to reverse most of its detrimental effects, although some patients who are heavy smokers are required to wait a little longer “to be on a safer side.”

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Many plastic surgeons will postpone or reschedule the surgery of their patients who are sick—e.g., common colds, flu, urinary tract infection, and even minor cough. This “guideline” is particularly true if symptoms such as fever, productive cough, and breathing difficulty are present.

Because plastic surgery procedures are commonly performed under general anesthesia, any sign of breathing difficulty is a reason enough to delay surgery until the patient is better.


However, some surgeons feel that patients with just a minor cough or cold can safely proceed with an elective surgery.

But when it comes to breast augmentation in which artificial prosthetics are used, it is not uncommon for surgeons to be extra conservative, meaning that even a minor cough might be enough to postpone the surgery because of the perceived increased risk of implant infection and capsular contracture.

The theory is that a “suppressed” immune system could predispose the patient to higher risk of implant contamination or infection, which could lead to capsular contracture, or a thick scar tissue that forms around an artificial prosthetic, causing the breasts to look and feel different.

In late stages of capsular contracture, the breast is painful and has a distorted appearance—symptoms that can be only treated by a revision surgery in which the thickened scar tissue and implants are removed. If there is plan to use new prostheses, most experts suggest waiting for a couple of months so the infection will clear up, thus minimizing the risk of recurrence.

Plastic surgeons are also extra conservative when the surgery involves the mid section—e.g., tummy tuck and extensive abdominal liposuction—since any amount of coughing could put tension on the incisions and lead to wound healing problems and “unnecessary” discomfort.

Because it is ideal to be in one’s optimal health prior to an elective surgery, LA plastic surgeons typically recommend frequent washing of hands to prevent cold and flu, sticking to superb nutrition, and avoiding strenuous exercise that could lead to injuries at least a week prior to surgery.

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Capsular contracture occurs when the scar tissue around the implant pocket becomes too thick, eventually leading to misshapen, painful breasts. Studies have suggested that a low-grade infection is one of the triggers leading to this complication, which requires a revision that always requires replacement of implants.

Los Angeles plastic surgery expert Dr. Tarick Smaili explains the five potential ways to minimize breast implant capsular contracture rate.


1.  Breast implants. Some studies have suggested that gummy bear implants (fifth generation silicone implants) and textured implants could reduce capsular contracture rate.

Gummy bear implants, because their filler material is extremely cohesive, have been known to drastically reduce the risk of rupture, which is tied to capsular contracture believed to be an over-reaction of the body to fight off minute leak and low-grade infection.

2.  Breast implant massage. Dr. Smaili typically advises his patients to begin implant displacement exercise a week after surgery to maintain the natural softness of the tissue and pocket, thereby potentially preventing capsular contracture. This postop care is also known to accelerate the settling of implants into their proper place, leading to a more teardrop appearance.

3.  Submuscular. Placing the implants under the muscle, as suggested by several studies, can reduce the complication rate by as much as 20 percent. The idea is to position the prostheses in a way that there is no contact with the breast tissue known to harbor staph bacteria, which can trigger capsular contracture.

4.  Asthma medications (Accolate). A small study involving patients with first stages of capsular contracture who were asked to take these drugs has shown that such treatments can soften the breasts in three to six months.

The theory is that these medications prevent the body to overreact from the presence of breast implants, the same way it works to relieve asthma.

5.  Sterilize everything. Contamination around the implant shell is believed to be a common trigger of capsular contracture and a wide range of complications. For this reason, it is crucial to sterilize the surgical facility, equipment, implants, and even the pockets where they will be positioned at the time of surgery.

To further minimize the risk of infection and capsular contracture, many reputable plastic surgeons, including Dr. Smaili, uses the no-touch technique in which the implants are opened only at the moment of implantation, and positioned into the pocket with the use of a cone-shaped device called Keller Funnel that is squeezed rapidly.

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