title: Contamination in smooth gel breast implant placement: testing a funnel versus digital insertion technique in a cadaver model.
abstract: BACKGROUND
  Overt infection and biofilm formation resulting from breast augmentation are rare but serious problems that can lead to contracture and a need for revision surgery. The Keller Funnel is a medical device composed of a rip-stop nylon sleeve with a hydrophilic inner coating. One claim of the funnel is that it facilitates a "no touch" technique, thereby limiting contamination. To date, there are no data to support this claim.
  
  
  OBJECTIVE
  The authors evaluate skin and breast parenchyma contamination with standard implantation techniques and the Keller funnel.
  
  
  METHODS
  Insertion techniques were tested in two fresh cadavers. Smooth, round, moderate-plus silicone gel implants were placed for each experiment. To quantify the amount of skin contamination, a 2% w/v fluorescein paste was painted onto the cadaver thorax. After implantation, the implants were soaked in 250 mL of sterile water, and the fluorescence emission of the resulting solution was measured with an ultraviolet-visible spectrophotometer. To qualify the potential contamination from breast parenchyma, the cadaver breast tissue was swabbed with methicillin-sensitive Staphylococcus aureus, and the implant surfaces were cultured postimplantation.
  
  
  RESULTS
  The funnel resulted in a 27-fold decrease in skin contact for all smooth gel implants (P = .00059). The amount of skin contact and potential contamination increased incrementally with increasing implant volume when either the funnel or digital implantation techniques were used. Bacterial contamination from breast parenchyma was two times more likely with the standard digital insertion technique (P = .06).
  
  
  CONCLUSIONS
  The Keller funnel appears to significantly reduce the amount of skin contact and potential parenchyma contamination.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Emory University, 1364 Clifton Road NE, Atlanta, GA 30322, USA. hmoyer@emory.edu
authors.forename: Hunter R
authors.initials: HR
authors.lastname: Moyer
authors.forename: Bahair
authors.initials: B
authors.lastname: Ghazi
authors.forename: Neil
authors.initials: N
authors.lastname: Saunders
authors.forename: Albert
authors.initials: A
authors.lastname: Losken
mesh_terms: D001940:Breast / Q000382:microbiology / Q000601:surgery*; D019928:Breast Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D018427:Breast Implants / Q000009:adverse effects* / Q000382:microbiology; D002102:Cadaver; D062109:Dermatologic Surgical Procedures; D004867:Equipment Design; D005260:Female; D006801:Humans; D008422:Materials Testing; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000517:prevention & control*; D020034:Silicone Gels; D012867:Skin / Q000382:microbiology; D013056:Spectrophotometry, Ultraviolet; D013523:Surgical Equipment
chemical_list: D020034:Silicone Gels