Effect of The Keller Funnel Method “No Touch” on Breast Augmentation and Reconstruction: A Systematic Review

Abstract

Introduction: Breast augmentation is one of the most common aesthetic surgeries. Implant contamination remains a critical problem with these surgeries 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. Materials and Methods: A systematic review of PubMed, EMBASE, the Cochrane database, and Google Scholar was performed between years 2005 to 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: 5 were retrospective cohorts and 1 was prospective trial. No randomized controlled trials were found. Outcomes reported included less rates of capsular contracture (RR:0.42; P=0.0006, %95 CI=0.25-0.69), decreased levels of contamination and implant shell trauma, shorter incision lengths (35.5+/-2.1mm), less insertion time (mean=6 s), decreased complications, and ultimately greater patient satisfaction with outcomes. Conclusion: This review suggests that the Keller Funnel is a useful method “no-touch” breast augmentation and reconstruction surgery. The Keller funnel reduces bacterial contamination and subsequent capsular contracture rate, surgical time, and incision length as well as allows for easier insertion. All of these mitigate the variables that lead to reoperation. However, our findings support recommendation of a prospective randomized controlled clinical trial with larger population size and follow-up intervals.