Implant Insertion Time and Incision Length in Breast Augmentation Surgery with the Keller Funnel: Results from a Comparative Study

  • Paolo Montemurro
  • Sebastian Fischer
  • Sybille Schyllander
  • Patrick Mallucci
  • Per HedénEmail author
Original Article Breast Surgery



The Keller funnel is an easy-to-use mechanical device that aids breast implant insertion. This study analyzed implant insertion time and incision length using the Keller funnel versus conventional manual insertion.


This was an analysis of two cohorts of adult patients undergoing primary breast augmentation with anatomical implants at a single center. In the ‘insertion time cohort’ (N = 20), implants were inserted with a Keller funnel on one side and manually on the other; follow-up lasted 4 years. In the ‘incision length cohort,’ both implants were inserted with a Keller funnel (N = 50) or manually (N = 50), with follow-up lasting 12 months.


In the insertion time cohort, mean total insertion time (from implant sterile-package opening to final positioning in the pocket) was 35 s (range 13–76 s) with the Keller funnel and 25 s (range 13–43 s) using manual insertion (p = 0.07); the mean time needed to push the implant through the incision was 6 s (range 3–10 s) with the Keller funnel and 16 s (range 13–40 s) with manual insertion (p = 0.04). In the incision length cohort, mean incision length was shorter with the Keller funnel versus manual insertion (35.5 ± 2.1 mm vs. 46.2 ± 3.2 mm; p < 0.001). There were no differences in complications based on insertion method.


The Keller funnel was associated with decreased incision length and reduced time to push the implant through the incision. This brings potential clinical advantages in minimizing scarring and reducing contamination of the device.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Breast augmentation Breast implantation Incision length Insertion sleeve Keller Funnel 



We would like to thank Dr. Timothy Ryder from Biological Communications Limited for editorial assistance, funded by Allergan. Allergan had no input into the content of the paper.

Author contributions

All authors participated in study conduct, data collection, and writing of the manuscript, and all approved the final draft.

Compliance with Ethical Standards

Conflict of interest

Dr. Montemurro is a consultant and speaker for Allergan. Dr. Fischer and Dr. Schyllander report nothing to disclose. Dr. Mallucci is a shareholder in B-Lite (Polytech). Dr. Hedén has had consultancy agreements with Allergan, Mentor, Establishment Labs, G&G Medical and GC Aesthetics, is a shareholder in Polytech and Establishment Labs, and has a Development Contract with Allergan.

Ethical Approval

The study was conducted in accordance with the Declaration of Helsinki.

Informed Consent

All patients provided written informed consent before surgery.

Supplementary material

Supplementary file1 (MP4 7095 kb)


  1. 1.
    Moyer HR et al (2012) Contamination in smooth gel breast implant placement: testing a funnel versus digital insertion technique in a cadaver model. Aesthet Surg J 32:194–199CrossRefGoogle Scholar
  2. 2.
    Flugstad NA et al (2016) Does implant insertion with a funnel decrease capsular contracture? A preliminary report. Aesthet Surg J 36:550–556CrossRefGoogle Scholar
  3. 3.
    Horsnell JD, Searle AE, Harris PA (2017) Intra-operative techniques to reduce the risk of capsular contracture in patients undergoing aesthetic breast augmentation—a review. Surgeon 15:282–289CrossRefGoogle Scholar
  4. 4.
    Newman AN, Davison SP (2018) Effect of Keller funnel on the rate of capsular contracture in periareolar breast augmentation. Plast Reconstr Surg Glob Open 6:e1834CrossRefGoogle Scholar
  5. 5.
    Deva AK, Adams WP Jr, Vickery K (2013) The role of bacterial biofilms in device-associated infection. Plast Reconstr Surg 132:1319–1328CrossRefGoogle Scholar
  6. 6.
    Adams WP Jr et al (2017) Macrotextured breast implants with defined steps to minimize bacterial contamination around the device: experience in 42,000 implants. Plast Reconstr Surg 140:427–431CrossRefGoogle Scholar
  7. 7.
    Hedén P (2011) Breast augmentation with anatomic, high-cohesiveness silicone gel implants (European experience). In: Spear SL (ed) Surgery of the breast: principles and art, 3rd edn. Wolters Kluwer/Lippincott Williams & Wilkins, Philadelphia, pp 1322–1345Google Scholar
  8. 8.
    Montemurro P et al (2017) Implementation of an integrated biodimensional method of breast augmentation with anatomic, highly cohesive silicone gel implants: short-term results with the first 620 consecutive cases. Aesthet Surg J 37:782–792CrossRefGoogle Scholar
  9. 9.
    Park AJ, Chetty U, Watson AC (1996) Patient satisfaction following insertion of silicone breast implants. Br J Plast Surg 49:515–518CrossRefGoogle Scholar
  10. 10.
    Kalaaji A et al (2013) Survey of breast implant patients: characteristics, depression rate, and quality of life. Aesthet Surg J 33:252–257CrossRefGoogle Scholar
  11. 11.
    Bizjak M et al (2015) Silicone implants and lymphoma: the role of inflammation. J Autoimmun 65:64–73CrossRefGoogle Scholar
  12. 12.
    De Boer M et al (2017) Breast implant-associated anaplastic large-cell lymphoma in a transgender woman. Aesthet Surg J 37:83–87CrossRefGoogle Scholar
  13. 13.
    Carson B, Cox S, Ismael H (2018) Giant siliconoma mimicking locally advanced breast cancer: a case report and review of the literature. Int J Surg Case Rep 48:54–60CrossRefGoogle Scholar
  14. 14.
    Hsu CK, Lin HH, Harn HI (2018) Mechanical forces in skin disorders. J Dermatol Sci 90:232–240CrossRefGoogle Scholar
  15. 15.
    Gowda AU et al (2017) Preventing breast implant contamination in breast reconstruction: a national survey of current practice. Ann Plast Surg 78:153–156CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  • Paolo Montemurro
    • 1
  • Sebastian Fischer
    • 1
  • Sybille Schyllander
    • 1
  • Patrick Mallucci
    • 2
  • Per Hedén
    • 1
    Email author
  1. 1.AkademiklinikenStockholmSweden
  2. 2.Mallucci LondonLondonUK

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