Funnel usefulness in direct-to-implant breast reconstruction using peri-areolar incision with prepectoral implant placement and complete coverage with acellular dermal matrix

Abstract Background The funnel has been used in aesthetic breast surgery that requires a small incision. Recent advances in minimally invasive surgical techniques have led to more cases of nipple-sparing mastectomy through peri-areolar incision. However, prepectoral implant placement and complete coverage with acellular dermal matrix (ADM) is almost impossible with the periareolar approach. Funnels can be also useful for direct-to-implant breast reconstruction. Methods Nipple-sparing mastectomy with peri-areolar incision and direct-to-implant breast reconstruction were performed with prepectoral implant placement between January 2017 to July 2019. The ADM full wrapped anatomic textured implant was inserted using a funnel without additional incisions during surgery. Results A total of 21 patients were enrolled, including 2 who received bilateral breast reconstruction. All operations were successfully performed using funnels with minimal peri-areolar incisions. Anatomic textured implants (mean: 251.7 cc, range: 90–450 cc) wrapped in acellular dermal matrix (ADM) can be effectively inserted in the prepectoral plane using a funnel. Two patients experienced delayed wound healing of the areola that was treated by conservative wound management. Patients also experienced less pain overall, and the cosmetic result was very good. Patient satisfaction scores were also very high. Conclusions While the peri-areolar incision is aesthetically pleasing, additional resection is often necessary. However, the use of funnels ensured that no additional incision was needed even in large implants. This subsequently led to better results in terms of pain and scarring. Prepectoral breast reconstruction involving complete implant coverage with ADM using a funnel through the peri-areolar approach represents a good alternative to the traditional dual-plane subpectoral method. This method provides good patient satisfaction without adverse outcomes.