fig1 illustrates a pre - filled silicone implant 2 and sleeve 10 according to the present invention provided to facilitate implant delivery . sleeve 10 has general conical shape that defines a first opening 12 at a larger end and a smaller opening 14 at a terminal end . the tip of the device may include indica 16 coordinated to various implant sizes to facilitate trimming the opening to the correct size . the indica provide a guide for a practitioner to cut along a selected line in order to size the exit diameter of the device for a given implant in a size range , for example , of between about 150 cc to about 800 cc . by so - trimming the sleeve , exit diameters from between about 3 cm to about 6 cm are provided . for a more typical range of implant sizes , the openings may be sized approximately as follows ( width dimension measured with the sleeve laid flat ): 4 . 5 cm for 300 cc implants , 5 . 0 cm for 300 cc to 450 cc implants , and 5 . 5 cm for 450 cc to 550 cc implants . sleeve 10 is advantageously constructed with a seam 18 formed using double - sided tape to close overlapping edges 20 , 22 of a cut sheet . of course , other joining methods ( e . g ., ultrasonic welding ), and / or constructional approaches may be employed . apart from such optional aspects , sleeve 10 , necessarily includes a user - activated lubricious coating 24 adhered to the interior of the sleeve . so - coated , no introduction of further lubricant into the sleeve or over the surface of the implant is required for implant delivery . instead coating 24 is stably adhered to the sleeve , and simply activated ( e . g ., by hydration ) for use . such a coating substantially mitigates or altogether eliminates risk associated with the introduction of additional foreign body material ( in the form of applied lubricant ) into the patient along with the implant . given that lubricant need not be applied to the surface of the implant and that the implant is neither directly manipulated during delivery nor introduced in such a way that it touches the recipient &# 39 ; s skin , the implantation procedure may proceed as a “ no touch ” approach . such an approach is advisable in avoiding capsular contracture . capsular contracture is an abnormal response of the immune system to foreign materials . the exact cause of contracture is not known . however , noted factors include bacterial contamination , silicone breast implant rupture or leakage , and hematoma . methods which have reduced capsular contracture include limiting handling of the implants and skin contact prior to insertion as well as irrigation with triple - antibiotic solutions . use of the present invention easily enables practicing these methods and further addresses the noted factors as a gentle , no - touch means of implant delivery . as shown in fig2 a and 2b , when an implant 2 , such as a silicone implant , is set into sleeve 10 , the sleeve can be manipulated to apply pressure to direct the implant along the length of the sleeve and toward distal opening 14 . the flexible sleeve is conformed to the implant where there is slack in the material , and the implant to the sleeve where sleeve material is taut . the larger proximal opening 12 of the sleeve allows for implant introduction into the sleeve with little or substantially no digital force or manual manipulation . with the implant set within the sleeve , the sleeve body 26 may be twisted closed . by any combination of such twisting and progressive compression action ( such progression illustrated in transition from fig2 a to fig2 b ) the surgeon is able to apply pressure via the sleeve to the implant and force it out of the delivery device and into a surgical pocket as illustrated in subsequent figures . generally , a proximal hand 30 grip is used primarily to drive the implant forward , with the distal hand 32 grip more for offering stability and guidance to the end of the sleeve . in addition , when introducing the implant into a surgical pocket , the pocket can be manipulated by a retractor to force the pocket open . such action opens the void / space into which the implant is to be set , and may further help draw the implant inward by creating a partial vacuum . moreover ( although by no means necessary ), the retractor may next be brought to bear on the sleeve to further assist the user &# 39 ; s manipulation of the sleeve to extrude the implant into the surgical pocket . fig3 a - 3f offer more detail regarding use of the subject delivery sleeve . specifically , this series of figures illustrates the manner in which the sleeve and an implant are prepared . fig3 a shows each an implant 2 in its packaging 4 , the sleeve 10 ( removed from sterile packaging ), scissors 40 , and a basin 50 as typically found in a surgical suite . the basin is shown partially filled with saline 52 ( optionally including antibiotic solution and / or betadine ™). to activate the lubricious coating inside the sleeve , the sleeve is folded or simply pushed into basin 50 in a compacted state as shown in fig3 b to soak . the sleeve preferably remains in fluid until time for use . at least some of the fluid in the basin can be poured - off into the implant packaging container 4 as shown in fig3 c in order to bathe the implant in solution ( especially useful if loaded with antibiotics ) prior to implantation . if trimming the sleeve end is desired in order to better fit a specific implant size , it may occur next as illustrated in fig3 d . however , sleeve 10 may be trimmed as soon as it is unpackaged . alternatively , the delivery sleeve may be specifically sized and / or packaged in coordination with a given size of implant to avoid any such need . fig3 e illustrates the sleeve 10 with an implant therein . because of the translucent nature of the sleeve material , implant orientation can be visually confirmed as indicated in relation to the landmark offered by the tape seam 18 . prior to delivering the implant in a medical procedure , a test run may be performed as illustrated in fig3 f by running the implant through the sleeve . after which , the implant is re - loaded in the sleeve for implantation deployment . performing such a test run offers a valuable fit check , especially when the sleeve end had been trimmed to accommodate larger - sized implants to ensure that the implant will push - out cleanly . fig4 a - 4d illustrate use of the subject device in delivering an implant employing a transaxillary approach . an incision 60 is created in an axillary site leading to a subcutaneous pocket ( not shown ) under left breast 62 . the pocket may be formed by employing various dissection techniques known to skilled practitioners . the access incision is shown held open by a small retractor 40 . the pocket itself may be created in either the subglandular or subpectoral space . the submuscular plane tends to be less vascular , and is associated with fewer sensory alterations of the nipple areolar complex . so , a subpectoral pocket may be preferred . in any case , fig4 b illustrates a larger deaver retractor passing through incision 60 into the breast pocket . in addition , the distal tip of sleeve 10 is received within the incision . as shown in fig4 c , while the implant is squeezed forward along the sleeve , the retractor may be used to urge the surgical pocket open and / or bear down on the sleeve as described above . fig4 d illustrates left breast 62 enlarged as desired . once right breast 64 is similarly treated and symmetry confirmed ( with any subsequent adjustments made ), the breast pocket incisions are closed . note , prior to undertaking implant delivery , an inflatable sizer will typically be placed in the pocket under each breast . these sizer ( s ) may be placed to aid in prosthesis size selection , and can also be over - filled to provide intraoperative tissue expansion . fig5 a illustrates a first sizer emplaced using a periareolar approach ( sizer fill tube 70 shown ). with a second sizer in place , fig5 b shows the deaver retractor inserted into the right breast 64 pocket and sleeve 10 being introduced into the incision . in doing so , the tip or distal end of the sleeve may be crimped or crumpled - down as shown to aid in passing through the incision . indeed , the same technique may be employed irrespective of access approach chosen . however , the technique may be more helpful or necessary for introduction into smaller incisions . fig5 c illustrates implant extrusion into the breast pocket much as shown in fig4 c . a complete augmentation procedure ( save final incision closure ) in which both breasts 62 and 64 are filled is presented in fig5 d . regardless of the surgical approach taken , it has been found that the step of inserting a prefilled silicone implant can occur within a timeframe of about 5 to about 20 seconds employing the subject invention as compared to a time interval of up to 5 to 15 minutes for a traditional hand manipulation of the same implant . additionally , because the implant can be inserted through a small opening , the size of the surgical incision can be made smaller than would otherwise be required for a silicone implant . essentially , saline implant - size incisions can effectively be used to deliver pre - filled silicone implants . illustrative examples of such use under confidential clinical site conditions include : viewed otherwise , a larger silicone implant can be delivered for a given incision - size as will be appreciated by those with skill in the art . such a consideration may be important especially when considering a periareolar approach as illustrated in fig5 a - 5d . the periareolar approach may sometimes be preferred because the color of the areola can offer “ camouflage ” to help the incision scar blend in . the periareolar approach is often less surgically challenging than a transaxial approach . but since the size of the incision is coordinated with that of the areola in a periareolar approach , the size of pre - filled implant that could previously be inserted therethrough is sometimes limited . use of the subject device relaxes this limitation , thereby offer each of the patient and surgeon more ( often better ) options . the invention includes the methods set forth above in terms of method of manufacture , preparation and / or use . the methods may be performed using the subject devices and sometimes by other means . the methods may include the act of providing a suitable device . such provision may be performed by the end user .. in other words , the act of “ providing ” merely requires that the end user access , approach , position , set - up , grasp or otherwise obtain the requisite device for the subject method . methods recited herein may be carried out in any order of the recited events which is logically possible , as well as in the recited order of events . exemplary aspects of the invention , together with details regarding material selection and manufacture have been set forth above . as for other details of the present invention , these may be appreciated in connection with the above - referenced patents and publications as well as generally known or appreciated by those with skill in the art . the same may hold true with respect to method - based aspects of the invention in terms of additional acts as commonly or logically employed . in addition , though the invention has been described in reference to several examples , optionally incorporating various features , the invention is not to be limited to that which is described or indicated as contemplated with respect to each variation of the invention . various changes may be made to the invention described and equivalents ( whether recited herein or not included for the sake of some brevity ) may be substituted without departing from the true spirit and scope of the invention . in addition , where a range of values is provided , it is understood that every intervening value , between the upper and lower limit of that range and any other stated or intervening value in that stated range is encompassed within the invention . also , it is contemplated that any optional feature of the inventive variations described may be set forth and claimed independently , or in combination with any one or more of the features described herein . stated otherwise , it is to be understood that each of the improvements described herein independently offer a valuable contribution to the state of the art . so too do the various other possible combinations of the improvements / features described herein and / or incorporated by reference , any of which may be claimed . reference to a singular item , includes the possibility that there are plural of the same items present . more specifically , as used herein and in the appended claims , the singular forms “ a ,” “ an ,” “ said ,” and “ the ” include plural referents unless specifically stated otherwise . in other words , use of the articles allow for “ at least one ” of the subject item in the description above as well as the claims below . it is further noted that the claims may be drafted to exclude any optional element . as such , this statement is intended to serve as antecedent basis for use of such exclusive terminology as “ solely ,” “ only ” and the like in connection with the recitation of claim elements or use of any “ negative ” limitation . without the use of such exclusive terminology , the term “ comprising ” in the claims shall allow for the inclusion of any additional element — irrespective of whether a given number of elements are enumerated in the claim , or the addition of a feature could be regarded as transforming the nature of an element set forth in the claims . except as specifically defined herein , all technical and scientific terms used are to be given as broad a commonly understood meaning as possible while maintaining claim validity .
a tapered sleeve is provided that includes a hydrophilic coating on an inner surface . in use , the device is typically removed from sterile packaging and soaked to activate the lubricous properties of the coating . an implant is introduced into a large end of the sleeve and extruded into a surgical pocket of minimal access incision size through a small - sized end of the device .