Does Bacteria in Saline Implants Show Up in Mammograms?

Question

My yearly mammograms show one of my saline implants to be opague and the other one clear. Does this indicate bacteria in one of them? The opaque one is firmer and tighter than the other one. My saline implants are 18 years old, and I previously had silicone implants, one of which ruptured after 5 years. I am 60 years old, slender, and still active in sports. I am worried about illness if bacteria leaks from a rupture. Aesthetically, I still look great.

Kenneth Dembny, II, MD · Answer

The presence of bacteria, on the surface of or inside a saline implant, cannot be detected by mammography. Both saline and silicone implants will be visible on mammograms. Relative to one another, saline implants are more radiolucent and silicone implants are more radiopaque. This means that saline implants will appear as more of a hazy/translucent white color and silicone implants will appear more densely white. That is because silicone blocks the passage of x-rays more than saline.

	The mammographic and clinical findings you describe are consistent with a capsular contracture. The thicker, contracted capsule of the firmer breast impedes the x-ray passage more than the capsule on the opposite side. Is this also the same side where you experienced the silicone gel failure? That may have contributed to the development of this capsular contracture. If there is any residual silicone gel left behind from that failure this might be visible on the mammogram as well.

	Capsular contracture is a frustrating unexpected outcome of breast augmentation surgery. Think of it as a form of scarring that occurs in excess or is caused by some sort of inflammatory process. Capsular contracture may occur in one breast or both, in the early post-op period or late, with saline- or silicone gel-filled implants, or with implant placement under or over the muscle&hellip;.so any individual with breast implants is at risk for capsular contracture. 

	The etiology of every capsular contracture is unknown, but infection and delayed hematoma do increase the risk. Some physicians will therefore recommend that their patients be treated with prophylactic oral antibiotics prior to dental visits because of the transient bacteremia that occurs following dental cleaning and procedures. There is a general consensus that the rate of capsular contracture is higher in subglandular augmentation, when compared to subpectoral augmentation. There was a recently published study that suggested that pregnancy increases the risk of capsular contracture as well. The risk of capsular contracture probably also increases with implant age; so after 18 years a capsular contracture would not be unexpected.

	From a surgeon&rsquo;s standpoint, we try to reduce the risk of capsular contracture by minimizing tissue trauma during the dissection of the pocket, maintain meticulous hemostasis, reduce the risk for infection by using pre-operative i.v. antibiotics, handle the implant gently, and avoid implant-skin contact. Subpectoral implant placement and implant displacement exercises are thought to reduce the risk of capsular contracture.

	Seek a consultation with a board certified plastic surgeon to discuss your findings and concerns. You can then decide how to manage this once you understand all the options that are available to you.

	Best wishes, Kenneth Dembny

Raffy Karamanoukian, MD, FACS · Answer

Capsular contracture can be associated with a subclinical bacterial infection that can lead to chronic inflammation. Mammogram is not the most sensitive diagnostic test for capsular contracture. I would advise my patients in Los Angeles to undergo a complete physical examination to determine the likelihood of capsular contracture or breast implant rupture.

Jed H. Horowitz, MD, FACS · Answer

Mammograms cant detect infection in implants after breast surgery

	an infection would have symptoms of fever, redness , pain

	this is most likely calcium in the capsule..  it is probably a goood time to change the implants though

Gerald Minniti, MD, FACS · Answer

Hello Mature Lady,

	You don't have bacteria in your saline filled breast implant.  You have capsular contracture around one though, causing the affected implant to feel firm and look opacified on mammogram due to calcium deposits in the abnormal scar tissue.  This is not dangerous, but does require a surgery to correct.

	Best of luck!

Richard Baxter, MD · Answer

About 20 years ago there was some concern about bacteria in saline implants but the use of what is called a "closed fill system" became standard so it would be extremely rare. Although yours are 18 years old, a mammogram would not show anything like that anyway. It is likely something else such as the scar capsule, and if it is firmer on that side then you should have a plastic surgeon check it out.

Robert L. Kraft, MD, FACS · Answer

A mammogram will show opacity indicating the presence of the implants.  It is possible that one breast has a capsular contracture while the other one does not.  This is borne out by your descriptiion.  You should return to your plastic surgeon to discuss treatment options.

Herluf G. Lund, Jr, MD · Answer

Dear Mature Lady, Thanks for the question but I am a bit puzzled by your description of your mammogram. Both saline and silicone gel implants will appear opaque on a mammogram. This has to do with the atomic number of the material filling the implants. This is why in the late 1980's and 1990's, researchers looked into filling implants with natural oils including peanut oil and soybean oil. Oil is clear on a mammogram making it easier to read and detect breast changes. Because of other issues, oil-filled implants were taken off the market. So I am not quite sure how to interpret your description of one implant being clear and the other opaque. As far as can a mammogram detect the presence of bacteria inside the saline implant, it cannot. If one of your implants is more opaque on your mammogram and you described that breast as being firmer and tighter, I suspect that you may have a capsular contracture. This is a process where the tissue that surrounds the implant becomes thicker and firmer. I would recommend you obtain a consultation with a board certified plastic surgeon who after reviewing your history and performing an examination can review the best treatment options for you. Hope this helps and good luck.

Tom J. Pousti, MD · Answer

Thank you for the question.

	Your mammographic findings to not necessarily indicate that your implant has "bacteria in one of them&rdquo;. It would be more likely that the &ldquo;opaque one"  which is firmer than the other side is involved with excessive scar tissue (encapsulation). This would not at all be unusual after having had the implants in place for 18 years.

	I would suggest consultation with a well experienced board-certified plastic surgeon. Depending on the clinical findings he/she may recommend removal and replacement of the implants.

	I hope this helps.

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