Does Bacteria in Saline Implants Show Up in Mammograms?

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….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’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

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.

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

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!

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.