Why Do Some Saline Implants Get Moldy Inside? How Can This Be Prevented?

In performing several thousand cases of breast surgery at this point, I have not seen nor have I known any of my colleagues to see a fungal contaminant in saline breast implants. We are careful to use a completely isolated closed system to fill the implants and also to wash the implants and the implant pocket with antibiotics and use a no touch technique to place them in the body. In the past, however, I have heard that some surgeons did not use a closed system and injected sterile saline into the implant that was in the open atmosphere of the operating room. Perhaps this was the culprit but no one really knows for sure. Suffice it to say that  this is a very rare problem these days and good surgical practices should all but eliminate this. You can feel safe in proceeding with a careful surgeon. Closed systems would be considered standard of care these days. Make sure that you see a Board Certified Plastic Surgeon with an extensive experience in breast surgery. 

       I have not seen an implant or implant pocket culture fungus, but it is possible.  Fungal infections tend to be more common in immunocompromised patients, like those with diabetes or HIV.  In general, infections are very rare.  I have not gone back in to remove implants after about 1000 or so breast augmentations.  So to go back in for a fungal infection in an immunocompetent individual would be even more rare.   

It is extremely rare for a fungal infection to happen with implants.  It is more likely in an immunocompromised patient.

This must be rare. I have certainly heard of some widely publicized cases, but in over 25 years of practice, mostly breast surgery, I am not aware of this problem in any patients I have seen or treated. This includes many implant exchanges after long periods of time, and some removals. 

The only suspicious case I had seen, which was an elective change from silicone to saline, was a patient with dark brown fluid in the saline implants. Cultures were negative, and when we finally go the the original operative notes, it turned out the surgeon filled the implants partially with Betadine. Because of the rarity, I doubt anyone knows how the mold got into the implants. It seems most likely that a contaminant was introduced somewhere along the line.  Safe practice demands a closed system where the saline goes right from the IV bag into the implant without exposure to the outside world. This is done in almost all plastic surgery suites, but that has not always been the case. 

Thanks for your question, all the best.