Blog — Notes of a Plastic Surgeon

Welcome to my blog. I am a plastic surgeon in Seattle and have been in private practice since 1991. I've seen more than a few interesting faces and cases through my years spent in the exam room, the operating room and the emergency room. And I have an opinion on just about everything relating to plastic surgery (and a lot of unrelated stuff). If you like my blog, let me know. Thanks for reading! Lisa

Louis Pasteur and why you shouldn’t worry too much about mold or fungus in saline breast implants.

Louis Pasteur in his lab.

I have had a lot of questions lately about mold and fungus in saline implants. I have even read online that some people think intact sterile saline breast implants can somehow get filled with germs.  When I read stuff like that my thoughts go to the great French Scientist Louis Pasteur and your thoughts should too.   Pasteur contributed many, many great inventions and discoveries.  If you drink milk or wine, you can thank Pasteur for the safety of those two nourishing beverages.  If you and your children benefit from vaccinations, you can thank him for that too.  If you have pondered the deeper meaning of stereoisomers in your organic chemistry class, thank Louis.

But enough about that stuff and lets talk saline breast implants. One of Pasteur’s greatest contributions was the debunking of the myth of spontaneous generation.  You see, way back then before microscopes, microbes could not be seen.  When something would ferment or rot or putrefy or suppurate (I’m making myself a little sick), it was believed that the agent of this process just materialized from, well, nothing. The noxious effluvia that generated the aforementioned conditions was referred to as miasma.

In a series of really elegant experiments using some custom made glass vessels, Pasteur showed that a liquid rendered sterile by heating would remain sterile unless it came into contact with something that had not been sterilized.  The infectious agent had to exist in the environment.  It just did not spontaneously generate.  He figured all of this out before even seeing those nasty little germs under a microscope.  Very smart guy.

So what does this have to do with mold, fungus or bacteria in saline breast implants?  Every reasonable implant surgeon on the planet uses a closed system to fill an implant. The saline that goes into the implant comes from a bag of sterile saline for intravenous use into a sterile length of IV tubing and into the sterile implant.  The saline is never exposed to the air which can harbor spores and other creepy things we cannot see with the naked eye.  No contamination means the saline in the implants stays sterile.

What about the implant pocket?  We know that bacteria are present in cases of capsular contracture.  The current working theory of capsular contracture is that it is an inflammatory response caused by biofilm caused by certain types of bacteria.  One type of biofilm causing bacteria, Staph epidermis, is ubiquitous.  A conscientious surgeon does everything he/she can to help minimize the exposure to the implant to the environment, including the patient’s skin, prior to insertion.  Another type of bacteria could be one cause of the very creepy BIA-ALCL and again a conscientious surgeon will use techniques to minimize contamination.   So yes, we know the breast is not a perfectly sterile environment.  The more we learn about the microbiome that is us the more we realize that healthy people co-exists with a lot of “germs”.  If the presence of a microorganism meant illness, we would all be at death’s doorstep.  In fact, our mitochondria (tiny organelles in our cells that generate energy) are likely the descendants of bacteria that some single celled organism co-opted.  God, I love cell biology.  Don’t you?

What about saline implants that leak from a tear or from the fill valve?   Could microorganisms creep in there?  Yes they could but they will need something to eat.  Normal saline, which is used to fill saline implants has no energy source. Those microorganism are going to go pretty hungry.  I am aware that here are some really weird life forms that seem to exist in the most hostile and unnourishing environments – bubbling mud pots in Yellowstone, deep ocean sulfuric steam vents, etc – but me thinks that those critters aren’t going to show up in a beast implant.

I have taken out a bajillion old saline implants and, I swear on a stack of plastic surgeon journals, have never seen one that was contaminated with fungus.  I have seen a few with little floaters that I cannot explain.  When I’ve sent the saline in such implants, the cultures have come back no growth.  What does that mean?  I don’t know.  There I said it:  I don’t know.  Could a little speck of something floating around in an intact saline implant destroy a person’s health?.  I don’t know but it seems unlikely to me unless that little speck was Polonium-210.

I have had a quite a few breast implant illness patients who were absolutely bummed that their implants were not contaminated because they had become convinced that they were.  Yes, I have seen photos of really nasty and moldy implants out there in cyberspace and yes it is obvious that some implants are contaminated and that there are unreasonable surgeons who don’t used a closed system but I think those cases are rare. Nobody posts photos of old, pristine saline implants (except me on my Instagram @breastimplantsanity).  Pristine saline implants are boring.  And I promise, cross my heart, if I take out a nasty implant filled with fungus balls, I will let you know.

Soooo, if you think your implants are moldy, you could be but probably are not right.   But as anyone who knows my practice, I will take implants out for any reason.

Thanks for reading and you should read up on Louis Pasteur.  The contributions he made to science are nothing short of amazing.  Dr. Lisa Lynn Sowder

I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.

 

Category: Breast Contouring, Breast Implant Illness, Breast Implant Removal, Breast Implants, Stuff I love

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