Medical articles explaining organisms in ** Saline filled and ** Silicone Filled Implants

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ASPERGILLUS COLONIZATION ASSOCIATED WITH BILATERAL INFLATABLE SILICONE MAMMARY IMPLANTS

Author: Walton, BunkisSource: Plastic & Reconstructive Surgery Journal, February, 1983, 71(2):260-1

ABSTRACT

A case of aspergillus niger fungal colonization associated with bilateral inflatable silicone mammary implants is reported. Painful fibrous capsular contractures without clinical evidence of infection or inflammation characterized the presenting symptoms. Operative findings included a cheesy-white exudate that surrounded the implants and turbid fluid within the implants.All specimens yielded a heavy growth of aspergillus niger. Special stains of the fibrous capsules were negative for fungal invasion.The etiology and pathogenesis of aspergillus colonization in this patient are postulated.

MICROBIAL GROWTH INSIDE SALINE-FILLED IMPLANTS

Authors: Young, V. L.; Hertl, M. C.; Murray, P. R.; Jensen, J.; Witt, H.; Schorr, M.W.Address: Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, USASource: Plast Reconstr Surg, July, 1997, 100(1):182-196

ABSTRACT

In vitro and in vivo experiments were conducted to determine whether intraluminal saline in breast implants can support the growth of common wound-infecting micro-organisms over a prolonged period of time. The bacteria tested were Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Corynebacterium jeikeium, Enterobacter cloacae, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Three fungal species also were tested: Aspergillus fumigatus, Paecilomyces variofii, and Candida albicans. In the in vitro study, four organisms survived in flasks of sterile saline for the 2 weeks in which serial cultures were performed: K. pneumoniae, C. albicans, A. fumigatus, and P. variotii.In the in vivo study, 61 white rabbits (122 implants) received both an experimental implant inoculated with one of the test organisms and a control implant containing only sterile saline. They were sacrificed at 1-, 3-, or 6-month scheduled endpoints. None of the control implants containing sterile saline had positive cultures. In contrast, the intraluminal saline was culture positive for 7 of the 10 inoculated organisms after varying lengths of time: S. epidermidis, E. coli, E. cloacae, K. pneumoniae, P. aeruginosa, A. fumigatus, and P. variotii. Samples of capsular tissue also were cultured. Of the 122 capsular tissue specimens, 21 (17 percent) had positive cultures and surrounded both inoculated and sterile implants.In most instances, capsules that were culture positive contained an organism different from the one that had been inoculated in the group. In only 3 cases was the same organism cultured from both the periprosthetic tissue and the intraluminal saline, and these may represent instances of the inoculated organism migrating through the implants filler valves. The data show that several types of bacteria (particularly gram-negative species) and fungi can grow and reproduce in a restricted saline environment for extended periods of time.

BACTERIAL GROWTH IN SALINE IMPLANTS; IN VITRO AND IN VIVO STUDIES

Authors: Chen, N.T.; , P.E.; Hooper, D.C.; May, J.W., Jr.Address: Department of Surgery, Massachusetts General Hospital, Boston, 02114Source: Ann Plast Surg, April, 1996, 36(4):337-41

ABSTRACT

The survival of bacteria was evaluated in custom-made saline breast implants with integral injection ports in vitro and in 10 New Zealand White rabbits for Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Serratia marcescens. Pseudomonas and Serratia survived in vitro in saline-filled implants and multiplied 24-fold and 22-fold, respectively, from the initial inocula of 300 colony-forming units per cubic centimeter in 21 days.Serratia alone survived in saline implants placed on the dorsum of rabbits, proliferated 80-fold in 7 days, and tapered to 10-fold at the end of 3 weeks. Chemical analysis revealed the presence of glucose in fluid from the implants in the animal study (mean, 1.2 mg per deciliter; standard error of mean [sEM], 0.6) after 21 days and from human subjects (mean, 3.8 mg per deciliter; SEM, 1.0) after 8 months to 10 years. Serratia incubated in human breast implant fluid samples proliferated 7-fold to 30-fold greater than in the saline control in a nonaerated environment. We conclude that some bacteria are able to proliferate in saline in breast implants. Furthermore, their survival may be facilitated by a substance (i.e., glucose) that diffuses across the implant outer shell.

PAECILOMYCES VARIOTII CONTAMINATION IN THE LUMEN OF A SALINE-FILLED BREAST IMPLANT

Authors: Young, V.L.; Hertl, M.C.; Murray, P.R.; Lambros, V.S.Address: Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, USASource: Plast Reconstr Surg, November, 1995, 96(6):1430-4

ABSTRACTThis report describes a case of gross contamination with the filamentous fungus P. variotii cultured from an intraluminal saline breast implant removed from a patient 14 months after implantation because of severe capsular contracture. We suspect the fungal contamination occurred when a container of saline was left open in the operating room prior to filling and placement of the implant. This case may be the first documented report of microbial growth and reproduction in the internal environment of a saline implant. We assume that organisms such as P. variotii can survive - and accumulate biomass - on the minute amounts of substrates that diffuse across an implant envelope.NOTE: One of the women in our support group brought her intact explanted saline- filled implants to a meeting locally. They are filled with black, brackish saline with particles floating profusely in them. She is also on disability and in a wheelchair. She was a school teacher; another intelligent woman struck down in her 30's or in the prime of life.The shells are permeable; fluid can flow in and out.