Tea-Colored Discoloration in Saline Breast Implants
Tea-colored discoloration in saline breast implants is caused by microbial contamination, most commonly fungal organisms such as Curvularia species or Aspergillus, which produce pigmented metabolites within the implant's saline medium.
Mechanism of Contamination
The discoloration occurs through microbial growth within the saline-filled implant lumen, producing visible pigmented sediment or metabolic byproducts that give the characteristic tea or brown coloration 1, 2.
Routes of Contamination
Microbial organisms can enter saline implants through several pathways:
Contaminated saline at the time of filling - The most common source involves environmental contamination of saline used during implantation, particularly when saline is warmed in open containers or poured into bowls exposed to the operating room environment before injection 2
Semi-permeable silicone envelope - The silicone shell of saline implants is selectively permeable, allowing passage of small molecules and potentially facilitating intraluminal microbial growth over time 1
Intraoperative contamination - Breach of sterile technique during surgery, including contaminated surgical environments (particularly water-damaged areas, negative pressure differentials in operating rooms, or contaminated storage areas) 2
Hematogenous seeding - Late infections can result from secondary bacteremia or invasive procedures at remote sites, though this is less common for fungal contamination 3
Specific Organisms Implicated
Fungal species are the primary culprits for visible discoloration:
- Curvularia species produce black sediment that appears as dark tea-colored fluid 2
- Aspergillus flavus can grow both within the implant lumen and in the pericapsular space, producing visible discoloration 1
Important Clinical Context
Despite these documented cases, intraluminal microbial contamination is extremely rare. A prospective study of 56 explanted saline implants and tissue expanders found zero cases of microbial contamination in the luminal saline, suggesting this is an unlikely event under proper surgical conditions 4.
Risk Factors for Contamination
Specific procedural factors increase contamination risk:
- Open saline filling systems - Pouring saline into open bowls before injection dramatically increases environmental exposure 2
- Prolonged surgical duration - Longer operations correlate with higher contamination rates (p<0.001) 2
- Environmental factors - Water-damaged ceilings, improper storage of saline bottles, and negative pressure differentials in operating rooms 2
- Inadequate aseptic technique - Failure to maintain stringent sterile protocols during saline preparation and implant filling 1
Clinical Implications and Management
When tea-colored discoloration is identified:
- Implant removal is mandatory - The contaminated implant must be explanted with thorough wound irrigation 1
- Culture the saline - Send intraluminal fluid for bacterial and fungal cultures, Gram staining, and acid-fast staining to identify the organism 4
- Assess for systemic infection - Though rare, evaluate for signs of systemic fungal infection, particularly in immunocompromised patients 3
Critical Prevention Measures
Surgeons must implement specific preventive strategies:
- Always use closed filling systems - Never expose saline to the operating room environment before injection into implants 2
- Maintain proper environmental controls - Ensure positive pressure differentials in operating rooms and eliminate moisture/water damage in surgical facilities 2
- Avoid intraluminal additives - While antibiotics and steroids may reduce capsular contracture, they increase deflation risk (odds ratio 2.6 and 2.4 respectively) 5
Important Caveat
Saline implant rupture presents differently than discoloration. Ruptured saline implants typically result in rapid deflation over days as saline is resorbed by the body, with clinically evident changes in breast size and shape 6. Tea-colored discoloration represents intact implants with internal contamination, not rupture.