A Nebraska woman was infected with salmonella in her breast implant after doctors say she came down with traveler's diarrhea during a vacation in Mexico.
In a case report from the journal JPRAS Open, surgeons from the University of Nebraska Medical Center in Omaha presented the case of a 34-year-old patient who underwent a breast augmentation and lift.
Five months later, she went to Cancun where she experienced abdominal cramps, diarrhea and fever and was diagnosed with the illness traveler's diarrhea.
She visited her doctors at the medical center when she returned to the US, complaining of swelling and pain in her right breast. An ultrasound revealed fluid around her implant that contained cultures of the bacteria salmonella.
The doctors argue in the report that her gastrointestinal illness from her trip to Mexico passed into the bloodstream, resulting in the infection of the implant.
But Dr Stuart Linder, a plastic surgeon from Beverly Hills, California, is skeptical of this explanation and told Daily Mail Online that he believes it's more likely a trace of Salmonella entered her implant during her initial operation, and lay dormant for months.
In the report, the authors wrote the woman visited the University of Nebraska Medical Center to undergo a breast augmentation and lift.
She received silicone implants for her augmentation and the surgeons wrote in the paper that the procedure went well.
One week later, she went in for a follow-up visit where physicians noted she was doing well aside from mild muscle spasms, which were treated with diazepam.
Most often marketed under the name Valium, diazepam is used to treat anxiety, muscle spasms and seizures.
Approximately five months later, she went on vacation to Cancun, Mexico.
During her time there she experienced symptoms including fever, chills, abdominal pain and diarrhea.
After the symptoms persisted upon her return to the US, doctors determined she had traveler's diarrhea.
Traveler's diarrhea is a gastrointestinal illness caused by eating contaminated food or drinking contaminated water.
Contrary to popular belief, food is actually the primary cause of the illness.
The Centers for Disease Control and Prevention estimates that around 80 percent of cases are caused by bacteria, most commonly E. Coli.
Traveler's diarrhea typically goes away on its own after a few days without the need for medication.
Nine days after her return to the US, she reported that her symptoms had improved.
But, two weeks later, she visited the clinic again - this time complaining of pain and swelling in her right breast.
An ultrasound revealed there was a fluid around the implant despite no drainage from her incision.
Doctors prescribed her amoxicillin-clavulanate, a combination medicine that treats bacterial infections.
Three days later, she returned with a large abscess in the lower part of her right breast and reddened skin.
She was taken to an operating room where the abscess was incised and drained and the implant was removed.
The surgeons took cultures of the fluid that grew the bacteria salmonella.
Salmonella infections occur after eating raw meat and eggs or foods that are contaminated with the bacteria.
Although less common, the bacteria can cause cases of traveler's diarrhea.
The authors say that past research has shown salmonella infections can occur outside the intestine due to the ability of the bacteria to live within a type of cell that absorbs bacteria, which then circulates in the bloodstream.
Dr Linder, a board-certified plastic surgeon who focuses on body work, is not convinced.
'Anything is possible but, in my 21 years of this, I've never heard of a single case of a salmonella infection in an implant,' he told Daily Mail Online.
His hypothesis is that the woman was contaminated during surgery, likely from someone who didn't wash their hand before the operation.
'I believe it was likely intraoperative. And I'm not saying it was necessarily the surgeon, it could have been the scrub tech or the assistant surgeon,' he said.
Dr Linder believes the bacteria remained dormant in the pocket created for the implant.
The bacteria could have then formed a biofilm, which is when microbial cells stick together and often to a surface.
As the patient became more active, even started working out, the biofilm may have opened up and spread - resulting in the infection.
'It's just highly unlikely that it crossed from the gastrointestinal tract into the bloodstream, passed through the tissues and through the capsule,' he said.
Capsules of scar tissue, the body's self-defense mechanism in warding off antigens, form a barrier around any breast implant.
The capsule generally helps keep breast implants and place and prevents them from slipping.
'After five months, the capsule would be well-formed. It's unlikely that the bacteria would pass it and surround the implant,' Dr Linder said.
He added that only about one to two percent of breast augmentations result in an infection and that most occur 10 to 14 days after the procedure.
'Five months later? Oh, give me a break,' he said. '[The bacteria] was likely seated in there the whole time.'