Risks of medical tourism you weren’t expecting

I had an interesting experience the other day with a surgical patient. Twelve years ago, she had a breast augmentation in Tijuana. At the time, she remembers the doctor telling her that she received 380cc silicone implants, placed under the muscle.

Luckily she had no problems with her procedure or any other issues in the subsequent 12 years. She had kids in the intervening years and as breast tend to do, she had ptosis, or breast droop. She decided she wanted bigger implants as well as a lift. While she was also getting other procedures, the only relevant procedure was the breast augmentation and lift.

Surprise findings during surgery

We had a few surprises in store for us. First, her right implant was ruptured as seen in the photo above and the video below. Of course, this isn’t necessarily an issue isolated to medical tourism. All implants have a risk of rupture. However, was that implant used in Tijuana approved for use in the US? Maybe that particular brand wasn’t approved by the FDA because of a known higher-than-normal rate of rupture?

We also found that the implants were on top of the muscle, not under. Within the plastic surgery literature, we do know that implants under the muscle have a lower risk of capsular contracture. That’s when the normal scar tissue that forms around an implant becomes so thick that it can distort the breast. It’s also a little more technically challenging to place the implant under the muscle because the surgeon must cut the muscle. So did the doctor in Mexico not place the implants under the muscle because it took more time and was more difficult to perform that procedure? Did the surgeon place the implants on top of the muscle and tell her otherwise?

You may think I’m being unfair in raising concerns of impropriety and dishonesty on the part of the doctor. But this last detail will explain my cynicism. There were two different implants used in this patient! And I don’t mean two different sizes in an attempt to improve symmetry (bigger implant in smaller breast and smaller implant in bigger breast). In this case, one implant was textured and one was smooth (as seen in the photo above and video below). I can’t think of a reason that would be necessary in a straightforward cosmetic breast augmentation.

Video of Medical Tourism Surgical Surprises!

So you may say, “big deal.” She was happy for 12 years. Even though there were some inconsistencies, everything turned out alright. I’m happy for her. I am glad everything turned out fine.

However, when you add up all of the risks: 1) possibly substandard breast implants, 2) lack of an operative report or transparency to confirm placement of the implants and 3) different style implants – it makes you wonder, what else did this patient not know about? Were the instruments unsterile and she just got lucky? Did they use a machine to minimize the risk of blood clots in the leg which is standard in the US? Did they use expired IV antibiotics or any antibiotics?

The bottom line is that there’s already a knowledge gap between doctors and patients in the US under normal circumstances. By going out of the country, you’re setting yourself for risks you don’t even know exist!

To check pricing on any procedures from Dr. Kaplan, click here.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post International Medical Tourism: Death isn’t your biggest concern! [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Is domestic tourism safer?

Whether domestic tourism is safer than the international travel associated with medical tourism depends on the motivation for traveling in the first place. Often times, the reason for medical travel away from home is affordability. Cheaper care can still be quality care. But there is a reality that the consumer must recognize.

In the United States, to adhere to a minimum standard of quality and to pass annual facility inspections costs money. And to cover those costs, a facility must charge a reasonable amount. Internationally, a facility may not have those same standards. And if they don’t have to pay for capital improvements, they can pass those savings onto the patient. So yes, it’s cheaper in other countries, but there’s no guarantee the facility meets the standards taken for granted in the US.

In contrast, domestic facilities must keep up with the latest regulations to stay in business. Maybe it won’t be as inexpensive as going outside of the country, but there’s no question you can find less expensive quality care in the US if you’re willing to travel. Click here to determine your out-of-pocket expenses at those accredited facilities with certified doctors.

The risk of complications

But even if you find a legitimate place to have a procedure domestically, you can’t eliminate the possibility of having a complication. And if you do have a complication after your procedure, you have to find a new doctor to take care of you.

It’s great if you can travel and save money and live happily ever after. But if you have a complication and your doctor isn’t available, that’s a problem. First off, if you’re suffering a complication, you’re not in the best position to start searching for a new doctor to help you.

It’s not a position your doctor wants to be in either. When addressing a complication that’s not their own, the doctor is trying to play “catch up” and figure out what’s been done, what’s going on now, and how to fix it.

I’m not suggesting the doctor won’t try and do their best to help the patient. But it’s less than ideal for a doctor to fix another physician’s complication mid stream. In the end, cheaper care, while potentially high quality, still has its unavoidable risks.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Medical tourism is now domestic tourism first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Travel after surgery: is it safe?

One of the more curious questions I get is whether it’s safe to fly after a breast augmentation. I think they’re asking because at higher elevations, the atmospheric pressure is lower so maybe the implants could expand and pop? I’m guessing here so I welcome comments below as to the reasoning behind this question. Regardless, it’s not true.

Modern airplanes have pressurized cabins so the atmospheric pressure isn’t changing. More importantly, even if the atmospheric pressure did change, I’m guessing it would have to change a lot (as in going into space without a pressurized cabin) for the implants to expand enough to pop. But if you’re in that situation, the state of your implants is probably not the most pressing issue!

The other concern about traveling after surgery which may not be obvious, is the risk of sitting for long periods of time. Whether you’re in a car or plane, sitting or being sedentary can lead to blood clots in the legs. This is known as a deep vein thrombosis (DVT). These blood clots, in the worst of circumstances, can break loose and travel to the heart and lungs. That can lead to shortness of breath, damage to the lung or even block the heart leading to sudden death.

To avoid these blood clots forming during your surgery, your doctor will place sequential compression devices (SCD’s) on your legs. SCD’s squeeze the leg veins, release the chemical nitric oxide and keep the blood flowing rather than clotting. After surgery, at home, or when traveling, simply get up and walk around to exercise your legs. Walking is the most effective way to decrease your risk of forming blood clots. So on a long road trip, stop frequently at a rest stop and walk around. And if you’re flying, wait for the fasten seat belt sign to turn off and walk about the cabin!

Again, as long as you’re feeling well, your incisions are healing nicely, there’s no carte blanche prohibition against traveling after surgery. But of course, ask your surgeon just to be safe. And if you’re looking for a doctor near you, as well as their pricing, click here.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

The post How soon can I travel after surgery? first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Antibiotics

While not based on personal experience, one of the more common infections on a trip is a skin infection from a scratch or a urinary tract infection (UTI). You can’t bring a whole pharmacy with you but there’s a group of antibiotics that can cover many potential infections. They’re called fluroquinolones.

You may know them better as Cipro or Levaquin. They also go by the generic names of ciprofloxacin and levofloxacin, respectively. The reason I go into such detail about their trade and generic names is because all of the drugs in this class have ‘flox’ in the name. So regardless of what country you’re in, and if you forgot to bring your own Cipro or Levaquin with you, you’ll know you’re getting the right medication because ‘flox’ will be part of the name on the bottle, even if the rest of name doesn’t look familiar.

DripDrop for Dehydration

If it was realistic to bring a bag of IV fluids along with your own IV tubing and needle, I would. But since this is difficult for a host of reasons – such as you may not be a nurse or a doctor and the TSA would probably question you – DripDrop is the next best thing. It’s a powder formulation that you add to a bottle of water to replace lost sodium and potassium and other essentials elements that you need in addition to water. It won’t treat your diarrhea but it’ll keep your diarrhea from leading to your dehydration! DripDrop is available without a prescription.

Nausea

I’ve got one word for you: Zofran. This is the greatest anti-nausea medication ever created. It comes in a dissolvable tablet. So even if you’re vomiting, this will be absorbed under your tongue. No need to swallow. It’s available in a generic form as ondansetron.

Enjoy your next trip abroad. And the best way to guarantee it is to bring along this trusty pack of meds.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

The post Medications to pack when traveling abroad first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.