There is no shortage of horror stories when it comes to medical tourism – traveling outside of the country for your medical care. Headlines abound of patient deaths from fat embolism, hypovolemic shock or overwhelming infections. And while death is obviously the worst complication, it’s not the main risk. Poor quality and cut rate procedures can reveal themselves in much more boring, but significant ways.
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!
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