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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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.

This recent article makes an incredibly interesting argument. That cosmetic surgery can lead patients to quit smoking! It’s not as far-fetched as you may think. It’s starts with the notion that smoking affects small blood vessels in healing skin.

Cosmetic surgery to quit smoking?

If you’re a smoker, you know surgeons always say to avoid all nicotine products. The nicotine in cigarettes or dip or nicotine patches/gum can cause small blood vessels to constrict. Those small blood vessels are critical to tissues healing after some type of damage, including an incision from surgery. It can also affect the skin after some type of skin resurfacing like a laser or chemical peel.

Doctors tell patients to quit smoking for two weeks prior to surgery so the affects of nicotine can wear off in active smokers. What happened in the study?

“In the follow-up, about 40 percent of those patients said they no longer smoked on a daily basis, and nearly 25 percent had not smoked at all since their surgery. Also worth noting: Most people said they had reduced their smoking habit by some amount, and 70 percent said that discussing their increased surgical risks with the plastic surgeon positively affected their ability to quit or reduce smoking.”

And all those warnings from doctors about the risk of postop complications from smoking?

‘The complication rate was higher in those [smoking] patients — 24 percent of them had post-surgical issues, as opposed to 14 percent of patients who stopped smoking. Serious wound-healing complications also occurred in two people, both of whom kept smoking before their procedure.”

Moral of the story, listen to your doctor when it comes to smoking and get cosmetic surgery to quit smoking! Just kidding on the last one…no I’m not…of course I am. But seriously, patients are more likely to quit smoking when they understand specific risks associated with nicotine.

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

The post Get cosmetic surgery and quit smoking…maybe first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Often patients ask when they will be go home after their cosmetic surgery. I will explain that they’ll go home mid or late morning or early afternoon depending on the procedure. There’s a look of surprise in their face because they ask, “oh, the same day?!” And I explain that an overnight stay will not be necessary. Just as they are surprised they’re going home the same day, I’m surprised they think an overnight stay will be necessary in the first place.

Is an overnight stay necessary after cosmetic surgery?

While I’m always quick to point out that cosmetic surgery is real surgery, the procedures aren’t necessarily long and certainly don’t have a great deal of blood loss. Procedures that are long or have significant blood loss can affect blood pressure. If blood pressure is labile, or not stable, it’s certainly appropriate for a patient to stay in the hospital overnight. In other words, there’s a reason some procedures require an overnight stay. Just because someone is having surgery doesn’t automatically require an overnight stay.

Therefore, you have to assess the type of procedure someone is having and if blood pressure is stable and blood loss is minimal, it’s appropriate to go home the same day. And since cosmetic surgery is often characterized by stable blood pressure and minimal blood loss, patients can safely go home.

Additionally, if a patient doesn’t need to be in the hospital overnight, they’re potentially avoiding hospital-acquired infections that can be resistant to antibiotics. Aside from avoiding these superbugs, why stay in a hospital if you don’t have to? Wouldn’t you rather recover in the comfort of your own home? Depending on the procedure, most oral pain medications will be enough to take the edge off. Oral medications won’t necessarily eliminate your pain but even the strongest of pain meds won’t do that.

So next time you’re considering cosmetic surgery, don’t assume an overnight stay is necessary. Recovering at home may be the best medicine.

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

The post Overnight stay after cosmetic surgery…necessary? first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.