Poster for cosmetic surgery in Kaohsiung, Taiwan (Keith Alexander, Flickr)
30 March 2018. Surgeons at a Boston hospital report a continuing flow of cases where people go overseas for plastic surgery, only to encounter complications needing repair, including drug-resistant bacterial infections, after they return. A team led by Dennis Orgill, a plastic surgeon at Brigham and Women’s Hospital and professor of surgery at Harvard Medical School, describes its findings in the April 2018 issue of the journal Plastic and Reconstructive Surgery.
The popular image of medical tourism, seen as a practice by wealthy people in poorer countries going to the West for medical care, is not borne out by statistics collected by a 2014 study in the U.K. on cosmetic surgery that show just the opposite. That report by University of Leeds points out that most medical tourist cosmetic surgery patients are immigrants and other people of modest means in Western countries going to their home countries or medical centers abroad where the price tags for procedures are lower.
Orgill’s group at Brigham and Women’s Hospital found much the same results. The team went back in their records for outpatient plastic surgery over 7 years and found 78 patients coming to the clinic to deal with problems resulting from procedures done in other countries. All of the patients included in the analysis were residents of the U.S. when they went abroad for surgery, with nearly all — 76 of 78 — women, and an average age of 43.
The most frequent destination of the clinic’s plastic surgery tourists is the Dominican Republic, accounting for three-quarters (59 of 78 or 75%) of all cases. The destination is not surprising given the large Dominican community in Boston, representing about 1 in 13 residents. Other locations were mainly in the Americas — Columbia, Brazil, Venezuela, Argentina, and Mexico — accounting for 20 percent of the patients, as well as Syria, Turkey, and China. Abdominoplasty, known as tummy tucks, and breast augmentation made up 60 of the 78 cases, followed by foreign substance injections, breast lifts or reductions, and liposuction. Nearly a quarter, 18 of 78 or 23 percent, of the patients say they had more than one procedure while abroad.
Many of the former medical tourist patients were diagnosed with conditions requiring hospitalization. More than 1 in 5 patients, 17 of 78 or 22 percent, were admitted to the emergency department, while 12 percent required hospitalization. Nearly 1 in 5 patients, 18 percent, reported infections at the site of their initial surgeries, including methicillin-resistant Staphylococcus aureus and cephalosporin resistant E. coli bacteria. Other more frequent complications include pain, unhealed wounds, scars or other unwanted cosmetic results, and hernias. In addition, 4 patients say they received breast implants they did not request.
For the vast majority of patients (86%), their additional care in Boston was covered by insurance, including more than 6 in 10 — 48 of 78 or 62 percent — covered by the state’s Medicaid program. Orgill cautions in a Brigham and Women’s statement that a lower price tag for plastic surgery abroad can mean more problems and higher costs later on. “Patients need to be very cautious when they go outside of the U.S. for elective plastic surgery,” says Orgill. “The safety and regulatory systems that protect patients in the U.S. are often not in place in a patient’s home country.”
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