The dangers of cosmetic surgery tourism

Mr Richard Matthews is a highly experienced Consultant Cosmetic & Reconstructive Plastic Surgeon based in Leamington Spa, Warwickshire. In a series of interview with Cosmetic Surgery Today he discusses the changes he’s witnessed in the cosmetic surgery industry in the UK and abroad in recent years.

Recent years have seen an increase in medical tourism, also known as cosmetic surgery tourism. What is your view on this development?

Top of the list of why people opt for medical tourism is price. It certainly usually seems cheaper but, as the saying goes, you get what you pay for.

To my mind, the problem with medical tourism is that you don’t know what you are going to get. I’m not saying that some of the plastic surgeons that you see abroad aren’t absolutely excellent and do a fantastic job and some patients may go abroad, get a good result, have no complications and come back and say that was brilliant.

However, by and large, if you go abroad for surgery, you will usually not have met the surgeon in advance of the day of operation, often language is a barrier and you have no control or even sometimes way of checking the infection rates in a hospital abroad.

Furthermore, you won’t know till after surgery whether you will be fit to travel back and, usually, your return flight will have been booked in advance. If you get a problem or complication while you’re there, then it may be sorted, but if you have it when you return home, which will still be quite soon after surgery, what’s going to happen? Are you going to be able to go back to get it sorted? Probably not.

I see patients at my private practice who have had problems after undergoing a cosmetic surgery procedure abroad. Obviously if they are going down the private route then they will be spending more money which they could have spent more favourably in the first place. One may or may not be able to restore them to a level where they are satisfied.

However, if the complication is life-threatening and the patient has to seek treatment from the NHS, then it is a completely different ballgame. In the first place the focus is purely on survival and achieving the least possible damage is very much a secondary aspect. There is also the separate issue of whether it is fair for the NHS, and therefore the UK taxpayer, to pick up the tab for problems arising from your decision to go abroad for surgery.

My worry is that people go into cosmetic surgery abroad without their eyes open and they leave themselves exposed to danger. I certainly would certainly do my utmost to dissuade any of my relatives and friends from travelling abroad for medical tourism purposes.

Consultant Plastic Surgeon Mr Richard Matthews discusses the need for a breast implant registry

Consultant plastic surgeon Mr Richard Matthews has a busy private and NHS practice in Leamington and throughout Warwickshire. He talks to Cosmetic Surgery Today about the report by Sir Bruce Keogh into the aesthetic industry and the recommendations of the report.

One recommendation of Sir Bruce Keogh’s report is that a breast implant registry should be re-established. Has it happened and why do you think it is so important?

We used to have a breast implant registry in the UK but unfortunately the funding ran out for that in 2004 and it’s not been re-established since and still has not been full re-established despite the recommendations of Sir Bruce Keogh.

A breast implant registry needs appropriate funding and it wouldn’t be very expensive, but its value shouldn’t be underestimated. We have a National Joint Registry (NJR) that was set up to collect information on all hip, knee, ankle, elbow and shoulder replacement operations and to monitor the performance of the implants which runs very successfully.

The reason why it is so crucial has been fully illustrated by the PIP implant scandal. We have no way of accurately tracing the women who have had these implants, let alone where or by whom. The exact date is very important in relation to PIPs as it is possible then to determine whether they were inserted during a period where the implants were possibly safe or, subsequently, when the fraudulent manufacturing took place.

If we’d had the implant registry we would have been able to get in touch with these women and recall them, in much the same way as if a fault is detected in the manufacturing process of a car you can get in touch with the owners to prevent accidents happening.

Then we could examine the implants and consider whether something should be done at once or whether the women should return for periodic evaluations.

Cosmetic Surgery Today Interview with Consultant Plastic Surgeon Mr Richard Matthews

Cosmetic Surgery Today talks to Leamington-based plastic surgeon Mr Richard Matthews about recent developments in the cosmetic surgery industry.

In your recent presentation to an international surgery conference you spoke about the PIP crisis. The big cosmetic surgery chains were responsible for the majority of the PIP implants inserted in the UK. How do you feel that they have cared for their patients?

The paper I gave was to an International conference for plastic surgeons in Santiago, Chile, and I presented a survey I had done with my Consultant Plastic Surgery colleagues in the UK into their experience with these implants.

My colleagues and I have been pretty horrified by the rupture rate of these implants. Clearly, the cases that came to us were slightly skewed in terms of the general population, but nevertheless we were seeing quite a lot of patients in whom an undetected rupture had occurred in one or both implants and, furthermore, the appearance of the silicone that we were finding outside of the implant was really horrible. Some patients had been experiencing side effects since having these implants inserted that had been causing them quite a lot of problems.

We know perfectly well that these implants are going to rupture sooner than standard implants and my view is that they should all be removed sooner rather than later.

With regard to the big four cosmetic surgery chains who are responsible for implanting the majority of PIP implants in the UK, one of them first liquidated and then reinvented itself as a different company but with more or less the same name. This has been done mainly to avoid its responsibilities to its patients. The other three Companies have been more responsible by removing the implants and offering reasonable terms for re-augmentation.

The Department of Health has stated there is no cause for concern unless there has been a rupture or suspected rupture. Do you share the government’s views?

I have some quite strong reservations about this and that’s not just confined to myself. Quite a lot of my colleagues – us guys at the sharp end who are taking these implants out of these poor women and seeing the devastation they’ve caused – have found on removal that, first of all, even when it hasn’t been detected pre-operatively on a scan, that some of the implants have ruptured. Some of them are producing grossly altered silicone which looks offensive and even sometimes smells offensive. Women are also reporting symptoms secondary to this.

There is a study going on at the moment, the aim of which is to evaluate this in a rather more extensive and scientific way than we feel the Department of Health, through the MRHA, have achieved so far.

Is it safe to combine multiple plastic surgery procedures into one operation?

Following on from the Mummy Makeover piece I recently posted, I have been asked whether it is really safe to combine multiple procedures in one lengthy operation.

My advice is that, for fit and healthy patients, combining plastic surgical procedures is very safe, despite the extra length of a combined operation, and offers the advantage of only requiring one general anaesthetic.

Naturally, there are still risks and complications relating to both the surgery and the anaesthetic and any particular risk factors, such as smoking, excessive weight, diabetes and the prescribed use of steroids for medical conditions, may lead to the decision that surgery would be more wisely carried out in stages.

However, there are some definite benefits in combining multiple procedures, particularly in regard to only undergoing one general anaesthetic, as there are a number of potential risks attached to this aspect of the operation and prospective patients often identify this as one of their chief concerns.

Getting everything done in one surgical operation also means just one hospital stay, which is also very appealing to prospective patients.

My patient consultations are exhaustive, considering the presenting problems carefully, including thorough examination, in the presence of a chaperone if desired, before moving on to talk about realistic solutions by way of surgery.

Do’s and dont’s after surgery are carefully talked through in terms of lifestyle and occupation, particularly with regard to length of recovery and I also discuss potential risks and complications, as well as cost to round things off. This is all backed up by a detailed letter covering all these aspects of the consultation, inviting further queries if anything is unclear or if a further point arises. A second consultation can take place if desired. There is no pressure on my part for surgery to proceed, this decision being entirely up to the patient booking a date through my secretary.

Is it safe to combine multiple plastic surgery procedures into one operation?

Following on from the Mummy Makeover piece I recently posted, I have been asked whether it is really safe to combine multiple procedures in one lengthy operation.

My advice is that, for fit and healthy patients, combining plastic surgical procedures is very safe, despite the extra length of a combined operation, and offers the advantage of only requiring one general anaesthetic.

Naturally, there are still risks and complications relating to both the surgery and the anaesthetic and any particular risk factors, such as smoking, excessive weight, diabetes and the prescribed use of steroids for medical conditions, may lead to the decision that surgery would be more wisely carried out in stages.

However, there are some definite benefits in combining multiple procedures, particularly in regard to only undergoing one general anaesthetic, as there are a number of potential risks attached to this aspect of the operation and prospective patients often identify this as one of their chief concerns.

Getting everything done in one surgical operation also means just one hospital stay, which is also very appealing to prospective patients.

My patient consultations are exhaustive, considering the presenting problems carefully, including thorough examination, in the presence of a chaperone if desired, before moving on to talk about realistic solutions by way of surgery.

Do’s and dont’s after surgery are carefully talked through in terms of lifestyle and occupation, particularly with regard to length of recovery and I also discuss potential risks and complications, as well as cost to round things off. This is all backed up by a detailed letter covering all these aspects of the consultation, inviting further queries if anything is unclear or if a further point arises. A second consultation can take place if desired. There is no pressure on my part for surgery to proceed, this decision being entirely up to the patient booking a date through my secretary.