I have recently seen a pamphlet for company that arranges cosmetic surgery trips to a South American country. It reminded me that medical tourism still exists. And it left me wondering: why do people go to other countries to have their cosmetic surgery? I’ve always been baffled by this. Money is clearly the main issue here. BUT there’s a big ‘but’…… When your health, well being, and life are on the line, are you really trying to find the cheapest surgeon???

Traveling to international destination, often to less developed countries puts you at risk. Assuming that the surgeon who will be performing you surgery is properly trained, you still don’t know whether or not the faciliity he works out of is properly equiped. Is he using the proper instruments. Breast implants, for example, are mady by various companies. Are getting a cheaper Chinese or Russian product??? How do you know. But here is the biggest problem… what if you develop a complication? While serious complications are rare, no surgeon can ever give you a 100% guarantee that a complication will not occur. And if it does, and it is serious enough to require hospitalization…. do you really want to be admitted to the local hospital in Guatemala or India? How much will that cost you? Will you get the same level of care you would have received in your home country?

Plastic Surgeon in North America are not the only ones with the knowledge and skill to perform cosmetic surgery. The issue here is, however, that when you travel to another country you have no knowledge of their system. You may get scammed by a person with no plastic surgery training whatsoever. You may be taken to a hospital with no supplies. Next time you go to the Carribean or another part of the world, take a look at their hospital system. Some healthcare systems require that the family bring in their own toilet paper, tovels, and medications.

Don’t risk your life. If you decide to travel for cosmetic surgery, make sure your surgeon has the proper certification and that there is a proper health care support system available.

Martin Jugenburg,MD, FRCSC
Toronto, ON

As I was browsing the web today, I came across people asking for advice on how to chose their Plastic Surgeon. Plastic Surgery is one of the most competitive specialties to get into. It usually ranks in the top 3 which means that medical students go through a rigorous process to be selected into these residencies. (This means, in addition to getting superior grades in medical school, that they do research projects, publish a lot, and do a lot of electives in Plastic Surgery.) These medical students then go through a rigorous residency where they learn everything they need to know about Plastic Surgery. Sometimes, they pursue additional training (fellowship) in Plastic Surgery subspecialties. In the end they are certified by the American Board of Plastic Surgery or the Royal College of Physicians and Surgeons (in Canada). This is the certification that you want to be looking for. It doesn’t guarantee perfection, but it guarantees that a responsible body has assessed this surgeon and determined that he was a safe and knowledgeable Plastic Surgeon.

Beware of ‘fake’ certification. Anyone can create a ‘Society’ and distribute certificates. Family doctors and other surgeons then pay a membership fee to these societies which in return issue a certificate of membership. These can be Am Soc of Laser Surgery, or Am Soc of Liposuction or International Society of Cosmetic Surgery etc…… They sound good, their certificates look impressive, but they only guarantee that the surgeon has paid his membership fee. There is no exam, no certification process involved (no, a two week course in liposuction is not a real training experience).

In conclusion, you want Am Board of Plastic Surgery or Royal College of Physician and Surgeons in Plastic Surgery. If you don’t know… ask another doctor or your family doctor.

Martin Jugenburg,MD, FRCSC
Toronto, ON

Nipple reconstruction can refer to creation of a brand new nipple after mastectomy, or to adjustment of a deformed nipple.
Yesterday I treated a lady with right breast lumpectomy which left her nipple depressed and deviated. The underlying problem here was that the lumpectomy removed breast tissue from under the nipple, thus the nipple looked like it was sinking in. To correct this problem (lack of breast tissue), I used liposuction to collect fat from another area of the body which I then injected under the skin of the nipple. This was designed to prop up the nipple. Fat grafting (which is the proper term to describe this technique) has a significant resorption rate. Up to 50% of the volume that has been injected will be absorbed by the body… thus one needs to over correct, and often multiple sessions are required until enough fat remains to achieve the desired effect.

Martin Jugenburg,MD, FRCSC
Toronto, ON