Medical Tourism: Traveling for Plastic Surgery

A Boston surgeon tells us why traveling for plastic surgery may not be the best idea.

medical tourismIs the risk worth the reward? Photo via Shutterstock

One morning, a new patient, K.E., walked into my office thinking that her silicone breast implant had ruptured. She had her breast surgery in another country in order to save on the cost of having a procedure done here in the U.S. Once in the operating room for the removal of the presumed ruptured implant, an unexpected discovery was made. Instead of the usual scar and gel material that would normally surround a ruptured implant, a large cloth was in her breast next to the implant, and that was ultimately the reason she was experiencing discomfort following her surgery overseas.

It’s been said that medical tourism dates back to Ancient Greece when pilgrims from all over the Mediterranean traveled to Epidauria in the Saronic Gulf seeking aid from the healing god Asklepios. “Medical tourism” is now defined by the Medical Tourism Association as the practice by which people from one country seek greater or equal medical care in another part of the world in an attempt to bypass higher medical costs (with a cost savings of up to 90 percent).

For example, the average cost of a tummy-tuck, or abdominoplasty, in the U.S. is $9,750. In South America, the cost is $3,500. Here in the Boston area, the price ranges from $7,660 to $16,400.

The United States has traditionally been a destination for medical tourism, particularly for patients searching for the latest in cutting-edge medical expertise and technology. A McKinsey and Co. report found that 60,000 to 85,000 medical tourists traveled to the United States in 2008 for medical procedures. But, an estimated 750,000 American medical tourists traveled from the United States to other countries looking for lower cost Western-accredited medical facilities, which was an increase of 250,000 from the previous year. There are a few reasons for this, but one standout is that certain procedures not yet approved in the U.S. by the FDA may be offered elsewhere. A report by Deloitte Consulting projected that medical tourism from the United States would increase tenfold over the next decade.

Medical tourism may carry risk. For example, the quality of care following surgery can vary significantly. Also, different countries have other infectious diseases and exposure to these infections without having built up natural immunity can be dangerous, especially for individuals with weaker immune systems. Plus, traveling long distances following surgery can raise the incidence of complications, and long flights can cause blood clots that travel to the lungs and are potentially fatal.

In the end, the cloth was removed from K.E. and she was able to keep her breast implant. Luckily, she went on to heal well.

—Samuel J. Lin, MD

 

Dr. Samuel Lin is an assistant professor of surgery at Harvard Medical School and a plastic surgeon at Beth Israel Deaconess Medical Center. He is also the site director at BIDMC for the Harvard Plastic Surgery Residency Training Program.

 

 

 

 

 

 

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  • geomark

    The people I know who have traveled overseas for plastic surgery did it for the quality not the price. Places like Yanhee hospital in Bangkok. They’re famous for cosmetic surgery, have done hundreds of thousands of procedures, and they have a stellar reputation for results particularly for Asian patients. I’m sure the prices are attractive but it’s the quality that’s drawn the people I know.

  • http://twitter.com/premhealthserv mark hughes

    I certainly agree that traveling overseas for medical procedure is not without risk especially with more serious conditions. However, it would be wrong to characterize all medical facilities abroad as a low cost inferior option. With more and more governments actively supporting medical tourism, increasing numbers of JCI accredited hospitals with western trained medial staff and greater transparency of options, the risks are not only with the patients but with the US medical profession.

  • http://www.facebook.com/rhys.branman Rhys Branman

    The trend toward going abroad for cosmetic surgery brings up several issues. I would like to think that anyone considering going has done
    their research. Different countries maintain different standards for physicians and medical facilities. Your country, whether that be the US or the UK, has no jurisdiction over substances, procedures or equipment used in foreign countries. I am not saying that all medical service abroad is substandard; what I am saying is that a medical facility in Mexico, Thailand, or Brazil, for example, may not be governed an easily accessible credentialing bodies. For instance, if a clinic is privately owned it may be impossible to research. Medical tourism has become popular, but think about this. Travel is tiring. Flying in particular increases the risk of exposure to germs in a contained environment. In addition, swelling or pulmonary embolism/blood clots may occur due to prolonged inactivity while flying. The exotic scenery may be hard to enjoy when on a liquid diet or in pain from a procedure. Combining a vacation with a medical procedure may not be as pleasant as advertised. Yet another consideration is infectious diseases not commonly found in your home country. You depend on your immune system to recover from any surgery and would not want it compromised by pathogens you are not accustomed to.

    Dr Rhys Branman
    Little Rock Cosmetic Surgery Center

  • Krishna Sharma

    Korea has some amazing medical facilities. I’m glad to see them getting some recognition!

  • Michal Metný

    I think it is great. I was in Czech republic at Medical Prestige clinic http://www.medprestige.eu/ and I must say, I am very happy with the results.

  • Arpita

    BoneWelding
    Technology: The concept of this surgical technique employs ultrasonic energy to
    liquefy a thermoplastic interface between medical implants and the host bone,
    followed by a quick cooling and solidifying process that forms a strong
    interlocked bond within seconds.

    Process: The process can be broken down into three
    general steps,

    1. An active sonotrode drives a thermoplastic
    implant into the bone.

    2. This sets up shearing forces at the contact
    surface of the polymer, causing it to liquefy at pre-defined locations and to
    penetrate into the cancellous bone.

    3. The liquid polymer is immediately quenched,
    resulting in a mechanically stable bond to the bone after only a few seconds

    Advantages:

    1. The short ultrasonic impulse and localized
    melting of the polymer has proven to leave the bone healing and
    osseointegration processes undisturbed in numerous animal studies.

    2. Licenses have been approved systems in global
    markets (no spine or sports medicine products available in US)

    3. The procedure is cost-effective, cutting back
    on implant costs, time of surgery, and risk of the implant failure.

    4. Bonds are significantly stronger and show
    improved osseointegration compared to other medical implant, fixation methods.
    This is particularly greater in areas with poor host bone.

    5. The method’s flexibility allows for the
    progress of further, innovative implant designs and surgical methods.

    a. It can be implemented through various methods:

    i. Direct bonding – fixation of implants during
    the insertion process

    ii. Interlace bonding – fixation after final implant
    placement by interface elements

    iii. InsideOut technology – reinforcement of the
    surrounding bone preventing cut-out or dislocation

    iv. In-situ assembly – process integrated
    ultrasonic fusion of multiple implants, e.g. to achieve superior angle locked
    pin to plate fixation

    v. RetroWelding –
    liquefaction of the polymeric component in direct contact to the
    sonotrode to achieve maximum bond strength independently of bone quality

    vi. Augmentation
    – reinforcement of weak bone prior to the placement of the implant

    6. Bonewelding is an easy, tangible concept,
    making surgery more comfortable for surgeons.

    7. Has been tested for resorbable polymers,
    biocomposites, non-resorbable polymerS, and in a great variety of implant
    materials, including: titanium, zirconia, biocomposite, or poly(aryl-ether-ether-ketone) (PEEK).

    Supporting Studies: (does
    not seem that clinical trials have been performed for spinal and sports
    medicine procedures just yet)

    http://www.sciencedirect.com/science/article/pii/S0266435611006073

    http://www.ncbi.nlm.nih.gov/pubmed/23898427

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3207336/

    http://www.ncbi.nlm.nih.gov/pubmed/16211571

    Applications:
    Licensed

    • Implants for cranio-maxillofacial surgery

    • Implants for fracture repair (traumatology)

    • Dental implants

    • Implants for fusion and motion preservation in the spine

    • Implants for sports medicine surgery

    Other areas of application

    • Joint implants (e.g. finger, elbow, hip)

    • Implants for minimally invasive joint arthrodesis

    • Veterinary orthopedics: implants for fracture & soft
    tissue repair and joint replacement

    • Drug delivery systems

    • Dental restorations (e.g. fillings and crowns)

    Doctors/Networks
    Overview:

    The production is based
    out of Germany and predominantly used globally outside of the US.

    Under the tab “licenses”
    on the main BoneWelding website, there are three websites http://www.spinewelding.ch , http://www.sportwelding.com , and http://www.klsmartin.com , which lead to I’m assuming the distributing
    branches of the technology’s company. At http://www.spinewelding.ch/index.php?page=team their clinical advisory board consists of the
    following doctors and professors:

    – Dr. Ulrich Berlemann, Spinecenter, Thun,
    Switzerland

    – Prof. Michael Blauth, University Hospital,
    Innsbruck, Austria

    – Prof. emeritus Dr. Dieter Grob, Ex-Schulthess
    Clinic, Zurich, Switzerland


    Dr. Stephen H. Hochschuler, Texas Back Institute,
    Dallas, USA


    Dr. Hansen A. Yuan, Upstate Medical, Syracuse, USA


    Dr. Frank M. Philips, Rush Medical, Chicago, USA

    It would appear that
    Doctors, Hochschuler, Yuam and Philips would be the best options in finding
    accessible doctors that use/have used the technique given their USA
    residency.

    At http://www.sportwelding.com/index.php?page=team their advisory board consisted of:


    Prof. Dr. Russel Warren: Hospital for Special Surgery
    HSS, New York, USA

    – Prof. Dr. Michael Blauth: University Clinic
    Innsbruck, Austria

    – Prof. Dr. Mathias Steinwachs: Schulthess Clinic
    Zurich, Switzerland

    – PD Dr. Michael Plecko: University Hospital
    Zurich, Switzerland

    Here is appears Dr. Russel
    Warren would be the best resource.

    As for http://www.klsmartin.com, under a
    “The Group” tab on their website, a small blurb is devoted to their KLS Martin
    LP sales company located in Jacksonville Florida. It that some of the applications/products
    (excluding spine or sports
    medicine products as mentioned before) are available for sale in the US, such
    as dental/oral or cranial surgery. The excluded techniques/products would be
    obviously more valued to use in the Cayman Islands due to being unavailable in
    the US.

    Here is a pdf brochure on
    the klsmartin products for dental/oral surgical procedures:

    http://www.klsmartin.com/fileadmin/Inhalte/Downloads_Prospekte/Dental/90-411-02-09_10_13_SonicWeld_Restoring_Nature.pdf

    For more information,
    please visit- http://www.voaygermed.com