Considering surgery in Mexico: do they offer Exparel? Extended TT, BA, BBL, and lipo

I am concerned for patients who choose "medical tourism", travelling far from home to have surgery. Surgical recovery takes time, often up to a year. Surgical complications are most common in the first 3 weeks, but can happen even months after the operation. I personally see my patients for up to 2 years after surgery, to ensure that they are healing well. I believe it is extremely important to think about the postoperative care you will NOT be receiving after you are home, with your surgeon miles away in a different country. These risks become even greater with multiple surgeries combined. You have done enough research to be informed about postoperative pain control and Exparel. I would urge you to also consider your postoperative care and recovery. Stay closer to home.

Most
plastic surgeons would have several concerns with what you are planning.

Combination procedures may be performed together. Whether you are a reasonable
candidate, however, for the combination of procedures you listed depends on
your anatomy, the extent of the abdominoplasty (tummy tuck) , the complexity of
the breast surgery, the amount of liposuction, volume of fat injection into the
buttocks, your medical history, medical clearance from your primary physician,
realistic expectations of the outcome and an understanding of the pros and cons
of the various procedures.

Most patients prefer undergoing one anesthesia and one recovery period which is
usually more cost effective, but many surgeons would prefer performing these
procedures in 2 separate operations to diminish the potential for
complications. Having stated that, most ethical experienced surgeons would feel
that the combination of procedures that you listed would be excessive to
perform at the same time.

Safety should always be the main concern. It is generally recommended that the
length of elective surgery be less than six hours. The procedures should be
performed in an ambulatory facility that is accredited by one of the nationally
recognized accrediting organizations like the American Association for
Accreditation of Ambulatory Surgical Facilities (AAAASF) or if it is outside of
the Unite States an international organization like the the American
Association for Accreditation for Ambulatory Surgery Facilities International,
(AAAASFI) or in a licensed hospital.

Having surgery at a reduced rate in a foreign country sounds appealing, but
there are many concerns that you should consider. Generally, there is no
preoperative direct discussion with the surgeon who is going to perform the
surgery in order to establish any reasonable doctor/patient relationship. There
are often language barriers that can interfere with your care. Even if your
surgeon speaks English, the ancillary personnel like the nurses and the
anesthesia provider who are involved in your care, may not. The quality of
hospitals outside of the U.S. varies tremendously. Some are accredited and
inspected, others are not. Even if the hospital has reasonable facilities and
the surgeon has training, which may not be up to the quality of training of a
plastic surgeon certified by the American Board of Plastic Surgery, the quality
of the nurses and others involved in your care may be very different from that
in the United States. They may have little or no formal medical education,
training or credentialing.

There is usually little follow-up care. In addition, the general sanitary
conditions often increase the risk of infections, including some that are
generally rare in this country.
There are also major potential problems that may occur with traveling
long distances just before and after surgery, like dehydration and fatigue, but
more importantly complications including clots in the legs called deep venous
thrombosis and clots to the lung which may be life threatening.

In most countries, if a problem develops, you will have little legal recourse
and no ability to file a complaint either against the hospital or about the
surgeon. If complications.,develop after you return home, it may be difficult
or impossible to obtain care from your local physicians. If problems do occur,
the cost of subsequent care can be far greater than the reduced cost of the
original surgery. While there are well-trained physicians in many other
countries, I would suggest that you travel for pleasure or business and have
your surgery closer to home.

Robert Singer, MD FACS

La Jolla, California