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.
Mostplastic surgeons would have several concerns with what you are planning. Combination procedures may be performed together. Whether you are a reasonablecandidate, however, for the combination of procedures you listed depends onyour anatomy, the extent of the abdominoplasty (tummy tuck) , the complexity ofthe breast surgery, the amount of liposuction, volume of fat injection into thebuttocks, your medical history, medical clearance from your primary physician,realistic expectations of the outcome and an understanding of the pros and consof the various procedures.Most patients prefer undergoing one anesthesia and one recovery period which isusually more cost effective, but many surgeons would prefer performing theseprocedures in 2 separate operations to diminish the potential forcomplications. Having stated that, most ethical experienced surgeons would feelthat the combination of procedures that you listed would be excessive toperform at the same time.Safety should always be the main concern. It is generally recommended that thelength of elective surgery be less than six hours. The procedures should beperformed in an ambulatory facility that is accredited by one of the nationallyrecognized accrediting organizations like the American Association forAccreditation of Ambulatory Surgical Facilities (AAAASF) or if it is outside ofthe Unite States an international organization like the the AmericanAssociation 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, butthere are many concerns that you should consider. Generally, there is nopreoperative direct discussion with the surgeon who is going to perform thesurgery in order to establish any reasonable doctor/patient relationship. Thereare often language barriers that can interfere with your care. Even if yoursurgeon speaks English, the ancillary personnel like the nurses and theanesthesia provider who are involved in your care, may not. The quality ofhospitals outside of the U.S. varies tremendously. Some are accredited andinspected, others are not. Even if the hospital has reasonable facilities andthe surgeon has training, which may not be up to the quality of training of aplastic surgeon certified by the American Board of Plastic Surgery, the qualityof the nurses and others involved in your care may be very different from thatin 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 sanitaryconditions often increase the risk of infections, including some that aregenerally rare in this country.There are also major potential problems that may occur with travelinglong distances just before and after surgery, like dehydration and fatigue, butmore importantly complications including clots in the legs called deep venousthrombosis and clots to the lung which may be life threatening.In most countries, if a problem develops, you will have little legal recourseand no ability to file a complaint either against the hospital or about thesurgeon. If complications.,develop after you return home, it may be difficultor 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 theoriginal surgery. While there are well-trained physicians in many othercountries, I would suggest that you travel for pleasure or business and haveyour surgery closer to home.Robert Singer, MD FACSLa Jolla, California