Journal time! Just read the Plastic and Reconstructive Surgery Journal November 2018. There was an article on “Breast Implant Mycobacterial Infection: An Epidemiologic Review and Outcome Analysis.” Mycobacteria? Interesting. So I read on.
Turns out the background for this study (Done out of centers in Canada, Cyprus and Saudi Arabia) thinks that the “recent boom in cosmetic surgery tourism has been associated with a rise of surgical site infections in returning patients.” They did a review of the literature and found 41 reports describing 171 women who had implant related mycobacterial infections. (This is a weird infection. It isn’t your garden variety skin bug we would normally see if someone had an infection.) When looking at the cases, they found an association with surgeries done in developing countries.
- Mean age of patients was 38 years old,
- most had bilateral breast augmentation,
- they presented with breast pain or tenderness
- incubation period was 9 MONTHS
- 52% had mycobacterium fortuitum
- treatment was immediate explant with delayed reimplantation and antimicrobial therapy for an average of 4.6 MONTHS
- mean follow up was 40 months, which showed a 12% recurrence
What do I think?
It is interesting. I think we know so much more now about biofilm, avoidance of BII and breast implant illness, and the need for high levels of sterility when doing breast augmentation. see my blogs on biofilm and an article on a 14 point prevention plan here. I found the incubation period til patients had symptoms and the length of treatment with antimicrobial therapy needed interesting.
I am not a fan of medical tourism out of the country. Do they know you? what you need? have they assessed your medical history well? Is it a good center? Sterility? There are risks of travel and DVT, and the risks of what do you do if you have a complication. Then there is the cost of travel and hotel. If I see a patient who had surgery out of the country, they frequently cannot contact the center to get simple things like an operation report or what implants they had placed.
Elective cosmetic surgery first and foremost needs to be safe. There are rigorous standards in the US for surgery centers. There are rigorous standards to be a board certified Plastic Surgeon. These standards mean something. Don’t be “penny wise and pound foolish.”
I started reading this article thinking it was just about weird implant infections, not realizing its conclusion was “to alert clinicians to the importance of educating the public about the associated risks of cosmetic medical tourism.” But it makes a good point for doing surgery at home.