There has been (more) media attention recently about events at a Sydney “cosmetic surgery” clinic.
I think it is worth (again) pointing out a few key issues in this case. A report from the NSW Health Care Complaints Commission has been scathing in its assessment of practices at “The Cosmetic Institute” (TCI), a popular cosmetic surgery clinic which operates from Sydney, but has recently become operational on the Gold Coast (which concerns my patients and I directly!).
The clinic was on the receiving end of a huge amount of bad press last year after another case of a young woman undergoing a breast augmentation procedure who had to be transferred urgently to an Intensive Care unit at a nearby major hospital, suffering from “local anaesthetic toxicity”.
The report, which it seems has been obtained by various media outlets, is reported to have found that:
- patients were given high doses of sedative medications in facilities not accredited to do so;
- anaesthetic drugs were given in excess of safe limits;
- patients suffered serious cardiac (heart) symptoms related to the massive doses of local anaesthetic given;
- and finally the report states that The Cosmetic Institute placed the health and safety of the public at risk.
So its all a bit of a big deal, particularly for the many women who have previously had their surgery at this clinic (and who may now be wondering exactly what happened during their surgery, and whether they were placed at risk), or who may be planning to have a breast augmentation procedure in the near future.
I think that given the publicity this is receiving, I should point out a few salient facts:
1. The surgeons who have been involved in the procedures performed at TCI are “cosmetic” practitioners. Cosmetic surgeons are NOT Plastic Surgeons. They are not members of the Royal Australasian College of Surgeons, and they do not have any recognised specialist qualification.
2. The women having their breast augmentation surgery were consented for having their surgery performed under so-called “twilight” anaesthetic, in facilities licensed only for this minor form of anaesthesia; but in many cases the procedures were performed as “deep sedation”, and the patients were actually given excessive doses of drugs, which placed them at considerable risk.
This may raise a few questions. Questions like: what is local anaesthetic toxicity? How can a patient get local anaesthetic toxicity? Why were they given such huge amounts of local anaesthetic?
Simply put, local anaesthetic drugs (numbing medications which are injected for dental procedures and removal of skin lesions commonly) have safe doses, depending on the weight of a patient. The small doses usually injected for removing a mole are safely metabolised by your body. If these doses are exceeded however, the drug can enter the blood stream and have serious effects on the heart and brain in particular. If this happens, the heart can develop unusual rhythms, patients can have seizures and in the most serious scenario, patients can die. The only way that local anaesthetic toxicity develops is by being given very large doses of anaesthetic. The only reason anyone would need very large doses of these medications, is if the patient is not having surgery under a proper, general anaesthetic. This is sometimes done as a way of saving money, as seems to have been the case at TCI. Unfortunately, in the pursuit of low cost breast augmentation, patients have suffered unacceptable risk in being exposed to very large doses of anaesthetic agents.
I think this report also brings us back to another (problematic) issue: just who should be allowed to perform aesthetic or cosmetic surgical procedures, and where should these procedures be performed? I have previously written about this, but it needs to be mentioned again.
Obviously, I believe that the cosmetic surgery industry must be regulated to ensure patient safety, and the only way that this is possible is if the authority to perform surgical procedures is limited to surgeons who hold a Fellowship of the Royal Australasian College of Surgeons (FRACS). Further, I think that any surgeon performing cosmetic procedures must be an accredited specialist with expertise in the field, and as it stands, only Specialist Plastic Surgeons (who are members of the Australian Society of Plastic Surgeons) or FRACS surgeons with post-fellowship qualification in aesthetic surgery have the appropriate training. As always, it remains a case of “buyer beware”.
Breast augmentation is not minor surgery. It is a significant procedure, and it should be treated with respect. Breast augmentation, in my opinion, should always be performed under general anaesthetic. Local anaesthetic agents can be safely used in this context to provide pain relief at the site of incisions, without ever approaching toxic levels.
Please, be careful when pursuing cosmetic or aesthetic surgery, Do your research. Know your surgeon. See a Specialist Plastic Surgeon (please follow this link to learn more about who we are and how we are trained), and don’t let cost be the only factor you consider when deciding to have surgery: cheaper isn’t always better.