The Grass is Not Always Greener on the Other Side of the Fence!

Recently, we have seen numerous news reports of tourists who have died while vacationing in the Dominican Republic. As of now, there has been no definitive cause of death. During this same time period, deaths of several “medical tourists” who traveled to the Dominican Republic for cosmetic surgery have gone almost unnoticed! I was unaware of this group until 2 weeks ago when I was asked to see a patient who had strange wounds on her back and legs and draining wounds from a breast augmentation procedure. The patient was a young woman from Alabama who had gone to the Dominican Republic to have the operative procedures. Several months prior, her sister had undergone cosmetic surgery by a “plastic surgeon” there and had a favorable outcome, so she also decided to go; her results were not as gratifying. 

A few days after the procedures, she experienced shortness of breath and wounds began to develop on her back and thighs. She began draining from her bilateral breast augmentation incisions. She was released from the hospital in the Dominican Republic to fly back to Montgomery, but she was so sick she went straight to the hospital from the airport. She was diagnosed with bilateral pneumonia and treated with antibiotics. She was released from the hospital after a few days of treatment, but she still felt terrible and short of breath. Shortly after her discharge, I was asked to examine the wounds on her back, which were obviously from a liposuction procedure. Initially, I was horrified by these wounds, and it takes a lot to horrify me! She had multiple necrotic wounds on her back and thighs, her breast wounds were draining necrotic and purulent material, and her breathing was labored. I debrided the wounds on her back and legs then started treatment. The breast wounds also were debrided and treated. She insisted that her breathing was better and did not want to look into it further. Her first follow-up visit was good and bad. The wounds all looked better, but she now had a large, tender mass on her buttock. Her breathing had worsened. The buttock mass was a 10-cm abscess that we drained and treated. Because of her worsening breathing, I insisted she go to the hospital. Fortunately, the cause of her breathing problem was identified — bilateral pulmonary emboli — and treatment was instituted quickly with good results. I saw her again this past week and was pleased to see she was doing better, although we still have the unhealed wounds and abscesses to manage. 

The day after we saw her this past week, we received a notice that a school teacher from Alabama had died following cosmetic surgery in the Dominican Republic. I called our patient who had heard the news. The two women had their procedures done by the same doctor, at the same hospital, in the Dominican Republic. The teacher died of pulmonary emboli 5 days after her procedure while still in the hospital. After further investigation, I found that a gentleman from New York also had died after undergoing liposuction at the same hospital by the same doctor the week before the Alabama teacher! He died of “respiratory distress” — probably pulmonary emboli as well. It turns out that the Centers for Disease Control and Prevention (CDC) began warning people in 2017 not to go to the Dominican Republic for cosmetic or plastic procedures due to a high rate of postoperative infections.¹ 

It appears our patient will survive her experience but not without more treatment and much scarring. Along with the CDC, I would suggest anyone looking for cosmetic or plastic surgery remember that the grass is not always greener on the other side of the fence. Always consider what makes the grass greener there! 

Terry Treadwell, MD, FACS
woundseditor@hmpglobal.com

This article was not subject to the WOUNDS peer-review process.