Cosmetic Surgery: Beware the Hefty Health Price of 'Brazilian' Bargains

The Food and Drug Administration's announcement Nov. 17 that it had lifted its 14 year ban on silicone gel-filled breast implants received broad media attention--not surprising since the demand for cosmetic procedures in the U.S. skyrocketed in the time period that the ban had been in effect.

In 2005, there were nearly 300,000 breast-augmentation operations in the U.S., making this procedure the third most common cosmetic surgery behind liposuction and rhinoplasty (nose reshaping).

Today, there are two types of FDA approved implants for breast augmentation: saline-filled for women 18-years old and older, and silicone gel-filled for women 22 years and older. Women of any age may receive either saline or silicone for reconstructive surgery. Both types of implants are manufactured by two companies, Allergan Inc. and Mentor Corp.

According to the FDA, the reasons for the different age minimums for augmentation is the differences in risks between saline and silicone implants.

For example, silicone gel-filled implants require frequent MRI monitoring to detect a silent rupture (a rupture that can go undetected by both you and your physician), while there is no risk for silent rupture from saline implants. There is no age restriction on the marketing of either saline or silicone for reconstruction, allowing women of all ages to have access to implants for loss of breast tissue due to cancer, trauma or general developmental abnormality.

Anyone considering breast implant surgery should review the FDA’s excellent "Frequently Asked Questions" on breast implants, which the agency has updated substantially to reflect the their recent decision. The FAQs provide general risk factors, considerations to bear in mind when choosing between the types of implants, a site for reporting problems with your implants, as well as the medical evidence upon which the FDA based its decision to release the ban.

Some women considering breast augmentation may have heard of a type of implant commonly known as "gummy bear" implants. Although these implants are used worldwide, these so-called "gummy bear" implants are only available in the United States through clinical trials. The FDA has directed women interested in these trials to the following website (

These implants are made of cohesive silicone gel which U.S. studies have shown to be firmer than regular silicone without the hardness of traditional silicone. Doctors who have participated in the trials report that "gummy bears" are preferable to saline implants because, unlike salines which can rupture, deflate and send the saline solution into the body, gummies' firmness holds and feels like breast tissue.

While the FDA’s announcement may offer welcome alternatives for women seeking breast redefinition or reconstruction, the lift (no pun intended), like the original ban, has attracted its own controversy. On Monday, the online edition of The Wall Street Journal reported that the president of the National Organization for Women called the decision "reckless" and vowed to lobby for it's reversal when the new Congress convenes.

But try explaining NOW’s position to a Brazilian who has had several cosmetic surgeries.

Brazilians take pride in being the "nip/tuck capital of the world." In 2000, Brazil became the capital of plastic surgery on a per capita basis, surpassing the United States. A legacy of beautiful Brazilians--starting with the lore associated with the song "Girl from Ipanema," to current super model Gisele Bundchen and a parade of buxom models who have succeeded her-- has created the perception that Brazilians have cornered the market on pulchritude perfection.

And Brazilians are unabashed in admitting to a little help from a surgeon’s hands.

"In Brazil, it’s more important to be perfect than to be natural," said Fabio Bragato, an artist who lives in New York but is originally from the outskirts of San Paulo. "If we see someone at the beach and his or her body is better, we want that body too," he added.

Bragato said that even his two younger brothers received nose jobs while teenagers.

With visions of curvaceous cleavages dancing in their heads, American women are flocking to Brazil for cosmetic surgery. The origin may be the fame of Brazil's most renowned cosmetic surgeon, Dr. Ivo Pitanguy, who continues to run a cosmetic surgery clinic in Rio de Janeiro.

"In the 1950s and 60s, many famous Americans went to him for procedures," says Cynthia Boxrud, a Los Angeles plastic surgeon. Ironically, Dr. Pitanguy received a significant part of his medical training in Ohio and at the Mayo clinic before returning home to Brazil.

Brazilian surgeons can use gummy bear gel breast implants and emphasize techniques that are supposed to minimize scarring for breast augmentation.

Frankly though, it is fair to say that Brazil’s popularity for cosmetic surgery is fueled by two other powerful lifestyle forces: cost and the desire for travel. If one can go on a vacation, stay in a fancy hotel and get a host of "plastics" done at a fraction of what it might cost in the U.S., it’s a formidable draw.

For example, the company Cosmetic Vacations bills itself as "Brazil’s Number One in Cosmetic and Plastic Surgery." With the "Girl from Ipanema" playing in the background, the web site proclaims a range of services by packaging vacation stays in Rio, junkets around the city, and arranging surgeons and medical facilities. If you can’t pay upfront, the site directs you to a company called Med Loan Financing for a low-interest rate loan.

Looking for a more secluded environment? Estetica Brazil offers post-surgical respite in the northeast coast of Brazil.

The American Society of Plastic Surgeons has done an excellent briefing paper on cosmetic surgery tourism, cautioning those thinking about cosmetic surgery tourism to look into accreditation of both the doctors and the facilities where surgery would be performed.

And, while it may be enticing to combine several surgeries for a fraction of what individual procedures might cost in the U.S. with a vacation, you ultimately may get less than what you paid for.

Richard C. Garvey, M.D., a board certified plastic surgeon in New York City and White Plains, N.Y., recounted the time he performed a nine-hour breast reconstructive operation on a patient who, during a one-week Brazilian stay, had her breasts done, eyes lifted and a tummy tuck.

"She told me that it cost $6,000, but I had to do reconstruction because the nipples were attached to the chest wall," he said.

Dr. Garvey’s concern is not only the doctor’s training, but the quality of the facilities where operations are being done.

"I tracked down the Brazilian surgeon and he told me that because the surgeries were in a clinic and not a hospital, when the woman bled they had to cut short the operations because they had no blood there," he said.

"While a woman may be saving money in the short term, the overall sterility and the rules of accredited facilities reduces risk of infection and complication in the long term," Garvey added.

Dr. Manny Alvarez is the managing editor of health news at, and is a regular medical contributor on the FOX News Channel. He is chairman of the Department of Obstetrics and Gynecology and Reproductive Science at Hackensack University Medical Center in New Jersey. Additionally, Alvarez is Adjunct Professor of Obstetrics and Gynecology at New York University School of Medicine in New York City.