The recent release of the autopsy report for Donda West, who died in November after having breast reduction and liposuction procedures, has brought renewed attention to the risks of cosmetic surgery. While the autopsy for West, the mother of popular rapper Kanye West, did not identify any missteps during her surgery, it found that she had pre-existing coronary artery disease—a fact that may have put the 58-year-old at increased risk for complications during and after surgery, experts say. West's autopsy report says she "died as a result of coronary artery disease and multiple postoperative factors."
"She certainly had a cardiac or heart condition, and that should've been a big red flag," says Richard A. D'Amico, president of the American Society of Plastic Surgeons, who was not involved in West's surgery or care but has been following her case.
West's experience should be a cautionary tale to anyone considering similar surgery. But there are steps you can take to ensure your cosmetic surgery is performed safely. Anyone who has a cardiac condition, for example, should be cleared by a cardiologist prior to any surgery, says D'Amico. U.S. News consulted several experts, including D'Amico and ASPS President-elect John Canady, to answer some questions that patients often pose.
How common is cosmetic surgery?
There were nearly 11 million cosmetic surgery procedures performed in the United States in 2006, up from 7.4 million in 2000, according to ASPS. The number of tummy tucks more than doubled, with 146,240 such surgeries performed in 2006, up from 62,713 in 2000. More than 104,000 breast reductions were performed in 2006, up 23 percent since 2000. How do I find a good plastic surgeon?
Choose a plastic surgeon who is board certified by the American Board of Plastic Surgery. Visit abms.org/login.asp (the site requires users to complete a free registration for access) to locate a surgeon near you. And don't be afraid to quiz your doctor about his or her training, education, and experience. "Ask some questions, and don't feel like the questions are inappropriate," Canady says. "If somebody gives you the impression that asking about their training or background or certification is a problem, that's when you know you might want to go get another opinion." I'd like to get multiple procedures. Is it safe to get them all at once?
"That's up to judgment of the surgeon because there are issues of how long the anesthesia and the surgery will be and how invasive the procedures will be," D'Amico says. Blood loss is also an issue, Canady adds. It's important to ask whether, if the procedures are combined, you'd need a blood transfusion that wouldn't be necessary if you had the procedures done separately. Also ask your doctor if you'll need to go to an aftercare center, with nurses on staff to monitor your condition. This is sometimes necessary for patients who have multiple procedures, complex pre-existing medical conditions, or lengthy surgeries. But no patient should go home alone, no matter how healthy he is and how straightforward the procedure. "I would never discharge [a patient] to their home or apartment alone," Canady says. "There should always be somebody there right after surgery."
I know that having certain pre-existing conditions may put me at increased risk for complications. How do I know if I have a condition that might make cosmetic surgery dangerous?
Get a thorough preoperative evaluation, including a complete medical history, physical examination, and laboratory testing, D'Amico advises. The requirements for such preop testing may vary depending on your age and sex, so ask your doctor what's appropriate for you. Some doctors may refer you to a specialist, such as a cardiologist, prior to surgery. But if a surgeon tells you that a procedure is too risky for you, take heed. Just because one surgeon agrees to perform a procedure that another doctor won't do doesn't mean it's safe, Canady says. "Unfortunately, if you knock on enough doors, you'll find somebody to give you what you want," he says. If a reputable surgeon has turned you away, "you as a patient really need to give that a lot of weight."
My surgery is to be performed in an outpatient surgical center. How can I check out the facility to make sure it's safe?
To help evaluate the quality and safety of outpatient surgical centers, find out if the facility is licensed by your state or accredited by a national accrediting body such as the American Association for Accreditation of Ambulatory Surgical Facilities, the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations), or the Accreditation Association for Ambulatory Health Care. Any amount of outside vetting is better than none. Also ask your doctor if he or she has hospital privileges at a nearby medical institution, which would allow the doctor to admit you to the hospital should complications arise, Canady says.
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