The authors found that the overwhelming majority of respondents considering plastic surgery would also consider seeking cosmetic surgical treatment abroad. The Internet sites that appear most prominently in an online search contained a distinct lack of information for potential patients, particularly with regard to complications and aftercare. There is, therefore, a need for improved public awareness and education about the considerations inherent in medical tourism. The introduction of more stringent regulations for international centers providing such services should also be considered to help safeguard patients.

We aimed to examine a cohort of patients presenting with breast implant complications to establish the sensitivity and specificity of clinical examination, Ultrasound Scanning (US) and Magnetic Resonance Imaging (MRI) in the diagnosis of implant rupture, and to examine the correlation between US and MRI. We performed a 26-month retrospective review. Patients underwent US and MRI to exclude rupture. Results of US and MRI were compared prospectively for concordance, then retrospectively to clinical findings and surgical diagnosis. Thirty-four patients with 60 implants were reviewed. The sensitivities of clinical diagnosis, US, and MRI for rupture was 42%, 50%, and 83%, respectively, while the specificities were 50%, 90%, and 90%. The concordance between US and MRI was 87%. MRI is the investigation of choice for implant rupture. US is a valuable alternative with good concordance with MRI. When US is positive for implant rupture an MRI is not necessary to confirm the diagnosis. Knowledge of the sensitivity and specificity as well as the concordance between the two investigations is useful to ensure the appropriate use of available resources.

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This survey shows that the management of patients taking estrogen-containing medication before plastic surgery varies, and guidelines regarding this should be sought.

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We aimed to identify risk factors that may influence surgeons' decision on the use of surgical drains in breast reduction surgery. Medical notes of 182 patients were reviewed. The mean age of the patients was 38 years and the mean body mass index was 25.4 kg/m. Eighty-three percent of the patients had bilateral breast reduction. The mean weight of the breast tissue excised was 581 g, with the inferior pedicle technique being the most commonly used (52.6%). Factors significantly associated with an increased total drain output were older age (> 50 years, P = 0.001), and larger amount of breast tissue excised (> 500 g, P = 0.004). Neither operative technique nor body mass index influenced the total drain output. We conclude that for patients of over 50 years old and breast reductions of more than 500 g, use of a drain should be considered. Younger patients and breast reductions of < or = 500 g may not benefit from the use of drains.

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