An investigation into practices at Australia's largest cosmetic surgery clinic, The Cosmetic Institute (TCI), has found that questionable levels of sedation were used during breast augmentation surgery, with some patients being placed under either deeper sedation or general anaesthetic without consent.
Excerpts from the Health Care Complaints Commission (HCCC) report into TCI, published on ABC Online, reveal that in the last 12 months six patients experienced potentially life threatening complications during their procedures as a result of their sedation. These adverse events included irregular heartbeat, seizure and cardiac arrest with patients needing to be resuscitated.
At the time of these incidents the clinics were only licensed to provide "conscious sedation", and the suitability of using this technique for breast augmentation surgery was questioned in the report.
The investigation determined that the documented drug combinations and doses used at TCI during these procedures would have resulted in deeper than conscious sedation, in many cases consistent with general anaesthesia. But patients hadn't provided consent to this level of sedation, the HCCC found.
HCCC recommendations to TCI
The HCCC's overall conclusion was that The Cosmetic Institute has put the health and safety of the public at risk.
Among its key recommendations for change are that:
- TCI no longer claims to perform breast augmentation surgery under conscious sedation,
- breast augmentmention procedures should be perfomed under deeper sedation or general anaesthetic, unless the use of conscious sedation is clinically necessary for a particular patient,
- all breast augmentation should only be performed at licensed facilities,
- TCI's consent procedures are amended so that patients are fully aware and informed of the level of sedation it is intended they will be placed under.
TCI takes action to address issues
In a statement to CHOICE, TCI told us it "rejects the HCCC's finding that it put the health and safety of the public at risk", referring to its compliance with and adherence to a range of relevant professional and procedural standards.
It told us it had already taken action to address the issues investigated by the HCCC, including:
- effective from last year, all TCI surgeries in NSW are now carried out at licensed premises at Concord Private Hospital,
- all breast augmentation procedures are now performed at Concord Private Hospital under deep sedation or general anaesthetic, unless the use of conscious sedation is clinically necessary for a particular patient.
- reviewing its procedures to ensure safe upper limits for adrenaline and local anaesthetic usage
- reviewing consent procedures and documentation to ensure that patients are fully aware of the level of sedation under which they will be placed
Questions to ask before surgery
With no regulatory body for cosmetic surgery in Australia, the onus is on the potential patient to navigate the system safely.
If you're considering undergoing breast augmentation surgery, our guide to breast implants suggests asking the following questions of your chosen doctor:
- What are your qualifications and experience?
- How many times have you performed the procedure?
- How many times have you performed it in the past six months?
- Can I speak to previous patients?
- Are there any complications associated with the procedure?
- If complications do occur or the procedure is not successful, how will you deal with this?
- Where will the surgery be performed?
- Will a qualified anaesthetist administer the anaesthetic and/or sedative medication?
- Who will be looking after me during the surgery?
- Will I need time off work?
- Are there post-operative side effects?
- Will there be any visible scarring following the procedure? How can this be minimised?
- What aftercare will be provided and will this be included in the treatment costs?