Epi in the News

1. How would you determine whether botched Brazilian butt lifts are a public health problem?

This operation could be a public health problem by causing death or by causing non-fatal complications which could be physical or psychological.

Looking for death rates should be comparatively straightforward as post-surgical deaths are well recorded in the UK.
Looking for physical complications would probably have to be done as a case series as this is an uncommon procedure.
Looking for mental complications would be really difficult as people may have been distressed before the procedure, so it would be hard to establish to what extent mental distress was due to the procedure and how much it was pre-existing.

Is there enough evidence to support a change in surgical regulation?

The British association of aesthetic plastic surgeons advise their members not to carry out this operation.
The amount of fat that can be transferred in a single operation in the UK is limited to 300ml.
All surgery has a learning curve - surgeons who are learning are more likely to make errors than those who are experienced.

I have not been able to find out by how much this limitation of the amount of fat injected reduces the risk.

Given that the relevant surgical body has advised their members not to perform the procedure it would seem reasonable to further restrict it.

2. How would you identify which groups of people are more likely to get the surgery?

Identify lists of patients from a given country who have had the operation.
Identify their age, gender or any other characteristic of interest
Compare these figures to those of the national population of the country.
For gender a proportion test could be used
For age a comparison of means could be used.

3. How would you identify the risk factors for major complications?

Firstly do a literature search to find likely factors - perhaps surgeon's experience, volume of fat injected might be two of these.
Then a cohort study of patients who had had the procedure could be analysed to compare the rate of major complications in those who were in different exposure categories by these risk factors.

"..free or low-cost cosmetic procedures are still available in the public health system."

4. How would you convince a policy maker to cover the Brazilian butt lift under the national insurance system?

I would not. The operation costs about £8000. I seriously doubt that it helps the patient. We are told that the man who invented it said that people who felt confident in themselves would not have cosmetic surgery. Given that the problems sadly lie in society, the internalisation of societal values, and lack of self confidence and psychological distress I would be very surprised if the operation on the body brings ease to the mind. It is clearly very risky with a 1/3000 risk of death with US surgeons.

Judith

Another nice read...
For the first question I was actually wondering what exactly would constitute a public health problem. So for a condition to be considered a public health problem, it should be significant in terms of incidence/prevalence, or severity/ sequelae, or mortality or socioeconomic impact, or the ability to spread rapidly, or if its considered as a significant problem by the public etc. This is according to CDC.
The article gives a fair bit of an idea about how the requests for the butt lift has rapidly increased over the past few years- so consequently the complications of the procedure also would increase. The mortality has been mentioned in the article, however I feel the information about the other surgical complications that could happen has not been explored- especially psychological and socioeconomic side effects. So, I think more information is required to determine if its actually a significant public health problem and if regulations are required. Some countries do have restrictions for the procedure so as to reduce the complications, however as per the article, its not the same in many other countries and its quite easily accessible to people who have the money to pay for it.

A retrospective look into the patients who underwent the procedure would give an idea about their demographic profiles. Furthermore, a anonymous survey sent out to the patients who underwent the surgery could provide more insight into their motivation behind undergoing the procedure and possibly into their mental health-  a qualitative study could give so much information about the cohort of people who request this procedure.

The retrospective look into the past procedures would give an idea about the risk factors as well. The butt lifts that ended up with complications vs the butt lifts that did not have any complications- the exposures in each group can then be compared- case control analysis.

I think it would be daunting task to convince anybody to include the Brazilian butt lift to be included in the national insurance system, considering that its a cosmetic procedure that is not a physical necessity ( especially when there is already a shortage of funds for procedures that are necessary). But If i had to do it, it would be necessary to show data from procedures done unregulated and the complications that have happened due to that. The numbers that choose to travel to places where the procedure is cheaper but less safer can also be used- it would be better to have the procedure under the safety of regulations within the insurance system, rather than enduring complications due to economic reasons. Even then, the data would have to be really convincing. 

Ref: https://www.cdc.gov/csels/dsepd/ss1978/lesson5/section3.html