Dr. Gustavo Gaspar, plastic surgeon
In the operating room with Dr. Gustavo Gaspar Blanco
Hospital de la Familia,
Mexicali, B.C.
Mexico
After interviewing Dr. Gaspar, he graciously invited me to join him in the operating room as an observer for several cases during the week.
Hospital de la Familia
As reviewed in the Mexicali! mini-guide to medical tourism, Hospital de la Familia is widely acknowledged as “the second best hospital in Mexicali.” Much like the Hertz automobile rental campaign “We try harder,” the directors of Hospital de la Familia have embarked on an aggressive publicity campaign to attract patients and physicians to their facility. This includes medical tourism – as Hospital de la Familia has partnerships with multiple brokers including PlacidWay and Planet Hospital.
Dr. Gaspar exclusively operates at Hospital de la Familia.
In the ORs at Hospital de la Familia
OR #3 is the plastic surgery suite. It is spacious and well-lit with modern and functional equipment. Along with a designated OR, Dr. Gaspar has an operating room team consisting of an anesthesiologist, an assistant surgeon, scrub nurse and circulating nurse.
Dr. Gaspar and his OR team
Anesthesia is managed by Dr. Armando Gonzalez Alvarez. He monitors the patient with due diligence and remains in attendance at all times. He avoids distractions during surgery (like texting or excessive cell phone use) and remains patient-focused.
Dr. Gonzalez Alvarez, Anesthesiologist
Dr. Binicio Leon Cruz, is a general surgeon who serves as Dr. Gaspar’s assistant surgeon during the case. Monica Petrix Bustamante is the instrumentadora (scrub nurse), and she is excellent, as always*. She knows the surgeries, easily anticipates the doctors’ needs while maintaining surgical sterility and ensuring patient safety.
Monica prepares a prosthesis for implantation
Adherence to international protocols
The majority of procedures are under an hour in length, which means that patients do not need deep vein prophylaxis during surgery. The procedure (including site) and patient identity are confirmed prior to surgery with active patient participation before the patient receives anesthesia with both surgeons, nursing staff and the anesthesiologist in attendance. Patients are then prepped and draped in sterile fashion, with care taken to prevent patient injury.
As with many plastic surgeons, Dr. Gaspar does not administer IV antibiotics for infection prophylaxis prior to the first incision. Instead, all patients receive a course of oral antibiotics after surgery***.
Surgical sterility is maintained throughout surgery. For the first case, after receiving adequate tissue preparation, since only limited liposuction is needed (for very specific sculpting), the patient receives manual liposuction (without suction) to prevent overcorrection or excess fat removal. Despite having significant adhesions due to previous liposuction procedures, there is very minimal bleeding during the procedure.
Following the procedure, the patient is awakened, extubated and transferred to the recovery room for hemodynamic monitoring and adequate recovery prior to discharge.
Throughout the case, (and during all subsequent checks in the PACU), the patient is hemodynamically stable, and maintains excellent oxygenation.
The second case, is a breast augmentation revision – in a patient with a previous breast reconstruction after mastectomy for breast cancer. The patient developed a capsular contracture which required surgical revision**.
Abdominoplasty
On a separate occasion, Dr. Gustavo Gaspar performed an abdominoplasty with minor liposuction of the “saddle bag” area at the top of the thighs. For the abdominoplasty case, the patient received conscious sedation with spinal anesthesia.
While an abdominoplasty, “tummy tuck” is a much larger procedure, the case proceeded quickly (1 hour 15 minutes), and uneventfully. There was very minimal bleeding, and excellent cosmetic results.
skin, and adipose tissue removed during an abdominoplasty
Gluteal augmentation (Gluteoplasty)
However, it was the gluteal augmentation case that attracted the most interest. As mentioned during a previous interview, Dr. Gaspar is well-known throughout Mexico for his gluteal implantation technique.
Pre-surgical planning
Due to the proximity to the anus, and potential for wound infection and contamination, the area is prepped in a multi-step process, in addition to the standard surgical scrub. A Xoban (iodine impregnated dressing) is applied to the area to prevent bacterial migration to the area around the incision.
For this procedure, Dr. Gaspar uses gluteal prostheses for intramuscular implantation. Using one, small 3 cm incision, Dr. Gaspar dissects through the gluteal tissue to the muscle plane. He then inserts the prosthesis and adjusts it into its final position. When he has finished placing the implant, it is buried deep in the tissue and invisible.
after the implant is placed within the muscle it is invisible to the eye
He explains that by placing the prostheses in the intramuscular layer, the implants remain in a stable position, and are invisible to the eye and imperceptible to the touch. (Even with movement and manipulation – there is no edge or pocket seen or felt after the gluteal prosthesis is placed).
The procedure is repeated on the opposite side. Two small drains are placed, and the incision is closed. The entire procedure has taken just 18 minutes.
incision and drains at the conclusion of surgery
Despite the speed by which Dr. Gaspar operates, he is meticulous in his approach. He frequently re-assesses during the procedure (particularly during bilateral procedures) to ensure symmetry of results.
*I frequently encountered Ms. Petrix during previous visits to the operating rooms at Hospital de la Familia during research and writing of the Mexicali book).
** Capsular contraction is one of the most frequently occurring complications of breast augmentation using breast prosthesis (implants).
*** this practice is somewhat controversial but the most recent surgical guidelines and literature on antibiotic stewardship suggest that pre-operative antibiotics may be unnecessary for some surgical procedures.
Thank you to the kind patient who graciously gave permission for publication of pre-operative, intra-operative and post-operative photographs on this site.
Additional readings: Gluteoplasty
The majority of publications originate in Latin America and Latin American journals (and are written in Spanish and Portuguese.) Here is a small selection of open-access, English language journals.
Bruner, T. W., Roberts, T. L. & Nguyen, K. (2006). Complications of buttocks augmentation: Diagnosis, management and prevention. Clin Plastic Surg 33: 449 – 466.
Cardenas – Camarena, L. (2005). Various surgical techniques for improving body contour. Aesth. Plast. Surg. 29:446-455.
Cardenas- Camerena, L. & Palliet, J. C. (2007). Combined gluteoplasty: Liposuction and gluteal implants. PRS Journal, 119(3): 1067 – 1074. Part of a series on gluteal augmentation.
Harrison, D. & Selvaggi, G. (2006). Gluteal augmentation surgery: indications and surgical management. JPRAS 60:922-928.
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