When the newspaper slid under the door of her Bogotá apartment that Sunday morning in July, Lorena Beltran’s stomach ached with nerves. She picked it up and stared at the cover, at a large picture of herself. In the image, her bare breasts were scarred and disfigured.
Until then, the 21-year-old journalist had stayed largely silent after a 2014 breast reduction surgery went horribly awry. Now, she knew the whole country was going to read her story. And not only that; they were going to see the wounds that had caused her so much pain over the past two years.
“When I saw the picture of myself I felt a huge emptiness,” Beltran told Univision News. “To see that image was to face a big challenge I’d had in my life.”
Cosmetic surgery is big business in Colombia, where every hour some 35 people undergo a procedure. According to data from the International Society of Aesthetic Plastic Surgery, in 2015 Colombia was among the top five countries by number of plastic surgeries performed, behind the United States, Brazil, India and Mexico. But when calculated by percentage of the population, Colombia was second after South Korea, with 6.52 surgeries per 1,000 people. The most common operations in Colombia are liposuction and breast enhancements. And people travel from all over the world to the South American nation to access surgeries.
The majority of those surgeries are successful. But the industry is also rife with safety concerns. So far in 2016, there have been a number of deaths during plastic surgery operations. In the Colombian press, it’s common to see news reports about faulty surgeries done in “garage clinics.” Earlier this year, the country passed a law that forbids anyone under 18 from getting plastic surgery without parental consent. But activists and lawmakers say much more needs to be done to ensure safety.
“We need laws that put life and health first,” says Ernesto Barbosa, the general secretary of the Colombian Plastic Surgery Society (SCCP), which is pushing for more government oversight of the industry. The SCCP has a rigorous screening process and ensures that its surgeons are properly trained and educated. “Until the state takes responsibility for overseeing and regulating medical specialties, it will be hard to make a difference.”
Plastic surgery abuses do occur in the United States, but experts say they're far less common due to more rigorous medical standards.
For Beltran, the complications began just days after her 2014 surgery. One of her nipples turned black and felt tender and hollow to the touch. When she went to her surgeon Francisco Sales Puccini for a follow up visit, he told her she would have to wait a year to undergo a second surgery to fix the first. That second surgery, she says, went even worse. That’s when she began to worry.
In April of this year, Beltran decided to see a different surgeon, who told her the shoddy quality of her surgeries meant the loss of feeling in both of her breasts was likely permanent. She also probably wouldn’t be able to breastfeed, he said. “I was devastated,” she said. “I’m only 21. To hear that news was horrible.”
The doctor also asked Beltran why she hadn’t gone to a “real plastic surgeon.” Confounded, she began to look into Sales Puccini’s accreditations. She contacted the TV channel Noticias Uno, who sent a reporter undercover to the doctor’s office. Beltran learned there were multiple lawsuits against Sales Puccini, and that patients had even died under his care.
As it turns out, Sales Puccini received his graduate degree from Veiga de Almeida University in Rio de Janeiro, Brazil, through a “weekend degree” program. The courses are currently approved by the Colombian Ministry of Education as equivalent to a plastic surgery residency. But the SCCP and a number of prominent universities in Colombia say they shouldn’t be. The SCCP has lobbied for years for better regulation of these courses.
“We don’t argue against them completely, we just say they should not be used as equivalent to a residency,” Barbosa says. “These are not medical specialties. These are not residencies. A few months is not the same as four years of intensive training. When we’re talking about public health, that’s incredibly important.”
In May, Noticias Uno published a segment about Beltran’s case. Then, the influential national newspaper El Espectador began to investigate, too.
As a result, between late May and early June, the newsrooms of Noticias Uno and El Espectador received an outpouring of complaints from patients who had suffered horrific complications at the hands of doctors with similar foreign-earned certifications, from universities in Peru, Argentina, Mexico and Brazil. A number of them were patients of Sales Puccini.
That’s when El Espectador decided to make the issue more visible. In its July 3 special issue, of which Beltran graced the cover, eight other women show the horrors of their surgeries. Among the stories are instances of breast amputation, prosthetics inserted incorrectly, severe infections, loss of sensation, leg deformities, psychological and sleep disorders and tens of thousands of dollars in expenses between lawyers, hospitalizations and reconstructive surgeries.
Ana Margarita Giraldo, a lawyer from Medellín, told of the breast enhancement she gifted herself for her 27th birthday. The following week she ended up in the ICU with an infection and liver, renal and respiratory failure.
“I really thought I was dying,” she told Univision News. “For a year I saw six specialists: an immunologist, rheumatologist, internist, infectious disease specialist, dermatologist and hearing specialist, because I had ringing in my ears all the time. I couldn’t sleep and I thought I was going crazy.”
Today, her breasts and stomach are deformed. She, too, will likely be unable to breastfeed. But, she says the outpouring of support she has received has been incredible. “People say I’m brave,” she says. “That’s what keeps me going. It’s not easy to speak out about this. But I know I have to.”
At a July press conference, Colombia's Education Minister Gina Parody told reporters that the current problem “does not have to do with the issue of course validation,” but with “integrity and medical ethics.” “Look elsewhere for the root of this problem,” she said.
Even Brazil does not consider the courses equivalent to a graduate degree. According to a spokesperson from Veiga de Almeida university, the course that Sales Puccini -- and dozens of other Colombian surgeons -- took lasted for 2,000 hours over the course of three years. Sales Puccini has publicly admitted that he did not live in Brazil while the course was taking place, but traveled there on weekends.
On July 27, Luciano Chaves, the president of the Brazilian Society of Plastic Surgery held a press conference in Bogotá to denounce the integrity of these certifications as standalone graduate degrees. Chaves told Colombian authorities not to allow these “express courses” to be considered “residencies,” and said “every new surgery is a risk.”
Colombian lawmakers are now preparing to introduce legislation that would provide comprehensive regulation of the industry through the health and education ministries. Certification for training received abroad will be just one part of that new legislation. Senator Jorge Iván Ospina, who is sponsoring the bill, recently told the press the new measure will aim to “reduce deaths and complications from surgeries done by surgeons that haven’t been properly trained.”
The law would, among other measures, require that procedures are only completed by surgeons with a degree in plastic or cosmetic surgery; set high standards for training, including a set number of required in-person hours; ensure materials used in surgeries are registered and approved; and require patients to have insurance.
“I think this is finally the moment for reform,” the SCCP’s Barbosa says. “We’ve spent a lot of years pushing for this, but there’s never been so much outrage. Finally there’s political will and a lot of people working together.”
Meanwhile, Beltran has become a national leader and spokeswoman on the topic. She launched the hashtag #CirugíaSeguraYa (Safe Surgery Now) to draw attention to the issue on social media. She’s had a seat at the table of talks about the proposed law, and she’s been interviewed on countless news programs.
After her image appeared on the cover of El Espectador, Beltran wrote a simple phrase on a piece of paper: “Adversity must be converted into a search for justice.” She pasted it on her mirror to be able to look at it everyday.
“I refuse to hate my body,” she says. “I’m not going to rest until we have a law. I will not be just another statistic.”