Travelling to Poland for two weeks, blood tests were done on arrival at the clinic. After the operation, Tracey experienced copious bleeding from her stomach, together with a yellow discharge. After a week-and-a-half, she was told she was fine to travel home, even though she had undone the bandage to find a black triangular "hole" in her abdomen.

Once she was back in England, the 35-year-old was sent to hospital by her GP, suffering from profuse bleeding. Her wound was heavily infected and becoming septic. She was treated with life-saving antibiotics and, once her condition had stabilised, underwent surgery first to remove a portion of
her stomach that had decayed as a result of the complications, and later to reconstruct the missing part of her abdominal wall.

The saga continued for nearly three years and included a total of six months in hospital, with Tracey's final surgery taking place early this year.

As a result of the disaster, she has been left with no sensation in the area around the bottom of her stomach, the left-hand side of her vagina and the top of her left leg.

The initial point of the operation in Poland, which was to get rid of an overhanging stomach, had been achieved, but she says she feels worse now than before she started. She has also been left with a prominent scar right across her stomach.

Although the price tag for the initial surgery was attractively cheap compared to what it would have cost in the UK, many thousands of pounds more have been spent since by the NHS, firstly in keeping Tracey alive and then in repairing the damage that was caused by rampant infection, which was started by the tummy tuck being pulled too tight, says Anthony Armstrong, the cosmetic surgeon who looked after her when she returned from Poland.

"Tracey's case highlights how difficult it is to get reliable information about clinics and surgeons abroad," says Mr Armstrong. "Some patients come back from having cosmetic surgery abroad and are fine, some return with minor complications, and others return in a state which, if not treated in a timely fashion, could be very serious indeed."

The growing popularity of so-called cosmetic surgery tourism is threatening patient safety and burdening the NHS, warns the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS). A survey carried out amongst cosmetic surgeons has revealed that patients are regularly turning to the NHS to patch them up when surgery performed abroad goes wrong. The procedures which most commonly lead to complications are breast reduction or enlargement and tummy tucks.

BAPRAS is calling on the Government to clarify whether the NHS should offer free treatment to people who run into such problems. In 2007, more than 200 patients were treated by the NHS after cosmetic surgery abroad, with nearly a quarter of the Association's members reporting that they had treated such patients. Tracey's tummy tuck, which in the UK would have cost her up to £5,500, including two nights in hospital and follow-up consultations, could have cost only £2,775 if
she had travelled to Tunisia for the operation, and just under £5,000 in some clinics in Barcelona.

Eastern Europe is the most popular region for Britons seeking cosmetic surgery abroad, followed by Western Europe and Asia. The rising trend – said to involve around 100,000 UK cosmetic surgery tourists each year – is fuelled by relatively cheap surgery, low-cost flights and extensive advertising over here by overseas clinics.

"The NHS is underwriting cut-price surgery, and we think that is not right," says Hamish Laing of BAPRAS. He said people whose foreign surgeons subsequently caused them problems were taking up space and time in the NHS which should be dedicated to patients needing reconstructive surgery on the health service, for example following breast cancer or burns.

Mr Laing said patients who travelled abroad for operations often did not think the process through well enough beforehand. "They are not really sure what will happen if something goes wrong, whereas UK clinics have a duty to deal with patients who later develop complications.

"But if your surgeon is in Tiblisi, you're not likely to go back, and that's one reason they charge less. They know you're very unlikely to go back again. We're not saying these are terrible surgeons. There are some very good ones all round the world. But it's much harder to check they are good abroad. And however good they are, there are patients who develop complications, and arrangements abroad are different to those in the UK."

BAPRAS say the NHS should only deal with emergency cases – such as Tracey's – arising from surgery performed abroad, and patients who've travelled overseas for treatment should be brought into line with private patients in the UK.

Mr Laing said NHS trusts across the UK currently differ in their approach, with some telling a patient a couple of days after emergency surgery that they will have to pay for any further care. "Patients need to know this before they go abroad."

The Department of Health's view is that, while the NHS does not carry out surgery for what it calls "beautification purposes", it did surgery to secure physical or mental health. "The Department does not issue guidance on which surgical procedures or treatments should or should not be available on the NHS," said a spokesman. "We expect care to be offered on the basis of individual clinical need, determined by clinicians and in line with locally agreed priorities for care. The general principle will also apply in cases where complications have arisen as a result of cosmetic surgery undertaken abroad."

Dr Vivienne Nathanson of the British Medical Association said it was essential that patients were aware of the potential risks of any surgery and specifically of the management of complications arising from surgery abroad. "What may seem like a bargain could cost them their health," she said.

Cosmetic surgeon Anthony Armstrong believes patients should make a check-list before signing up for surgery abroad. "They should be able to have a consultation with the actual surgeon who will do the operation in this country before they travel; they should also check the surgeon's qualifications, experience, and how many times they have performed this procedure and whether they belong to major professional organisations which set high standards. All this should be done before they pay any money.

"While the patient themselves needs to be assessed properly on arrival at the clinic and their suitability and readiness for surgery addressed by the actual surgeon, they should do all in their power to be confident about the surgeon's credentials.

"They should also be extremely careful where insurance is concerned. If complications happen and they need repatriation, say, they may well find their travel insurance will not cover it because they went abroad for elective surgery."

Mr Armstrong said the price disparity between cosmetic surgery in the UK and some other countries was due to lower costs of living and also because surgery in some overseas countries is less heavily regulated than over here.

"Overheads for running private clinics are much higher here, and so is the insurance paid by hospitals and surgeons. There are many good surgeons and clinics abroad, but the process for gaining information about them seems to be a very difficult one."

KEY QUESTIONS FOR PATIENTS

The British Association of Plastic, Reconstructive and Aesthetic Surgeons recommends patients ask these questions before committing to surgery abroad:

Does your prospective surgeon speak English well enough to communicate issues related to your surgery?

What are the clinic's credentials?

Ask to view before and after photographs of other patients' surgeries

What facilities does the clinic have, and what back-up if something goes wrong?

Is there always a doctor in the clinic, and is there an intensive care unit?

What complications or risks are associated with the procedure?

What are the actual complication rates?

What are the arrangements for post-operative care?

Who is on the surgical team, and what qualifications and experience do they have?

Who will sort out any complications that may arise once you have returned to the UK?

Would you have to pay to return to the clinic for advice or further care?

Is there a body that relates the clinic to secure that it meets minimum standards of care?

Will you be covered by travel insurance for a trip which involves surgery?

What medical insurance arrangements exist for if an error occurs?

Always check the small print to be clear about what you are paying for. There could be hidden costs.

www.bapras.org.uk