GUADALAJARA, Mexico - Gabriela Sanchez always felt self-conscious about her small breasts, and at age 40 she decided to do something about it.
At 41, she has no breasts at all - they had to be surgically removed after implants inserted by an allegedly bogus plastic surgeon caused a severe infection.
The charges against Agustin Huerta, a sweet-talking, snappy dresser who zipped around town in a blue Jaguar, raise new questions about how easily untrained scam artists can pose as qualified doctors in Mexico.
At risk are not only the patients, but Mexico's campaign to attract Americans with the promise of cheap and safe medical care.
Sanchez is one of 43 patients to file complaints since 2003 against Huerta, a medical doctor who allegedly branched into plastic surgery without a licence and botched dozens of facelifts, liposuctions, breast implants and other procedures.
"I can't even look at myself in the mirror," Sanchez said, fighting back tears. "I can't be with my husband."
Huerta, arrested Dec. 6, faces about eight years in prison if convicted on charges of fraud, medical irresponsibility, severe damages and professional usurpation, according to lead prosecutor Elsa Arias.
"He was operating left and right for easy money and didn't perform the proper follow-up treatments," she said. "He knew he didn't have the seven years of training required for those surgeries. He was lying."
Such cases are surprisingly common. That same month, authorities detained a man in the border state of Coahuila for working as a doctor for more than 30 years with nothing but an accountant's degree. And Arias made her name prosecuting former stripper Miriam Yukie Gaona, dubbed the "Beautykiller," for allegedly injecting industrial silicone and other substances into hundreds of women.
No one keeps records on how many U.S. citizens travel south for medical procedures, but anecdotal evidence suggests the number is growing.
In the border city of Tijuana, most patients in some hospitals are American. Most come from California for dental work and plastic surgery that isn't covered by insurance. This month, Tijuana's medical community announced an initiative to encourage even more patients to cross the border.
The U.S. Embassy warns that while elective surgery may be cheaper in Mexico, "facilities may lack access to sufficient emergency support."
And when things go wrong, seeking redress can be next to impossible. Class-action lawsuits - a foundation of consumer protection in the United States - don't exist in Mexico, and the judicial system remains plagued by corruption and bureaucratic inertia.
Huerta's patients found an advocate in Arias because of her experience prosecuting Gaona, who still has cases pending against her five years after her arrest.
Arias said Huerta distributed business cards reading in English "Cosmetic and Aesthetic Surgeon." Huerta, she said, would often pressure patients to undergo surgery immediately, boasting he could make them look like the Mexican pop star Thalia.
Many were left with severe infections, disfiguring facial scars, lopsided breasts or lumpy stomachs, she said.
Huerta declined to be interviewed, but his lawyer, Victor Varela, said he held a medical degree and had undergone postgraduate training in liposculpture in Europe. He said Huerta was well-qualified to perform "aesthetic procedures" but insisted none of them qualified as plastic surgery.
The doctor "only performed liposculpture, which encompasses breast and buttocks implants and liposuction," Varela said. "It's a question of aesthetics. It's not plastic surgery."
Dr. Alberto Smeke, who investigates medical misconduct for Mexico's Health Department, called that rubbish. He said what Huerta did was clearly plastic surgery, and requires a licence.
Varela said the complaining patients are after money, and accused many of bringing on their own problems by failing to follow post-operation treatment and drinking or smoking after surgery.
But patients and their families denied that they were responsible for the outcome of the procedures, and said they simply want justice.
"I've given up," said Montzerrat Ramirez, 21. "I'm not charging him with homicide - I just want my money back."
Ramirez's mother Lorena, 39, saw Huerta in July because her back was hurting. He recommended breast reduction, a tummy tuck and liposuction, even though she had diabetes and hypertension. Once she was under the knife, Huerta performed a full mastectomy, replacing her breasts with implants, the daughter said.
Following the surgery, Lorena Ramirez's incisions repeatedly opened and became infected, and she spent 37 days in the hospital, racking up medical bills of more than US$23,800, her daughter said. She died of a heart attack in October.
Operating on a patient with diabetes and hypertension requires careful testing and monitoring, even when the most qualified plastic surgeons are involved, according to Dr. James Wells of Long Beach, Calif., former president of the American Society of Plastic Surgeons.
Gabriela Sanchez went to Huerta two days after the doctor inserted threads into the face of her mother Consuelo to lift her nose and help her breathe better, a procedure he performed in the hallway of his clinic.
Gabriela Sanchez woke up the morning after her breast surgery with a gaping wound in her abdomen. Huerta, she said, told her he had inserted the implants through her belly - and even given her "a bit of lipo" as a gift. Eventually, she had to have both breasts removed because of an infection, and scars now stretch across her abdomen.
Her mother's nose, meanwhile, became so infected that doctors had to remove the entire bone, leaving her disfigured.
