When a group of women from Uganda embarked on a trip of a lifetime to India, little did many of their friends and families at home know that a secret surgical "mommy makeover" was on their itinerary.
The three mothers from the east African nation meticulously planned their month-long tour around surgical procedures in New Delhi that they hoped would enable them to return to their husbands looking trimmer and healthier.
They admit that vanity is a key motive behind their choice to go under the surgeon's knife in a faraway country, saying they want their tummies tucked and breasts firmed up so they can again wear swimsuits with confidence.
"There are certain activities you can't do if your top is very heavy," one of the women told AFP, requesting anonymity after breast reduction surgery at a clinic in the Indian capital.
"I am feeling so light now. I can go for a jog or a swim without attracting all the negative male attention that I earlier did," said the mother of four.
The women, staying at a guesthouse in the upmarket area of Greater Kailash, have been mixing two weeks of post-operative care with shopping and visits to sight-seeing favourites such as the Red Fort and the Qutub Minar monument.
"It's been a girls-only fun trip for us," giggled the eldest of the group, aged 40, who is doubling up as a guide to the rest of the women, having visited India once before.
"We had thought of visiting South Africa, which is nearer home but expensive," she said. "We are glad we decided to come here."
The Ugandan mothers are among foreigners from many countries who are adding surgery to holiday trips that often include trips to the Taj Mahal in Agra and other tourist spots.
Millions globally choose to reshape their bodies through cosmetic surgery each year, despite risks such as those highlighted by the French breast implant scandal, in which tens of thousands of women have been told to have defective implants removed.
Popular cosmetic surgery destinations include Brazil, Thailand and South Africa, but the Ugandan women said India's relatively low costs, good medical facilities and English-speaking doctors were deciding factors in their choice.
Having surgery away from home means the women do not need to worry about their family or work. They also have the luxury of revealing the surgery only to those they want to.
"Our country is very image conscious. When you run into a friend, instead of saying hello she will comment on your weight. It makes you feel bad," said one, a 37-year-old mother to three including three-year-old twins.
"They will gossip and make a mountain out of a molehill. I wanted to avoid all that," she said.
A "mommy makeover" in countries such as the United States and Britain would cost nearly five times as much in India where an average bill would be about half a million rupees ($10,000), said Delhi plastic surgeon Ajaya Kashyap.
Medical tourism is a booming business in India, especially the cosmetic surgery sector, which industry experts say is growing between 20 and 30 percent annually.
The number of medical tourists, including those seeking cosmetic surgery, is expected to reach one million by 2012, according to a report by FICCI, a prominent trade body.
Kashyap said mothers seeking makeovers are typically in their thirties or early forties, have completed their families and are financially independent with some disposable income.
"My journey began long before I actually took the flight to India," said one of the Ugandan mothers. "It began in my bedroom to be precise.
"I squirmed at the thought of taking off my clothes. My protruding belly and hanging breasts made it so difficult. My husband teased me as well," she said. Kashyap says business has been good as awareness about the relatively low-risk procedure increases.
"We have 10-12 people coming in from abroad in a month," Kashyap told AFP at his busy New Delhi clinic, tastefully decorated with scented candles and elegantly carved sculptures.
But he said sometimes he has had to disappoint prospective clients from abroad.
"Expectations have to be realistic. They must realise that just by having a surgery, they cannot look like a film star," he said.
Patricia Brown, a 38-year-old British mother of two, was in Delhi to seek bigger breasts after various creams and lotions failed to bring any results.
"My dressing table had started looking like a pharmacy," said Brown. "I used these to the last drop because these were so expensive. I realised their futility slowly.
"Coming to India meant neighbours back home would not get to know about my surgery as the change is not very obvious, but it is just as much as I wanted to get my self-esteem back."
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