The Takotsubo Syndrome (TTS) is a cardiomyopathy induced by emotional or physical stress with secondary sympathetic hyperstimulation and catecholamine release. The diagnosis is showed through an image-tool evidencing its classical left ventricular apical ballooning or any of its multiple morphological presentations.

Surgery has been documented as a physical triggering factor. Although its physiopathology is not completely understood, some factors during aesthetic procedures seem to have a relation with the manifestation of this disease. Most takotsubo cases are self-limited to its reversible natural history of the illness. However, some patients can rapidly worsen, where the actual medical treatment appears to be controversial and sometimes insufficient.

Few case reports have documented TTS as a complication of plastic surgery. We describe 4 cases of young women, ages 28, 27, 31 and 34, who underwent plastic surgery (1.- Liposculpture and Mammoplasty 2.- Mammoplasty 3.- Liposculpture, Rhinoplasty, Abdominoplasty and Mastopexy 4. Mammoplasty + Liposuction). None had a history known related to the possible development of this cardiomyopathy. During the surgery, tachycardia, electrocardiographic abnormalities and hypotension were identified. Diagnosis of TTS was confirmed by transesophageal echocardiography with rapidly progression to severe CS. VA ECMO therapy was utilized. 1 patient was canulated under ECPR strategy after 25 minutes of low flow cardiopulmonary reanimation. We registered circulatory assistance of 1-4 days, main hospitalization stay of 5.5 days and 100 % survival.

It should be contemplated nowadays that plastic surgery is a potential trigger of this syndrome, which can become catastrophic. For complicated cases, ECMO is a must consideration.