CALGARY — When Aisling Gamble was about to give birth to triplets, the 4-foot-10 woman stood just 11 inches taller than what she measured around her pregnant belly.

Five years after the birth of her sons, the fold of loose skin around Gamble's stomach remains.

"Exercise will not do it. It would bring it down, but it would never be completely gone. For me, bringing it down or making it smaller or less noticeable — that's not enough," says Gamble, a Calgary communications professional. "Nobody sees it so it's completely on me. But there's a daily reminder there — there's this thing I really don't want to have anymore."

The 37-year-old mother is now considering a tummy tuck to surgically remove the extra skin.

Before making her decision on the procedure, Gamble, like other potential cosmetic surgery patients, has wrestled with whether it's worthwhile to undergo an operation that's not medically necessary. It's a contentious issue highlighted recently by a provincial inquiry looking into the death of a young Calgary mother, Ashish Toews, from a complication following liposuction and a tummy tuck.

The fatality inquiry has raised new questions around the risks of plastic surgery. It's also prompted a closer look at why so many Canadians choose to undergo cosmetic procedures every year.

Across Canada, 108,758 cosmetic procedures, including non-surgical treatments, were performed in 2009, according to the International Society of Aesthetic Plastic Surgery.

Doctors are responsible for informing potential patients about the risks and benefits of the procedure, and whether they're healthy enough for surgery, says plastic surgery expert Dr. Nick Carr.

But determining whether to go ahead with cosmetic treatment is a decision each candidate must arrive at on their own, he says.

"The patient has to be sufficiently motivated to accept the cost, the downtime, the economics of it, and the risk, relative to what they stand to gain," says Carr, head of the University of British Columbia's division of plastic surgery. "That's something that's very individual, but it's an important part of the process."

Calgary's Toews had done her plastic surgery homework.

She was a small lady and a "fitness fanatic," but after having two children her stomach skin was stretched, her husband told the fatality inquiry into her death.

In 2008, the 33-year-old teacher scheduled a consultation with a plastic surgeon to discuss a tummy tuck.

The surgery, called an abdominoplasty, is a demanding procedure that involves slicing off loose skin, stitching together muscle fabric and creating a new belly button. It leaves patients with a massive scar and may require months of recovery time.

In cosmetic surgery, the most common complications, such as infection, are minor, experts say. More serious risks, such as a blood clot, are rare.

After the surgery on July 18, Toews was coherent but groggy after the procedure at Surgical Centres Inc., a private clinic in northwest Calgary. She was sick throughout the night, and the next morning, headaches hit. She began screaming in pain.

Her husband called an ambulance and Toews was rushed to the emergency room. In the waiting room, she was given a shot of morphine. She went into convulsions and stopped breathing.

She was moved to intensive care where she remained in a chemically induced coma, on life support.

On July 31, 13 days after her surgery, the young mother died from "presumed fat embolism syndrome" due to a small amount of liposuction that accompanied her abdominoplasty.

Such complications are extremely rare in plastic surgery, says Carr.