Read the Conversation
Meeting highlights:
- Key to Success: Resilience and focus during early funding struggles were critical to long-term growth.
- Global Impact from Costa Rica: Establishment Labs built an innovation campus and global learning center that trains surgeons and develops surgical techniques alongside new technologies.
- Breaking Barriers: Initial skepticism about being from Costa Rica was overcome with superior clinical outcomes and a strong commitment to women's health.
- Looking Ahead: Plans include global rollout of minimally invasive platforms and integrating sensor tech into implants for predictive medicine.
- Advice to Entrepreneurs: Solve real global problems, stay focused, start small, and scale - capital will follow.
EF: During your successful journey, what was the most pivotal challenge you faced in scaling Establishment Labs from being a Costa Rican start-up to a global public company?
JQ: One of the most significant challenges we encountered at Establishment Labs was securing access to capital. In the medtech sector, the transition from prototyping to manufacturing and global scaling requires substantial funding, often hundreds of millions of dollars. At that time, such resources were simply not available in the Latin American region, and there was no venture capital interest in companies like ours. This was undoubtedly the most difficult obstacle we faced.
Resilience was essential during those years without major funding. We operated with a minimal budget and relied on a handful of small investors who provided just enough support to initiate our journey. Above all, we maintained our capacity for innovation despite limited resources and preserved a global vision for the company. This experience demonstrated that with determination and just enough to sustain operations, it is possible to continue building and eventually attract the right investors. In our case, those investors ultimately came from Wall Street.
EF: How do you think Costa Rican culture has influenced the persistence and resilience of the Costa Rican people?
JQ: Costa Rican culture is characterized by a strong work ethic and a tradition of engaging in international projects. In a country of our size, expanding globally is not merely an aspiration but a necessity for business growth. This mindset of embracing hard work and cross-cultural collaboration was essential to our success at that time. We established ourselves as a global hub, a role we continue to fulfill. Even today, all major decisions for Establishment Labs are made in Costa Rica, as they always have been. This demonstrates that Costa Rica has cultivated the management expertise required to lead global companies from within our borders.
EF: Could you elaborate on the Establishment Labs' footprint and how your portfolio has evolved to address market needs?
JQ: Establishment Labs has always maintained a clear focus on women's health, specifically in breast aesthetics and reconstruction. Our singular commitment has been essential to our identity and success. Over the past two decades, we have transformed an industry that was previously stagnant and dominated by large multinational corporations. While these companies led the market, they did not drive innovation.
Our approach has been to shift the industry dynamics through advanced technology and a genuine dedication to women's health. Today, we continue to lead by introducing minimally invasive techniques that are unique within our field. These advancements, developed in Costa Rica, are redefining standards and bringing the benefits of minimally invasive procedures to women worldwide.
EF: How do you balance business growth with your commitment to responsible innovation?
JQ: From the outset, sustainability has been at the core of our operations. We have built our company around the principle that true sustainability must encompass financial, environmental, and community dimensions. We continually challenge ourselves with a fundamental question: Is the world better because Establishment Labs exists? This mindset keeps us focused and drives our commitment to meaningful action.
For us, genuine sustainability means securing the resources necessary to innovate in ways that advance women's health, while also safeguarding our environment. Costa Rica sets a global standard in sustainability, and we are proud to lead by example within our industry. We have achieved full carbon neutrality, and our newest innovation campus has earned LEED Platinum certification. These initiatives reflect both our values and sound business strategy. For instance, our internal microgrid generates significant savings in electricity costs each year. Additionally, our on-site physical therapy clinic, latency rooms, and other facilities support our employees' well-being and productivity. We pursue these efforts not only because we believe in them, but also because they make strong business sense.
EF: Can you describe the process and considerations that guided your selection and transition to a new CEO at Establishment Labs, and why you believe this approach was effective?
JQ: We initiated the process of appointing a new CEO by first bringing someone on board as president to oversee the company's operations. This approach allowed us to assess whether the individual could truly excel within the unique environment we have cultivated at Establishment Labs. In this environment, innovation is paramount; every employee plays a vital role in advancing women's health, and hard work and accountability are central to our mission.
It was essential for us to find a leader who not only understood Costa Rican culture but also embraced the internal culture we have developed over the years, which now extends globally. We found these qualities in Pete. Since his confirmation as CEO, he has demonstrated exceptional leadership. Importantly, this transition was not rushed; Pete spent 18 months with us before assuming the role full-time, which we believe is the ideal way to ensure a successful leadership transition.
EF: What is the role of your organization in addressing the global disparities in access to breast reconstruction, and how are you working to advance surgical education, improve patient access, and drive innovation?
JQ: We run awareness campaigns that we identify as a fundamental aspect of our mission. We operate in the field of breast aesthetics, and we are committed to breast reconstruction. The disparities in access to reconstruction are striking. In the United States, particularly in urban areas and among white women, over 90 percent of breast cancer survivors receive high-quality reconstruction. In contrast, in Latin America, the rate does not reach double digits, and in Brazil, the wait time for reconstruction can extend eight to ten years. In India, the rate is less than one percent, and in Africa, reconstruction is, in most cases, not a possibility.
Addressing these disparities requires more than raising awareness. It is essential to help women understand that reconstruction is their right, and to work with governments to ensure this care is accessible. We also collaborate closely with the surgical community to ensure practitioners are equipped with the necessary skills and resources. Through these efforts, we are not only expanding the market for our solutions but also helping to democratize access to reconstruction—a long-term commitment that will take decades to fully realize.
In Africa, through the Africa Recon Network, we are bringing together breast reconstruction specialists to train a new generation of surgeons and provide access to appropriate tools and techniques. This work distinguishes our company and connects our employees to a broader purpose.
Our commitment is not only at a global level, but also at a local level in Costa Rica. At our innovation campus in Costa Rica, we have established three state-of-the-art surgical theaters and a global learning center. Here, we develop both new technologies and the surgical techniques of the future, welcoming surgeons from around the world to learn and advance the field. For us, technological progress and surgical innovation go hand in hand, and this integrated approach is how we are shaping the future of breast reconstruction.
EF: How would you like to see Establishment Labs be positioned within the next five years?
JQ: Over the next five years, our primary focus will be the global expansion of our minimally invasive platform. This initiative is essential not only for the opportunities it creates but also for the significant competitive advantage it provides. Additionally, we are advancing the integration of sensor technology into our long-term implantable devices, which I consider pivotal for the future of the industry. This innovation paves the way for predictive medicine and, ultimately, enables early detection of breast cancer. These developments are set to be transformative and will materialize in the near future.
EF: What advice would you give other Latin American entrepreneurs seeking to build globally relevant companies that also truly make a positive change?
JQ: The process begins by identifying a genuine, global problem to solve. Addressing a real issue is what enables your work to achieve scale and create meaningful impact within society. With a clear understanding of both the problem and its solution, the effort invested becomes worthwhile. It is important to remain focused on your core strength and not become distracted by peripheral concerns. Significant capital is not required in the initial phase; rather, this is a time to learn and appreciate the challenges ahead. If you successfully navigate this stage, access to capital becomes increasingly important. By staying closely engaged with each step of the process, success becomes attainable.
