Within minutes of riding into Mexico in a rented white minivan last month, Latavia McGee knew that she was lost.

She and three of her closest friends — close enough that she called them brothers — had driven from South Carolina to Matamoros in the state of Tamaulipas so that she could get a tummy tuck procedure. It was a journey she had made once before, as part of a wave of American women seeking cosmetic surgery across the border.

But this time, she was running late, had no phone service and had veered off course, Ms. McGee recalled in a recent interview. She was struggling to remember where the clinic was supposed to be.

Also in the wayward van were Zindell Brown, Shaeed Woodard and Eric Williams, old companions with whom she had grown up in South Carolina. That morning in Mexico, they had been enjoying one another’s company, Ms. McGee said, as Mr. Brown, the best Spanish speaker of the four, asked strangers for directions.

Then gunshots rang out, and the friends found themselves caught in the crossfire of a Mexican cartel. Mr. Brown 28, and Mr. Woodard, 33, would be killed, and Ms. McGee, 34, and Mr. Williams, 38, would spend four days in captivity, with the dead bodies of their friends beside them.

The deadly encounter drew international attention, highlighting the relentless violence that the Mexican government has failed to contain and bringing Republican criticism of the Biden administration for not doing enough to confront cartels across the border. Though the episode is still being investigated, officials have said that they believed the friends were taken by mistake: criminals in Mexico do not usually target Americans. Two days after Ms. McGee and Mr. Williams were released, five bound men were found by the Mexican authorities with a letter, purportedly from a powerful cartel, blaming them for the attack on the Americans.

The two survivors are only now beginning to speak publicly about their ordeal, as they continue to cope with the physical and emotional aftermath, which has left Mr. Williams using a wheelchair. In an interview with The New York Times, they described confused captors and gutsy escape attempts before they were released, and they provided more details about what drew them to Mexico.

Ms. McGee, who lives in Myrtle Beach, S.C., first had cosmetic surgery in Matamoros about two years ago, she said, and was returning for another procedure. She saw it as a form of self care after having six children. “It wasn’t that I was self-conscious, because I always thought I was beautiful,” she said. “I wanted to do it, so I saved my money, and I went.”

While her path across the border was risky, it was also well worn. Experts who track the practice known as medical tourism say that tens of thousands of U.S. residents, most of them women, make the trip every year in search of body-sculpting operations that are cheaper than what they can find at home. Despite the experience of Ms. McGee and her companions, the trend shows no sign of slowing.

Cross-border medicine

Cartel violence is distressingly common in Tamaulipas, one of six Mexican states that the State Department warns Americans to avoid because of crime. Even so, women cross the border from Brownsville, Texas, every day to visit clinics in Matamoros offering liposuction and cosmetic procedures known as tummy tucks and Brazilian butt lifts.

About 1.2 million Americans traveled to Mexico in 2019 to save money on medical procedures, according to Patients Beyond Borders, a group that offers guidance on health care options abroad. The organization estimates that cosmetic procedures account for about 15 percent of all medical travel from the United States.

Jasmine Wilson, 28, of Washington, D.C., went to Mexico last October for body shaping surgery that might have cost her $20,000 domestically, she said. In Mexico, the procedures came to only about one-quarter of that price. In the months since, she has used TikTok to promote the work of her surgeon, whom she found through a Facebook group.

Ms. Wilson said larger women often have a hard time obtaining cosmetic procedures in the United States. “A lot of plus-sized women don’t even know that they can get plastic surgery,” she said, “because they get turned down.”

Some cosmetic surgeons consider it too risky to operate on patients who have high body mass indexes. But compared with their American counterparts, surgeons in Mexico appear to be more likely to accept those patients, said David G. Vequist IV, founder of the Center for Medical Tourism Research at the University of the Incarnate Word in San Antonio. Americans with limited access to health care, a category in which people of color are overrepresented, are also more likely to travel for procedures abroad, he said, pointing to a 2016 survey conducted by the U.S. Centers for Disease Control and Prevention.

For many patients who undergo butt lifts and related procedures, complications like blood clots or embolisms, which can be fatal, are a bigger concern than the cartels. Even a normal recovery involves bruising, bleeding and painful swelling, which has led to a homegrown system of postoperative recovery houses arising along the border.

Roxanne Flores has crossed into Matamoros hundreds of times, she said. She underwent cosmetic surgery in Mexico years ago, and now rents a house in Brownsville where women can pay to stay before and after their operations.

“I’ve never, ever been caught up in something” while driving women to Tamaulipas and back, she said, adding that Ms. McGee might have looked out of place in Matamoros because she was in a car with three men.

Like many other medical tourists, Ms. McGee prepared for her first surgical trip by sifting through social media platforms where women had recommended doctors and shared photos of their figures before and after procedures.

A friend recommended the same doctor that Ms. Wilson had visited. “I was kind of scared,” Ms. McGee said this week about her first procedure in Mexico two years ago, because she knew that complications were possible. But she was happy with the results, and decided to go back again for a tummy tuck.

‘All I could do was cry’

After roaming through Matamoros with her friends on the day of her appointment last month, Ms. McGee was ready to head back to Brownsville when a car cut them off.

From the back seat of the van, Mr. Brown insisted that he had seen a gun, and he urged his friends to flee, Ms. McGee recalled. Mr. Williams, who was driving, said he did his best to escape as shots rang out, throwing his arm across Ms. McGee in the passenger seat to try to protect her.

Someone on the street died in the shooting; news outlets identified her as Areli Pablo Servando, a 33-year old Mexican woman.

In the violent, noisy blur, each of the four friends either tried to run from the minivan or was pulled from it, Mr. Williams and Ms. McGee recalled. Then, in a moment that was captured in a bystander’s video and shared widely on social media, the four were loaded into the bed of a white pickup truck.

As the truck began to pull away from the scene of the shooting, Ms. McGee was the only one of the four who had not suffered a major injury. She and Mr. Williams, who had been shot in the legs but remained conscious, decided that she should try to escape and find help. So she jumped, she said, and ran toward a fence with a gate. But the gate was locked, and the fence was too high to climb over.

The assailants forced her back into the truck and beat her, she said. The four Americans were then taken somewhere and accosted by more men with guns, who threatened them and asked them if they were in the drug trade.

“No,” Ms. McGee recalled answering. “We came for surgery.”

Confusion seemed to creep in as their captors consulted with one another. Some of the assailants told Ms. McGee that she would be released, she said. Still, the threats and beatings continued.

The four were taken to a sort of clinic, where Ms. McGee said she saw that both Mr. Brown and Mr. Woodard appeared to be lifeless. “All I could see was their heads and the dreads hanging off the bed,” she said. “And all I could do was cry.”

Mr. Williams — who by then had been stripped — said his injured legs were hastily stitched up. The two survivors and their dead friends’ bodies were moved again, to a place where they were surrounded by about a dozen other captives who looked as though they had been badly beaten.

The surviving friends languished there for about two days, Ms. McGee said. They prayed together and took turns feeling hopeless, each asking the other to relay loving messages to their spouses and children.

‘I’ll never be OK’

Eventually, they were driven to yet another location, where Ms. McGee again tried to escape, they said. She managed to grab the phone of a guard who seemed to be incapacitated, and dialed 911 repeatedly. Each time, she said nothing to the operator, she said, for fear that the cartel might be listening. But she hoped that the police would come if she kept dialing.

Her last attempt to flee came after she spotted an empty vehicle outside the place where they were being held. Finding the keys inside, she hauled Mr. Williams into the vehicle with her and hit the accelerator. Rough terrain slowed her down, she said, and then she was spotted; bullets flew again. She was taken back to the room with the bodies.

Not long after that, the police arrived. According to the Mexican authorities, Ms. McGee, Mr. Williams and their slain friends were found on the morning of March 7 in a wooden shed surrounded by farmland on the edge of Matamoros. A couple of hours later, the two survivors were in the custody of U.S. officials.

The full story of what happened to them in Mexico remains unclear, and many details of their account could not be verified.

Since the kidnapping, Mr. Williams has undergone surgery to repair his legs and is unsure when he will be able to walk again. He and Ms. McGee are grieving the loss of their friends, whom they described as supportive and sweet.

“I’ll never be the same,” Ms. McGee said. “I’ll never be OK.”

Sometimes, Ms. McGee’s phone still brings her notifications from the cosmetic surgery groups she joined years ago on social media, where women continue to post about their plans for procedures in Mexico.

Ellen Gabler contributed reporting.