Dr Phil Hammond, broadcaster and sessional GP in Bristol

Cosmetic surgery isn't necessary if you're healthy

There are many lessons to be learned from the latest breast implant scandal. The most obvious is that there's no need for cosmetic surgery if you're healthy. Breasts are beautiful, whatever their size or shape. If your penis does the job, be grateful and stop obsessing about its dimensions; your nose and ears were made for you and we all get wrinkly and balder as we get older. Breast is best, and if you're lucky enough to have two, don't spoil them by filling them with bags of chemicals.

Breasts clearly have a role in sexual attraction, and the vast majority of men are attracted to all breasts. Their role in infant nutrition is vital and yet the British are so prudish about breastfeeding that the public sign for a breastfeeding cubicle in the UK is a bottle. Why, when breasts are all over newspapers and magazines, do we shun a public information sign with a breast on? And why do we make women go into cubicles or retreat into cars to do something that is both natural and essential for infant health?

For most of their lives, breasts have an important metabolic role, which is often overlooked, particularly by men and implant manufacturers. Women caught up in the current scandal are victims of a crime. In 2001, Jean-Claude Mas, owner of the now defunct Poly Implant Prosthese (PIP) company, began making his own illicit silicon to meet 'economic objectives'. Suppliers were told that the industrial silicon was going into hand creams and when the inspectors called—always giving 15 days notice—the rogue ingredient was cleared off site.1,2

The clue that something was badly wrong should have been the low price—PIP implants were up to 80% cheaper than competitors and, as with most things in life, you get what you pay for. The NHS sensed a bargain and implanted 7000 of them, mainly to cancer patients. In 2007, a British surgeon was so appalled by the 'massive failure' of an implant he wrote a warning letter to the British Journal of Plastic Surgery.2 In 2009, the MHRA was warned by a Cardiff solicitor, but the implants were not banned until 2010.2

There have been previous scandals: in 2000, hydrogel implants, also made by PIP, were withdrawn when the company was unable to produce safety data. The 4000 British women who had received these implants since 1994 were never contacted. Soya implants were introduced in 1995, but banned in 1999 after inflammation and swelling caused by ruptures and leakage. More than 4500 women were advised to have the implants removed, with costs paid by the manufacturers Trilucent. In 2000, American regulators issued a warning that saline implants made by PIP had been adulterated. It stopped the devices being sold in the US.3

Cosmetic surgery is so poorly regulated that you could make your own facial filler in the garage with a chemistry set, and sell it to the public without breaking the law. Implants receive manufacturing licences, but are often not followed up for quality and safety once they've been implanted. Until this happens, there will be many future scandals, the industry will deserve the bad press it gets, as will governments and regulators for allowing it to happen.

As for the affected women, the Government has agreed to remove and replace those fitted on the NHS and hopes private companies will follow suit.4 Companies that refuse should be banned from operating, but the NHS must pick up the pieces, regardless of the reason for the implant. The NHS has always treated according to need, and we need it now more than ever.

  1. The Independent website. I knew our silicone was inferior, admits breast implant chief. www.independent.co.uk/life-style/health-and-families/health-news/i-knew-our-silcone-was-inferior-admits-breast-implant-chief-6282553.html (accessed 10 January 2012).
  2. The Telegraph website. Breast implant scandal: the whistleblowers. www.telegraph.co.uk/health/healthnews/8986746/Breast-implant-scandal-the-whistleblowers.html (accessed 10 January 2012).
  3. The Telegraph website. Breast implant scandal: Q&A. www.telegraph.co.uk/health/healthnews/8986743/Breast-implant-scandal-QandA.html (accessed 10 January 2012).
  4. Department of Health website. Department of Health statement on breast implants and response to expert group report. mediacentre.dh.gov.uk/2012/01/06/statement-on-breast-implants/ (accessed 10 January 2012).G

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