Sunday, 29 December 2013

Getting knifed for bigger breasts

‘More than a mouthful’s a waste, I was told decades ago, by a woman who had no intention of enhancing the size of her breasts. 

Sadly, not everyone shared that admirable attitude. Huge numbers of women have decided to have breast implants fitted: in Britain alone, the market has grown from an annual value of £750 million in 2005 to £2.3 billion in 2010 and is expected to reach £3.6 billion in 2015.

It’s always struck me that we have far too casual an attitude towards surgery. Let’s face it, in the final analysis it involves someone taking a viciously sharpened instrument and cutting you open with it. 

It’s true that this happens under anaesthetic, in highly controlled surroundings, with strict infection control, careful monitoring of vital functions, and highly trained people around to carry out the procedure itself or to spring to your rescue if anything goes wrong. That’s all very different from what might happen on a street corner outside a club on a Friday night. And there are reasonable grounds to suppose that the person wielding the knife in the operating theatre doesn’t actually intend to do you any harm, whereas the man with the knife on the street corner probably isn’t motivated by the best of intentions towards you.

Despite those differences, from the point of view of your body, there is a fundamental similarity: your skin and the flesh underneath it is supposed to remain unbroken, and someone’s breaking it.

Now I fully appreciate that most of us have to undergo surgery at some time or other and, as I grow older, the likelihood of its happening to me grows all the time. All I’m saying is that I have no intention of letting anyone stick a knife in me unless it’s vital, which means that the alternative is potentially fatal or involves a massive reduction in life quality.

Cosmetic surgery? Forget it. You don’t like the way I look? Talk to someone else. I don’t like the way I look? I’ll avoid the mirror.

The worst aspect of cosmetic surgery, and in particular breast enlargement, is that it doesn’t just involve a knife. It involves leaving something alien inside the wound afterwards. Usually a plastic bag full of some more or less noxious substance.

In the case of French company Poly Implant Prothèse, PIP for short, the content was particularly unpleasant. In order to give the impression that it was using approved materials, about 25% of its breast implants contained the traditional US-certified silicone gel, Nusil. The other 75% contained industrial-grade silicone, less indicated as conducive to human health.

Why the mix? In 2009, Nusil cost 35 Euros a litre, the industrial grade material just five. This represented a 10 euro saving per implant which, on the Company’s annual production of 100,000 at its peak, generated a saving of a million euros a year.

Sadly, the containers weren’t particularly good either, suffering more than twice the rate of ruptures of other brands. Given the contents, a rupture was particularly serious when it happened on a PIP implant.

A ruptured PIP implant. Not so nice to have inside you...
The seriousness of the problem is perhaps best expressed by the fact that Jean-Claude Mas, the founder of PIP, is now serving a four-year gaol sentence, which came with a 75,000 euro fine, and a lifetime ban from activity in any way connected to healthcare.

Sadly, when this all started to emerge in 2010, there was no way of establishing just who in England had a PIP implant in place: France had a registry of all such operations, but in England there was none. So the only way to get to the more than 47,000 women affected – or to describe them more correctly, Mas’s victims – could only be done by advertising and calling on anyone concerned to contact a doctor.

In passing, it cost the NHS £500,000 to treat the women affected, so we’re not talking about a trivial charge for the health service.

At least some of these things are beginning to change. Just as we have had a registry of orthopaedic operations for over ten years now, England is about to set up a registry of breast implants. That way we shall at least have a better idea of just what’s being done, with what, to whom. Other nations (and 400,000 women were affected by PIP around the world) need to make sure they have such a system in place. Wales, Scotland and Northern Ireland in particular might look to follow England
’s lead

Better training standards for surgeons are also being introduced, and action is likely to be taken against aggressive advertising, such as 2 for 1 or so-called mother and daughter deals.

There are probably some morals to draw from this story.

In the first place, these were operations carried out by qualified surgeons. Just because the professionals are in white coats, it’s probably best not to assume that our interests are their top priority – particularly in an industry worth multiple billions of pounds.

Secondly, surgery, however carefully controlled the setting, does involve sticking a knife in you. And implants are things that get left behind at the end of the procedure.

And finally, there's that wise principle that more than a mouthful’s a waste. 
Does anyone really need to be knifed in a sensitive part of the anatomy just to be wasteful?

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