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?

The wonders of private healthcare and of Scottish government

In Britain, a very small proportion of healthcare is delivered by private hospital


These are organisations that provide healthcare for profit, or at least try to (anyone can run a business badly). As a result, they only do what is referred to in the trade as ‘cold surgery’ - in other words operations carried out on a planned basis rather than in response to an emergency. 


These can be relatively low-key operations such as a hernia repair, or something more substantial, like a hip replacement. But what they all have in common is that they are carried out on patients who are, broadly speaking, in good health: they obviously have the condition for which the surgery is needed but otherwise they’re well - they don’t have anything likely to turn into a nasty heart attack, or a major neurological problem such as a seizure or, even worse, a stroke. 


It will come as no surprise that this is the kind of case that is most likely to generate a profit. 


Partisans of private hospitals argue that by handling this kind of work, they relieve the NHS of having to do it. What that argument leaves out of account is that what’s left is the more difficult cases that are likely to be the most expensive. What it leaves even more out of account is what happens if things unexpectedly go wrong, as they have a tedious way of doing in healthcare. 


What if, against all the available indicators, a patient has a heart attack while in the private hospital? 


I came across exactly such a case some years ago, though I won’t mention the private hospital involved, because why should one embarrass the guilty? What happened was that reception staff called for an ambulance. When it arrived, NHS paramedics took the patient into their charge at being shot of all further responsibility for him. 


Because that’s what the private sector does. It cherry picks the easiest cases. And it avoids any of the huge infrastructure costs associated with building centres capable of dealing with the serious problems, with the life-threatening conditions. No wonder the private sector can aim at profitability. 


Why is this important today? 


Because the latest reorganisation of the NHS aims to make it possible for ‘any willing provider’ to deliver healthcare. That form of words led to a bit of a storm of controversy so now the government is saying, ‘well, yes, of course the provider as well as being willing also has to be suitable, properly qualified, and shown to be capable of delivering quality.’ If only they’d said that from the outset I’d have less trouble believing them. But suitable or not, these hospitals are still going to be creaming off the most lucrative cases while avoiding the burden of the difficult ones - for which they’ll have to turn to the public sector for support. 


Anyone in Britain questioning that suggestion need only look at what’s happening in connection with the latest healthcare scandal: breast implants provided by a (now-bankrupt) French company, PIP, using industrial-grade silicone. That’s a bit like putting a load of diesel oil in your body and being told, ‘don’t worry - there won’t be a problem unless the pack leaks.’ Inspires confidence, doesn't it?


And guess who did 95% of the operations? Private hospitals, of course. And who picks up the tab if things go wrong? Oh, yes, you guessed it: the public sector. The private cosmetic surgery companies reckon that they just can’t afford to do the work of removing the implants themselves - it would cost too much. Why, it might wipe out their profits. So they expect the rest of us to cover them for them. 

Leaking industrial grade silicone - just what every woman wants inside her
The private sector can fit them. To take them out, just turn to the NHS

Oh brave new world that has such people in it! 


What a wonderful, liberating experience it’s going to be having all those ‘willing providers’ helping out the NHS. 




Postscript: they order these things better north of Hadrian’s Wall 


This week David Cameron, Prime Minister of the United Kingdom, decided to confront Alex Salmond, First Minister of Scotland, a major part of that same United Kingdom. 


Salmond wants to hold a referendum on independence for Scotland. But because he’s a wily old fox and he know time’s on his side, he wants to hold it in 2014. And, because he knows he might lose the referendum, he wants it to include an alternative possibiliy - maximum devolution, with Scotland running all its own government except for foreign affairs and defence (often the same thing these days) which would be left to the residual UK. 


Now Cameron is calling him out. The referendum must be held in 2013. And, he maintains, it can’t contain the maximum devolution question. 


So Cameron is taking on Salmond head on. Cameron. Self-confident to the point of brashness, indolent when it comes to preparing his ground, convinced that success is his due. Against Salmond. The smartest operator in the UK today. 


I’m looking forward to watching the contest. Cameron might best him. But I won’t be putting any money on that.

Cameron, left, looking for an idea. Salmond looking as though butter wouldn't melt
I know who I'd put my money on