Some 40,000 women in the UK out of 300,000 worldwide received the PIP implant, which has now been banned. In December, the Department of Health stated that only NHS patients who had received the PIP implants could get removal and replacement on the NHS. Then on 6 January the DH announced that the NHS would now cover explantation (but not replacement) for private patients with clinical needs, such as implant rupture or extreme anxiety, and insisted it would recover the costs from private clinics who refused to remove implants for free, arguing that after-care is still part of best medical practice.
I was disheartened to hear of more than one GP who refused to refer a distressed PIP patient for an NHS scan citing the December DH guidance as he had not read the latest January DH guidance. This would have caused the patient undue stress and further unnecessary anxiety. One GP reported that her local PCT refused to fund a NHS scan for a private patient – even they had not read the latest guidance.
I have been advising patients whose GP is refusing to refer them for a scan to print off the Department of Health letter on PIP implants from 6 January and enlighten their GP on current advice.
We GPs are non-judgemental and practice holistic medicine. We empathise with both patients' physical pain, from the effects of leakage of toxic industrial fillers untested in human beings, and their psychological pain from the anxiety that comes with having banned PIP implants. A one in four rate of rupture was quoted by Mr Jan Stanek, a leading private surgeon, rising to a 31% rupture rate, according to an independent PIP implant support group survey.
Women have implants for many reasons: asymmetry, lack of confidence, society's unrealistic perception of women as portrayed in magazines and television, etc. Those who went privately chose not to see their GP and ask for special consideration funding from the local PCT for breast augmentation for psychological reasons (which has been granted to some, for either breast augmentation or reduction) but instead chose to self-pay, with contributions from parents, partners, or by raising funds themselves.
Our role is not to judge or castigate but to show compassion to the distressed. This is affecting their well-being, marriage, relationship, family, finances and employment, causing depression and extreme prolonged anxiety. All they ask of us GPs is sympathy, and referral for an ultrasound.
Symptoms that have been reported associated with a rupture include silicone in the lymph nodes, swelling, pain and inflammation of the breasts, burning breasts, numbness in the arms, fatigue, fibromyalgia, etc. There is also a condition called ‘silent rupture' - in many cases, a patient only learns that her implants have ruptured on scan. GPs should be referring at-risk patients for a breast scan regardless of examination findings, which when normal have been sometimes subsequently been contradicted by scan findings.
It is inhumane to expect our patients to live with the extreme anxiety of knowing they are at risk of rupture of PIPs made from window sealant, brick weatherproofing, and mattress fillers that could enter their lymphatic system and migrate. As no research has been conducted into window sealant and mattress filler leakage inside human beings, how can the MHRA confidently say they should remain in situ, as they have not ruptured yet, and have no risk of cancer?
Even if patients have their implants removed on the NHS, they must face a daunting decision as to whether to remain without implants - which may lead to further disfigurement with stretched skin and removal of affected breast tissue - or face a second operation and pay £3,000-4,000 to have a new approved implant inserted. Each general anaesthetic is a mandatory two weeks off work, so having two operations – one NHS to remove and one private to replace – means a month off.
Culpability lies jointly with the MHRA for approving the PIP implants and not recalling them sooner, and with the remaining private clinics charging to replace faulty implants instead of funding replacements with their malpractice insurance. An urgent review of the MHRA is called for as the US Food and Drug Administration did not approve trilucent, hydrogel or PIP implants, yet all three were approved and subsequently banned by the MHRA.
GPs, please show compassion to the distressed. If a scan does not show rupture but the patient still has symptoms, refer the patient to breast clinic for an MRI scan or for removal. Give the patient the freedom of choice to self-pay for replacement of the implant at NHS explantation or do as compassionate Wales and Europe are doing - offer all private or NHS patients free removal/replacement.
Let us as a nation of GPs come to patients' aid - not judging them as private or NHS patients but treating them as human beings, and always putting the disease in the psychosocial context.
Dr Una Coales is a GP in Stockwell, south London, and RCGP council member
