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Dictated to by surgeon’s knife

Breast implants are both a scandal and saga. The French have advised their 30,000 women who received poly implant prostheses (PIP) to have them removed.1

In the UK, there are an estimated 40,000 women with these implants, 95% of which have been put in privately for purely cosmetic reasons.2

This has illuminated three issues. First, that it was possible to put industrial-grade silicone – designed for mattresses – into the human body. Second, that there have been no registers recording the use of these implants or generating surveillance data to allow safety checking and audit.

The third issue is the absurd relationship of private medicine to the NHS. The Department of Health says: ‘If your private clinic no longer exists or refuses to remove the implants, speak to your GP. The NHS will remove your implants if your doctor agrees there is a medical need.'

So, the private clinic is allowed to use substandard implants and then wash its surgical hands, and the NHS is expected to pick up the tab. The NHS is a limited resource – so what aren't we going to do for which people as a result?

This hardly bodes well for the Government's plans for private companies to make inroads into providing NHS services. The private sector can take the profit but cast back problems to the state – we in the NHS are left to sort out the mess.

But then, the nature of private medicine runs counter to best NHS practice. We in the NHS are encouraged to use evidence and statistics like ‘number needed to treat' to clarify and fairly explain the risks and benefits of treatments. In the private sector, it seems enough to advertise to women on the basis that cosmetic surgery might make you more ‘confident' or ‘feminine' – ignoring the fact that no randomised controlled trial has shown this.

Worse, it is hardly made clear to women that all breast implants have to be replaced after 10-15 years because of the risk of rupture.3 Cosmetic surgery websites merely allude to a ‘10-year guarantee'. This makes a mockery of the NHS's own position on the matter – that all of these implants would have to be replaced sooner or later in any case – and is unfair on women.

The market for breast implants in the UK would not exist were there not surgeons advertising and providing it. Were clinics more open in explaining the disadvantages of implants, the potential effects on breastfeeding and the dimpling and scarring, I'd be willing to bet that fewer women would want it done.4

The damage spreads to the NHS, which is expected to give up time to deal with the fallout – and then beyond to our wider society.

Images of unnatural body shapes are paraded in popular media so frequently that it is easy to lose sight of what normal is. This leads to perverse outcomes – who is telling young women that their natural shapes aren't enough to feel ‘feminine' and ‘confident' about already?

When we allow our psychologies to be dictated to by the surgeon's knife, we all lose, and when we make the NHS pay for the private sector's folly, health inequalities only cut deeper.

This may seem to be about breast implants, but it's really about politics.

Dr Margaret McCartney is a GP in Glasgow


1 Henegan C. The saga of poly implant prosthèse breast implants. BMJ 2012;344:e306
2 NHS Choices factsheet 2010. Breast implants. Online 20 August.
3 Brown S, Middleton M, Berg W et al. Prevalence of rupture of silicone gel breast implants revealed on MR imaging in a population of women in Birmingham, Alabama.
Am J Roentgenol 2000:175;1057-64
4 FDA factsheet 2011. Risks of breast implants. Online 6 June