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PIP implant story raises key questions about openness and accountability of cosmetic surgery industry in UK

The recent and ongoing events surrounding PIP breast implants have exposed key concerns about the cosmetic surgery industry in the UK. Patients were quite simply not fully informed about the nature and risks of the PIP implants. Although it has only recently come to light, during an investigation in 2006 by cosmetic surgeons in California, concerns were raised about the suitability of the silicone used in PIP implants and their short life span, which was 3.5 times lower than a comparable implant.

This not the first time that a cosmetic product has not lived up to expectations. Back in 2002, Isolagen was marketed as the permanent cure for wrinkles; a permanent face lift injection using only the patient’s own cells. However by 2006, it had become clear that it was not the permanent solution many had hoped it would be. Many clinics also failed to mention that although it used the patient’s own cells, these were stored in fetal calf serum first to assist in rejuvenation.

The cosmetic surgery industry has grown, and continues to grow, quietly and largely unchecked. There were approximately 38,000 cosmetic procedures in the UK in 2010, up 5% from 2009 and growing steadily. Yet if you were to look for clinical guidance with NICE or the Care Quality Commission, you would find very little on how practitioners and clinics should operate. Professional organisations such as the British Association of Aesthetic Plastic Surgeons do provide some skeleton guidance for practitioners, but this is largely insubstantial. There is, for example, no requirement or even advice for surgeons providing breast implant procedures to recommend or refer a patient for a mammogram, or even to discuss breast cancer screening with the patient at all.

The source of the problems with the cosmetic surgery industry comes down to a key question; is the patient a patient, or a customer? There is no comparable service in the NHS, and the industry is driven by consumer demand, as opposed to medical necessity. There is therefore less of a focus on patient’s best interests, and more in providing procedures. Many clinics provide very little information about the risks of a procedure, or discuss whether a procedure is the most suitable option for a client, as opposed to counselling or non-surgical assistance. Nearly a third of all clinics carrying out procedures fail to allow a ‘cooling off’ period to allow the client to consider their options before agreeing to a procedure, often offered a discount if they pay immediately. There is also very little aftercare, and when things go wrong, the clinics usually direct the patients towards the NHS, as the PIP story has shown.

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