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Louise Naughton Reporter, Nursing in Practice

Implanting fear: cosmetic surgery

complications in primary care What happens when problems arise following private cosmetic procedures, and who should take responsibility?


hen cosmetic surgery goes wrong, it can land on the doorstep of primary care, and practice nurses can be faced with frightened patients with nowhere to turn. Freedom of information requests sent by Nursing in

Practice to all 151 primary care trusts (PCTs) in England showed just how little we know about how many patients with botched cosmetic surgery walk through the doors of GP surgeries. None of the PCTs were able to generate any indication of the burden

of cosmetic surgery on general practice as all primary care consulta- tions are confidential and as such, this is not data they collect. The recent French-made Poly Implant Prothese (PIP) scandal

has shown how quickly an overwhelming reliance on primary care health professionals to step in and pick up the pieces of private cosmetic work can manifest itself. Women all over the UK were thrown into panic when, in 2010,

the French authorities banned PIP implants made with low-grade silicone – developed to fill mattresses, among other uses,– fearing they could rupture and leak. An estimated 8,000 women have breast implant surgery in the

UK every year. More than 4,500 of the possible 47,000 women fitted with PIP

implants in the UK have been referred to the NHS so far, according to figures released by the Department of Health in March. Such women had implants privately fitted by clinics that have

refused treatment or no longer exist. Over 2,170 women have had their implants scanned to check

for a rupture, yet only 224 have decided to go under the knife once again to have them removed. An expert group, commissioned by the government and led by

NHS Medical Director Professor Sir Bruce Keough, has already discounted a cancer link with ruptured PIP implants and the results of further investigations are expected to be published in May this year.

The NHS in England did use the PIP implants for reconstructive

surgery but only in a small number of patients. Of the 747 women fitted with PIP implants through the NHS, 98 have made the decision to remove them. It is not known whether such women have had their implants replaced. Not only is NHS England helping its own patients anxious about

their PIP implants, it is acting as a last resort for women with privately-fitted PIP implants. Only those with a medical need, such as distress or rupturing of the implant, or those who are refused treatment from their original surgeon, will have the implants removed by the NHS but not replaced. The NHS in Northern Ireland has taken a similar line to its

English counterpart, but said it will remove and replace implants inserted by the NHS for health reasons. However, the NHS in Wales has committed to replacing PIP

implants fitted both by the NHS and private providers where there is a medical need. A statement from NHS Scotland to NiP confirmed PIP implants

were not used by the NHS in Scotland but were used by the private healthcare sector. Therefore Scottish officials currently do not hold any information

on the number of implants which have ruptured or need removal. A survey of NiP readers has shown 87.8% of you believe the

NHS should fund the removal of PIP implants even if there is no clinical need. Responses were more diverse when asked whether the NHS

should go further and fund the replacement of PIP implants when a medical need is shown. Almost 20% of you believed the NHS should cover the costs for

both the removal and replacement of the sub-grade implants, with 28.6% agreeing on the basis of the woman paying for the operation out of her own pocket. However, 16.7% agreed with the government in preventing the

taxpayer from footing the bill. The largest portion of you (41.9%) agreed the NHS should fund

18 Nursing in Practice March/April 2012

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