The social, and psychological reasons women have breast implant surgery are complex and multi-faceted says Professor Julie Kent a sociologist from the Center for Health & Clinical Research at UWE Bristol. These considerations, as well as ethical issues, need to be part of the debate on faulty breast implants, in order for lessons to be learned from the current crisis says Professor Kent.
Professor Kent is an expert in the ethics and policy issues relating to health technologies and she has carried out extensive research into the politics of breast implants.
Professor Kent says, We live in a society where appearance matters a great deal and the social pressures to look good, to conform to notions of a 'normal body' create demand for implant technologies to restore or enhance bodily form.
What kinds of risks are women willing to take with their health? Breast implants of all kinds are known to have a limited life and are likely to need replacement. Surgery in itself is a risky procedure.
Women need support and information which enables them to make informed decisions about the risks breast implants can pose to health whether they contain defective filler materials or not, while anyone who deliberately flouts safety standards in manufacturing healthcare products should expect to face the rule of criminal law.
Despite the current crisis, Professor Kent says safety concerns about breast implants are not a new issue. There have been debates in the past about whether commercial interests exploit women who seek breast implantation and whether regulation of the cosmetic surgery industry is adequate.
Professor Kent continues, Successive UK inquiries and government reports have concluded that a duty of care towards those who seek cosmetic surgery should be a key ethical principle. However, it remains to be seen whether this will lead to private clinics providing appropriate support to women in the current crisis.
While the risks to women's health and concerns about safety are being taken very seriously by the regulatory agency MHRA and the Department of Health, the absence of reliable data on which to formulate policy is a longstanding problem.
Funding was withdrawn from the UK National Breast Implant Registry and it was closed in 2007 because the data was considered inadequate and unable to provide a clear picture of what the health risks to women are of different types of breast implant.
The recently convened Expert Group now needs to consider the problem of how to draw conclusions about implant performance in the absence of any national database. This gap in information was entirely predictable and relates to the problems associated with voluntary registration of implant procedures and of regulating the market in breast implants.
Professor Kent says, however, that the issues of regulation are not just national, they are global.
Regulating the global market in healthcare products is a difficult process not least because regulatory regimes vary across different parts of the world. Weaknesses in the European regulatory approach in relation to medical devices have previously been identified and reliance on 'notified bodies' to ensure products meet safety standards has been a concern for some years. Women may assume that they can trust regulators to act to protect their health but enforcement of safety standards across international borders raises real problems for regulators and exposes consumers and patients to risks.
In conclusion Professor Kent says the debate needs to focus on the ethical issues, as well as psychological and social issues, to ensure that lessons are learned from the current crisis.
Breast implant technology is discussed by Professor Kent in a forthcoming book edited by Professor Nichola Rumsey and Dr. Diana Harcourt from UWE's Center for Appearance Research, entitled, 'The Oxford Handbook of the Psychology of Appearance' published by Oxford University Press.
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Kent, J. (2003) Lay experts and the politics of breast implants. eprints.uwe.ac.uk/6622/ Public Understanding of Science, 12 (4). pp. 401-419. ISSN 0963-6625 pus.sagepub.com/content/12/4/403