Harley Street Secrets

I have been on holiday for few days, away from the UK and, as much as I could, from cosmetic surgery. I had fun, especially at the airport, trying go past the baggage check carrying a tiny glass snowball. The snowball was actually so small that it could fit easily in my clear plastic bags for the liquids, but still commanded the attention of four different people and had to be inspected by a supervisor. I couldn’t help but notice that in a matter of minutes that little glass ball with about 10 cc. of water went through an x-ray machine, a complete consultation and finally a swab (apparently to check for explosives) before being diagnosed fit for travel. I wish the same level of care could be provided by the NHS and private companies.

Coming back, I have seen a couple of new cases of ruptured breast implants, which would be an ordinary event, except for the fact that the implants were not very old. Still, implants can sometimes rupture quite early for no special reasons, and I am not going to discuss the problem in detail on here. What is interesting is not the scientific, but the commercial side of the problem.

The typical scenario involves a very worried patient, that rushes back to the company where she had her breast enlargement immediately after a GP or a surgeon from the NHS diagnosed her with a ruptured implant. In quite a few cases, the diagnosis of ruptured implant is not unequivocal, and surely the doctors that made it could learn something watching my little snowball going through the baggage check. Almost always there is some degree of ‘competitive behaviour‘, with surgeons from the NHS making naughty comments about their counterparts in private practice, and surgeons working for companies claiming that there is very little knowledge of cosmetic surgery within the NHS. In any case, what the patient understands is that she needs an immediate replacement of implants, and that her surgeon, her brand of implant and the company that she used are the cheapest on the market and not, as she was led to believe, the top of Harley Street.

From there, it only gets worse. I’ve heard that at least one company is now telling patients that their ‘aftercare’ didn’t actually include the replacement of a ruptured implant, unless the rupture happened during the first year. As a consequence many patients will have to pay and turn to their solicitors. I will never stop being amused with the fact that there is at least one manufacturer of implants that is issuing reports about their own ruptured implants, apparently always blaming the surgeons for the rupture. Leaving alone the fact that the manufacturer is directly involved, so the reports are necessarily partial and would never stand a test in a court of law, the pretended reasons for the ruptures are slightly outdated to say the least: I have even been told that the use of povidone-iodine solutions during the procedure is one of the suggested reasons for rupture (not going more into details here, but just for the manufacturers, and the solicitors, I hope they remember a couple of studies that examined peroxide-catalyzed elastomers and platinum-catalyzed ones).

I can see this story snowballing down a perilous path. Patients are unhappy, surgeons are unhappy, companies know no accountability. It could happen that, for the first time, the entire business model of commercial cosmetic surgery companies will end up tested in court, especially if a surgeon knowledgeable enough (and there are a few) will be asked to pay for faults that are not his/hers. Ruptured silicone implants are part of the risks of breast enlargement and quite a simple problem: as far as we know from many studies, they pose no major risks and only need to be replaced. Why this is becoming so difficult, it is one of those commercial mysteries that I don’t really understand.

While going through many of the old posts and comments, I realised that this blog is beginning to look too much of a crusade against companies, instead of what it is really intended to be: a discussion about the limits of commercial cosmetic surgery and the excesses of the recent years.
I wouldn’t be honest if I didn’t say something about the good things that companies have done for patients and cosmetic surgery in general (there are a few…). This is especially important since few private surgeons have been quick in ‘piggybacking’ this blog, claiming credits they do not necessarily have.
So, here we go. Many years ago, I was discussing with the owner of one of the big companies why patients were happier to have an ‘impersonal’ relationship with a company instead of going to a private surgeon’s office. There were many reasons that we could think of, the most obvious being the lower cost, but the guy surprised me when he said ‘because private surgeons in the UK are rude to patients’. It may not be true today, but during those years surgeons had a very distant and patronising attitude. Being a surgeon myself, I was just taking it for granted. The ‘friendly’ coordinators, and the surgeons from abroad changed the scene: all of a sudden the world of cosmetic surgery became approachable, and even the average age of the surgeon went down to the point that they could almost be friends with patients (and this was actually a problem, if you see it from the GMC’s point of view).
While cheaper procedures and ‘friendly’ staff were a benefit, I believe that nothing helped patients more than the introduction of the so-called ‘comprehensive aftercare‘: private surgeons never included the cost of treating the possible complications in their original fees, so many years ago you could never know, in case of a problem, how much you were going to spend. Companies not only offered an inclusive coverage for complications, but also started competing against each other, and today it is not unusual to have 5 or 6 years of postoperative coverage. It is peace of mind, and it is obvious why companies do it: it helps to sell, but it is also a massive improvement over the previous situation. Hopefully comprehensive aftercare is here to stay: some small companies already tried to sell it as a separate part of the package, and I wouldn’t be surprised if, in credit crunch times, the aftercare became ‘restricted’. I would like to see it continuing the way it has been till now, even if I am a surgeon, and surgeons have been forced by companies to accept to work for free, in case of any re-operation.
Finally, and I am not completely sure this turned out to be a true benefit, companies introduced loans and made it easy to pay for procedures. Patients that could have never afforded their dream managed to pay little by little, till recently when we all ended up in massive debt… Interestingly, cosmetic surgery is still an area where is relatively easy to get credit, even if at interest rates close to prohibitive.
If you are a patient, or if you happen to be from a company (and I know quite a lot of my visitors are…), feel free to drop a comment and add you opinion, listing any other benefits you think companies introduced to the market and that I may have forgot.

PS
Some of you may have noticed the new look of the blog. It was a courtesy of my young friend 01dNe0h (he likes to be called with his ‘hacker’ nickname). It is actually another improvement due to the presence of the companies: they have great websites, and this blog has to try hard to stay in their league…