UK - Cosmetic surgery tourism and the PIP implant controversy

The PIP breast implant controversy continues to grab the headlines across Europe. Concerns have been raised by women who have had their breast implants as “cosmetic surgery tourists”.

What do they do if they have received a PIP (or a Rofil M) implant in a cosmetic surgery clinic in another country? Research by Treatment Abroad shows that UK patients may be less at risk than if they had gone for breast augmentation in the UK.

It is estimated that 40,000 women in the UK have received implants manufactured by the French company Poly Implant Prostheses (PIP). PIP implants contain low grade silicone; there are concerns about the risk of rupture of PIP implants and the effect that this silicone will have on the patient.

Reaction has varied across Europe. The French government has offered to pay for implants to be removed. The Czech, Dutch and German health authorities say that the implants should be removed. The UK government has said that there is no evidence that routine removal of PIP implants is necessary.

However the NHS has agreed to remove PIP implants for free if the original operation was undertaken by the NHS (usually as part of a breast reconstruction after surgery for breast cancer). It has also said that women who are concerned about their breast implants should be able to have them removed for free by their private cosmetic surgery clinic.

The reaction from the private cosmetic surgery clinics in the UK has been mixed. Many providers such as BMI Healthcare have agreed that women who wish to have their PIP implants removed and replaced will be able to do so, at no cost.

However, the company that has done the largest number of PIP implants in the UK has said that it will not replace them free of charge. The Harley Medical Group has 13,900 clients who received PIP implants between 2001 and 2010 at their 31 clinics in the UK and Ireland. At the weekend, patients marched on the offices of cosmetic surgery clinics in Harley Street demanding that private clinics replace PIP breast implants.

The use of PIP implants in cosmetic clinics abroad

UK clinics and cosmetic surgeons pointed at the failure of the UK government to monitor and regulate the supply of implants. But some also raised concerns about patients who may have travelled abroad for their implants. According to the British Association of Aesthetic Plastic Surgeons, “Many UK women would have had them implanted when they travelled abroad to countries such as Belgium, Poland and the Czech Republic for cut-price operations.”

This prompted us at Treatment Abroad to contact our clients to establish the use of PIP implants and also of Rofil M implants (a Dutch company re-sold PIP implants under the brand name Rofil). We contacted more than twenty cosmetic surgery clinics who are clients of Treatment Abroad and asked them a series of questions (shown at the end of the article) regarding their treatment of UK patients and the use of breast implants in their clinics.

The response from the clinics was a resounding...”No, we have never used low-cost implants”. We haven’t been able to identify any of our clients who have used PIP or Rofil implants.

What does this say about the quality of cosmetic surgery clinics abroad?

Domestic cosmetic surgery providers, such as the plastic surgeon associations in the UK or the USA, often criticise surgeons and clinics abroad who offer cosmetic surgery at a lower cost. The issue of “what happens if something goes wrong?” is frequently raised. Cosmetic surgery abroad is presented as low cost, low quality and high risk.

The truth is that no-one really knows whether this is fact or fiction. There is little comparative data, if any.

But the PIP implant story presents a different view from that which is usually presented in the media. The cosmetic surgery clinics abroad that we contacted were very clear that they use the highest quality (and higher priced implants) and that they avoid cheap implants. What people tend to forget is that surgeons, clinics and hospitals that target the international patient market are usually the best in their field.

Thus, the Harley Street doctors and London hospitals who attract patients from across the world have built a worldwide reputation based on expertise, not on low cost. Similarly, in outer European markets such as Belgium and Spain, it is the leading cosmetic surgeons who have sought to spread their wings by developing an international patient business. The cosmetic surgeons treating UK women are often the best in their own country.

Setting standards for cosmetic surgery clinics across Europe

CEN – the European Committee for Standardisation – is currently drafting a European Standard on Aesthetic Surgery Services. The new standard will help consumers to make better choices and create a level playing field for aesthetic surgery service providers, complementing existing legislation and filling gaps where no regulation or standards exist.

The Standard is widely supported by cosmetic and plastic surgeon associations across Europe. But it will be interesting to see where the greatest efforts will be required to bring local, national practices up to the new European standard. In the UK, in an unregulated cosmetic surgery industry, standards vary.

Not all clinics and providers live up to the standards expected by the plastic surgery associations.  In some cases, the new European initiative will no doubt bring some UK providers (and many elsewhere) up to the standard already provided in other clinics in Europe.

Addendum: The questions that we asked

Here’s what we asked the cosmetic clinics in Europe:

1.Which brand of implants do your patients most often receive?

2.Have you used PIP implants in the past?

3.Do you keep a record of what kind of implant has been inserted in each patient?

4.Do you inform the patient of the brand of implant that has been inserted?

5.Do you provide the patient with documentation confirming the brand of implant that has been inserted?

6.Do you monitor rupture rates on the different types of implants that you use?

7.What is your view/experience of rupture rates with the PIP implant?

8.Have any of your UK patients received PIP implants?

9.How many of your UK patients have received PIP implants?

10.What action are you taking regarding the current issue:

a.Have you contacted patients with PIP implants as a result of the concerns?

b.What is your recommendation to them?

c.Have you offered them removal and replacement of these implants?

d.If you have offered a removal and replacement, how much will patients be charged for the removal and replacement?

e.Are you offering removal and replacement of PIP implants to UK patients who have not previously visited your clinic/s? If so, what will be the price for this?

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