Cosmetic surgery: Protecting the right to choose -- safely [Blowback]
Jeffrey M. Kenkel, a medical doctor and the president of the American Society for Aesthetic Plastic Surgery, responds to The Times' Jan. 4 Op-Ed article, "Is it time to ban cosmetic surgery?" If you would like to write a full-length response to a recent Times article, editorial or Op-Ed, here are our FAQs and submission policy.
Over the last several weeks, the media have published disturbing reports of a French manufacturer that sold faulty silicone breast implants containing industrial silicone. These are implants no U.S. board-certified plastic surgeon could or would ever use. There is no question that women who received the so-called PIP implants should immediately contact a board-certified (or equivalent) plastic surgeon for immediate evaluation. A listing of plastic surgeons outside the United States who meet the necessary qualifications to be performing any aesthetic procedure can be found on the website of the International Society of Aesthetic Plastic Surgery (isaps.org). To find a U.S.-based board certified plastic surgeon, please visit the American Society for Aesthetic Plastic Surgery's website at surgery.org.
An immediate lesson to be taken from this unfortunate and poor medical practice is that all surgeries are serious choices and should be done by and in consultation with a board-certified plastic surgeon, not as part of a whim or medical vacation. This was a point of agreement my colleagues and I found with Alexander Edmonds' Op-Ed article.
That, unfortunately, was the only point of agreement we had with the medical anthropologist. In his piece, Edmonds uses the fraudulent manufacturing process in France and the experiences of misguided medical tourists as reasons to wonder aloud whether millions of Americans should be denied their right to make choices about their bodies. As president of the American Society for Aesthetic Plastic Surgery, I would like to clarify several issues that Edmonds discussed.
Edmonds writes, "It's well known that breast implants of many types can cause burning pain, loss of sensation, hardening of breast tissue and serious infection." But there is no data in the medical literature to suggest that these complications are a quid pro quo for the millions of women who have elected to have breast implantation, using saline or silicone products.
Breast implants manufactured in the United States have been proved safe not only by the Food and Drug Administration but through more than 30 studies published in peer-reviewed medical journals that confirm their safety. They are, in fact, the most studied device in the history of the FDA.
Edmonds' statement that "an argument could even be made that aesthetic surgery violates the Hippocratic Oath because it carries a potential for harm without curing or preventing disease" is a worrisome assault on patients' rights. What would be next? Will physicians be banned from performing procedures on cleft-lip children because it does not prevent or cure disease? Or, using the most literal reading of this statement, perhaps Edmonds would prefer to limit the rights of adult women to pharmacologic birth control?
Do patients "benefit" from cosmetic procedures? There are many studies that show the positive impact aesthetic surgery has on a patient's self-image and self-esteem. The practice of medicine involves much more than simply "curing or preventing disease," as Edmonds seems to suggest.
I find some common ground in Edmonds' notion that medical advances may contribute to a normalization of cosmetic procedures. The scandal in France, and trends even in our country such as "Botox parties," are sobering reminders of the need to keep these procedures in the domain of medical practice. A surgeon manages risk, regardless of the procedure, by focusing on patient safety, whether the surgery is aesthetically based or medically necessary. We should respect a patient's right to choose, and protect that choice through guidance and vigorous participation in the medical process.
-- Jeffrey M. Kenkel
Photo: A nurse holds defective breast implants manufactured by the French company Poly Implant Prothese, or PIP. Credit: Lionel Cironneau / Associated Press