French Breast-Implant Disaster: How Do Europeans See Cosmetic Surgery?

The controversy reveals that we wrongly assume, with dangerous implications for public health, that women who get breast implants must be rich.

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A Venezuelan woman sits next to the two PIP breast implants that she had removed. The yellow implant at left, made by Poly Implant Prothese, had broken. / AP

In the past few months, the leak-prone breast implants of French company Poly Implant Prothese has turned into an international furor. At issue is the company's use of non-medical-grade silicone, which has an increased risk of rupture. The gel inside the implant, once released, can inflame the surrounding tissue. Though there's limited evidence for this, fears persist about the irritation leading to an increased risk for cancer. The scope of the potential impact is tremendous. As of last week, the estimate cited by the BBC was that "up to 400,000 women in 65 countries are believed to have been given implants" from the company. PIP founder Jean-Claude Mas is now facing charges of involuntary injury, while policy professionals, journalists, and the public are asking how the implants could have made it past safety inspectors to have reached so many women.

If there were ever a time to move beyond our dangerously facile debate about cosmetic surgery, it's now. European media have been hammering the point that it's time to take implant safety as seriously as drug safety, and take cosmetic procedures as seriously as any other operations, which is what they are.

To answer the question of how the implants could have made it to so many women, though, one has to ask how and it is that so many women are getting breast implants at all. Paris-based plastic surgery and dermatologist organization IMCAS recently released some  new numbers that help explain. Cosmetic surgeries not only rose by 10.1 percent in 2011 but are expected to rise by another 11.12 percent in 2012, despite the scare.

A significant portion of the debate touches on a longstanding theme of how people think about cosmetic surgery: who, if anyone, should help cover the costs for removing and replacing defective implants? Though insurance policies and national governments have already declared themselves willing to foot the bill for the faulty implants' removal, that doesn't come without caveats. The implicit moral question the responsible officials seem to be asking themselves is, Should governments compensate for losses in botched vanity projects? And herein lies the need for a more careful look at the phenomenon of plastic surgery.

In France, the government will only pay for new implants if the originals were for reconstructive surgery. Politicians in Germany have been urging similar policies. Elizabeth Niejahr neatly summarized this thinking in Die Zeit as "one shouldn't make cosmetic surgeries even more popular. ... Those who, out of vanity, decide to undergo the knife, should be aware of the consequences." SPD Carola Reimann, Niejahr pointed out, has also argued that "It's about the beauty ideal and the pressure to conform."

These politicians have a point, namely about moral hazard. But behind these sentiments lies a deep confusion about plastic surgery that's worth surfacing. The idea that implants are for "vanity" seems to imply selfishness and, with it, an exercise of will. But the charge that implants are about a "pressure to conform" implies the opposite. Which is driving the trend towards plastic surgery? A projected growth in surgeries, despite the dire stories of the past year, begins to look like a pathology not just in individual women and men, but in society itself; if that's the case, how helpful is it to blame individuals for succumbing to what appears to be a mass psychosis?

Niejahr, criticizing the French and potential German positions, makes an important related point: many politicians are assuming that the women paying for non-reconstructive implants must be rich, and are adjusting their rhetoric accordingly. But a glance merely at "trash talk shows," Niejahr notes, suggests this is "a false picture." How? "There may be many women who save for new breasts or with what little credit they have choose a larger chest over a new car."

It's not just an inaccurate image: the suggestion that women who get breast implants must be rich is a dangerous misconception with real implications. The enormous black market in cosmetic surgery, as well as the apparently flourishing cosmetic surgery tourism trade -- with terrifying stories of incompetently executed, dangerous procedures -- should be evidence enough, even without Niejahr's trashy TV.

This isn't to say that governments should pay for implant replacements (though Niejahr does make that argument): it's questionable fiscal policy to pay for implant replacements in the current European economic climate, even before you get to the possible moral hazard argument. But in the debate over the appropriate policy position, European politicians do need to be careful about the assumptions they convey in their rhetoric.

As these few critics in the current Continental debate show, this may be the perfect time to probe the dark undercurrents of plastic surgery trends. Tighter regulations may reduce dangers within the European Union, but they don't change the fact that these surgeries still carry risks -- and they're definitely not going to help the women who head to Mexico. Double-D millionaires aren't a public health problem -- but they are a disturbingly convenient fiction.