The future for women who've had PIP breast implants carries "significant uncertainty", a senior director of the NHS has told MPs on Tuesday morning, amid signs that the private cosmetic surgery industry is set for a major overhaul.
Professor Sir Bruce Keogh, the NHS Medical Director, said in the wake of the PIP scandal: "We are dealing with significant uncertainty. It's that level of uncertainty which creates the anxiety with relation to the 'ticking timebomb'."
The NHS is currently engaged in two reviews. The first one, urgently being conducted, will look at the scientific evidence underpinning the advice on how the implants should be dealt with. The second longer-term review will look at aspects of governance of the industry and will take about a year.
But on the matter of the urgent review, Sir Bruce said: "We are left with uncertainty around the potential damage from the silicone itself."
He told the Commons Health Committee that of the 40,000 women in Britain with PIP implants - made from industrial-grade silicone and believed to be at greater risk of rupture or toxic contamination than more expensive medical-grade implants - only 745 women received these PIPs on the NHS.
Those women are entitled to free surgery to have their implants removed and replaced, but the rest of those living in England with private implants won't get replacements on the NHS. Sir Bruce said private providers had a moral obligation to help their former customers, but evidence to the committee revealed the industry was in disarray.
Sir Kent Woods, Chief Executive of the Medicines and Healthcare Products Regulatory Agency (MHRA) told MPs they did not have a centralised register of women who'd had breast implants.
"There is no possibility of contacting the patients concerned," he said, adding there was a "striking reluctance" among women who'd had breast implants to provide further information. This had scuppered previous attempts to run a national breast implant register.
Further concerns came from the industry itself. Simon Withey, a member of the Council of the British Association of Aesthetic Plastic Surgeons, said there was concern surrounding the codes of advertising in the industry, saying the portrayal of breast implants in the media had led to a "trivialisation" about the procedure.
"We have patients who come in on a regular basis who are surprised they will have a scar, surprised they're going to be off work for a few days," he told MPs, speaking of a "strong commercial pressure" among some private doctors.
But he said as things stood, women should not automatically opt for removal of PIPs just because they were worried. "Anxiety alone is not good enough reason to remove an implant," Withey told MPs, saying women who have them should "see a surgeon who could give them advice on the relative risks."
"But I don't think that necessarily means you should be taking out every implant from every anxious woman," he concluded.
MPs have just launched their inquiry into the PIP scandal, which has affected women across Europe. The advice in each country varies, with the French and German health authorities recommending removal.
The boss of PIP, Jean-Claude Mas, was arrested last month in connection with the scandal, which has led to calls for cosmetic surgery adverts to be banned or more tightly controlled.
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