Division of Inappropriate Analogies: Surgery as Haircut

The NYT’s Natasha Singer reports that breast augmentation has become “the country’s most popular cosmetic operation.” Carol Ciancutti-Leyva (director of the documentary “Absolutely Safe”) warns women that they may be in for more than they bargained for:

Your implants may last less than 10 years or more than 10 years, but when you start having problems with them, your health insurance is unlikely to cover the M.R.I. tests or the reoperations. It can be a very expensive proposition, especially if you are young.

I wonder if company wellness programs will soon be asking women to reveal if they’ve had implants? But they shouldn’t worry about “maintenance” in general, says a past president of the American Society for Aesthetic Plastic Surgery, offering one of the more bizarre analogies I’ve seen:

Women are used to having their hair or nails done on a regular basis to maintain their appearance. Ultimately, breast implants may also be a matter of maintenance.

More on what this maintenance can entail after the break.

[A] rupture is only one of the local complications that may engender additional surgery. Like cocoons that grow around larvae, scar tissue can form around implants; and sometimes that scar capsule hardens and squeezes the implant, causing pain and deforming breasts. And saline implants can cause visible, tactile rippling beneath the skin.

[E]xplantation surgery, in which a surgeon removes implants for good along with scar tissue, can be more complicated, particularly for older silicone models. “If the envelope has broken down and the silicone has leaked out, you are trying to get out all of that goo,” said Dr. Susan E. Kolb, a plastic surgeon in Atlanta who performs three to five explantation surgeries a week. To remove scar tissue, which can adhere to muscles and to the fibrous tissue covering the ribs, some doctors mistakenly remove too much muscle or breast tissue, which can cause chest deformities, she said.

Despite all the risks, “[d]octors nationwide performed about 329,000 breast augmentations in 2006, up from about 291,000 in 2005, according to a survey of doctors from the American Society of Plastic Surgeons.”

I’ve proposed taxing cosmetic surgery before, and some cities (like Beverly Hills) are starting to target taxation in this way. Beverly Hills merely argues that “the centers become a drain on resources relative to the taxes they pay” (as Rhonda Rundle puts it in her article on the topic in the Wall St. J.). But if these interventions also “constitute the kind of annuity medicine that will entail regular surgical tuneups,” their externalities are larger than once thought. A 2007 article in the American Journal of Psychiatry on “Cosmetic Breast Augmentation and Suicide” suggests some even higher stakes:

Across six [epidemiological] studies, the suicide rate of women who received cosmetic breast implants is approximately twice the expected rate based on estimates of the general population. Although the first study of this issue suggested that the rate of suicide among women with breast implants was greater than that of women who underwent other forms of cosmetic surgery, the largest and most recent investigation in this area found no difference in the rate of suicide between these two groups of women. (Am J Psychiatry 2007; 164:1006-1013).

Given growing societal pressure to pursue such surgery, it might be easy to feel hopeless when “medical experts [have] said they could not determine exactly how long breast implants may last.”

One last note: a 1992 note by Emily C. Aschinger (entitled “The Selling of the Perfect Breast: Silicone, Surgeons, and Strict Liability,” 61 UMKC L. Rev. 399) anticipated the issue and proposed the following:

Plastic surgeons, through advertising, have created a demand for elective plasticsurgery. In the case of breast implants, the doctors who created the demand are now reluctant to deal with the problems these implants have caused. Many of these doctors refuse to remove implants from former patients who have experienced problems; however, these are patients upon whom they were all too willing to perform the initial unnecessary procedure.

Elective cosmetic surgery is less a medical practice that involves the health of the patient and more a marketed response to societal demands dictating that people must do anything it takes to live up to the ideal. [Old liability standards are] outdated[;] plastic surgeon should be held strictly liable from a products liability standpoint under [Restatement of Torts] section 402A for breast implants. . . . [I] explain how plastic surgeons have met the criteria for a seller of products and should be treated as such under section 402A.

As Ms. Aschlinger argued, “Someone must be held responsible for the many women who, as a result of defective breast implants, will be injured.” And also those who will find even “non-defective” implants the cause of health problems.

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