After recently attending Cosmetex 2017, lots of excitement and questions have left us contemplating the role of politics within the realm of patient safety. One would assume patient safety is paramount above all and within the medical arena, science leads best practice. Quite simple really, the experts investigate and look at retrospective data which is then published. The publication then in turn improves patient outcomes, protocols, and the way we practice. In all fields of medicine this is widely accepted, research and development is facilitated, praised, and acknowledged.
One must ask, why is this different in breast augmentation? Professor Anand Deva explained what he referred to as the “Game of Implants”. The emotionally charged implant debates, are driven by numerous parties, all with a personal stake. From the manufacturer, distributer, cosmetic tourism provider, cosmetic surgeon, plastic surgeon, and marketers. A lot is at stake financially when any topic regarding implants comes into the spotlight. So, it is no wonder the room was full for Professor Deva’s discussion on the controversial implants, biofilm and ALCL.
The atmosphere was intense to say the least. An audience of cosmetic surgeons certainly outnumbered Professor Deva. Dr Daniel Fleming spoke via skype and debated the incidence and significance of BIA-ALCL, noting that further research is required to understand the cases that spontaneously reverted. This was certainly heated and somewhat emotionally charged, it became apparent the issue was far bigger then BIA-ALCL. In one corner was Professor Deva, encouraging all surgeons who perform breast augmentation to share any samples and data with his lab for further research.
The data Professor Deva and his team accumulate is used to compile evidence and data for the greater good of the patients. However, this was met with resistance due to a sense of dis-trust. It appeared that information collected by the study had been strategically leaked pertaining to clusters of patients and seemed to be specifically targeted at cosmetic surgeons. Professor Deva was not keen to comment on the clusters as he stated that the study was not complete and had not been published. Professor Deva was not privy to where the information had come from but was saddened by its effects.
So, the key issues became apparent, no one disputed the need for research and development. In fact, the delegates wanted to hear more from Professor Deva. The issue was a deep seeded rivalry between Cosmetic surgeons and Plastic surgeons. Professor Deva remained calm, composed, and rational and his argument became impossible to dispute. Professor Deva reiterated the need for all parties to work together. This message was clear and repeated numerous times. Professor Deva urged all parties to rise above the politics and focus on the patient outcomes. There was even talk of an ACCS member becoming part of the study to further cement the collaboration everyone spoke of. This was received well and was an extremely productive session and I believe all the delegates left feeling positive.
However, it does feel somewhat like a messy custody battle. There are other factors at stake here as the implant company’s also play a significant role. Should this sort of study be performed by an independent researcher? Why is Professor Deva being a integral part of the Plastic surgery fraternity leading the research and development as opposed to an independent researcher? And why should Anand Deva be punished for his academic achievements due to politics. It was interesting that the implant companies funding the research are mentioned numerous times and supplied their data voluntarily. Yet there is no mention of the companies not supplying any funding. If said company’s supplied data and no funding can the evidence be misconstrued. As one would predict with a study run entirely by the manufacturer. Should the major manufacturers be incentivising and encouraging all surgeons who purchase their implants commit to providing information of complications? Why is Motiva implants (noting one of the smaller companies) a company active in relation to research and development, not mentioned? Motiva provide patients with a warranty, an app and are devoted to ongoing research, education, and development. Motiva implants contain a chip for easy identification and data collection. However, Motiva Implants do not reap the benefits of a majority market share.
The other leading companies promote the 14-point plan but how much are they investing into marketing to consumers? Most consumers we speak to have not heard of the 14-point plan, yet they know who the major implant companies are. Is this message and education a true priority? This is where the waters become muddy. Is the market of breast implants purely about improving one’s confidence, symmetry, and self-esteem? I think not, this is big business.
The most concerning point is that, if the primary goal of patient safety is lost, where does this leave the patient? Without collaboration, energy and time is lost on argument. Even more distressing is the grey area of Cosmetic Surgeons. While the members of the Australasian College of Cosmetic Surgery (ACCS) are not acknowledged as cosmetic surgeons on the safer breast implant webpage (at the time of publication they could only select ‘other’ as a category), why would they support the research? Keeping in mind many internationally recognised surgeons are members of ACCS namely; Dr Anoop Rastogi and Dr John Flynn. Meanwhile, any medical practitioner can title themselves a “Cosmetic Surgeon”. The collateral damage in this battle is the patient. How does one differentiate who is a trustworthy cosmetic surgeon and who is not? Do patients simply eliminate cosmetic surgeons entirely? And furthermore, how is a patient meant to understand BIA-ALCL if the consensus is not shared. Until everyone is on the same page, the reality is that patients are left reliant on reviews, 3rd party websites and word of mouth. The rogue surgeons without any qualifications and possibly no awareness of BIA-ALCL are continuing to practice.
On a positive note, the delegates were hopeful of collaboration and open to the opportunity to collaborate. All the delegates attend these conferences for their professional development, to learn and grow their skill and expertise. Better patient outcomes are at the heart of all delegates and speakers, let’s hope the different parties can remain focused on this common goal.
After all the patient is not a professor, a doctor or researcher. The patient should not be held accountable for trusting the policies of our government or the implant company's R&D. The implant company sells untrained doctors implants without recourse. The patient who does not know the difference and those who trust a surgeon who is not qualified is left scared. Neither cosmetic or plastic surgeon want to pick up the pieces at no cost. The issue is ethical and the monetary gain combined with the risk of liability clouds one's ability to remain ethical and empathetic. So who is accountable? it would appear Professor Deva is one man taking on a mammoth task. As professor Deva stated "Let's rise above the politics and focus on the patient".