First, they Came for the Smokers...

[steepholm]

The continuing story of the sub-standard French breast implants, and whether or not they’re more likely to rupture than other ones, and whether (if they do rupture) they’re more likely to cause serious harm, has been playing out for some time. It’s a question that combines medicine and statistics in a way that I don’t feel I can (or particularly want to) comment on.

But I've been getting very uncomfortable about the way this has become yet another platform for those who wish to ration NHS care on moral (or, as they would no doubt say, "lifestyle") grounds. This kind of debate has come and gone many times over the years. Should smokers be treated on the NHS? Or people who choose to drink over 30 units of alcohol per week? What about people who have an accident when driving without a seatbelt? Or skateboarding? Or flipping pancakes while on the phone? Now there's a new group of people about whom to feel smugly judgemental: the women who have breast implants for - gasp! - cosmetic reasons. I've seen this line taken in several places, most recently this morning on Broadcasting House (forty minutes in).

I do think there's an element of misogyny here. The speakers seem so fixated on the motives for which the women got the implants in the first place that they seem unable to accept that the reasons they may need them removed are medical, not aesthetic. Someone in that radio clip mentions the analogy of tattoos, but the NHS won't remove your tattoo for you because you no longer like dolphins. On the other hand, if your tattoo becomes infected, you'll get treated for that. Is this a difficult distinction to grasp?

There's more to it than misogyny, though. Let's try this thought experiment. Imagine it turned out that a well known brand of lipstick was highly carcinogenic, and that it had given thousands of women cancer of the mouth. Would there be voices in the media loudly arguing that the women be refused treatment, on the grounds that they had only used the lipstick for cosmetic reasons? I doubt it.

I think at least two other factors are in play. First, fewer people get breast implants than use lipstick, and they cost a lot more. The sense that it is an unjustifiable extravagance - and that neither we nor any of our close friends would do it - will have put it above many people's prudery threshold. Second, the women involved have in almost all cases suffered no harm, so far. The removal would be because of the increased risk of rupture, rather than to treat the consequences of rupture. And there's a stubborn feeling in this country that preventative medicine isn't real medicine at all.

Comments

[steepholm.livejournal.com]

That may end up happening for purely logistical reasons, I suspect, and also because the industry will want to regain public confidence and be seen to be doing all it can to help. The main thing is that the logistics shouldn't delay medically necessary procedures.

I think we may disagree on the general principle, but I'd be interested in how far you take it. Would you be in favour of requiring tobacco companies to pay for the treatment of smokers who get lung cancer, for example? Or the drinks industry paying for liver transplants? Perhaps so - but I don't see anyone campaigning for that, while people are queuing up to complain about this far smaller, far less lethal problem.

Also, when you say you're opposed to non-reconstructive cosmetic surgery, I personally think that's a rather sweeping position (I'm in favour of letting people do what they like, unless there are compelling reasons not to), but also one that doesn't reflect the variety of reasons people might seek such a procedure. To take one example that was alluded to upthread, what about a trans women who is unable to develop breasts using hormonal treatments alone? It's clearly not a case of reconstruction, but are you happy to class it with a lunchtime botox session?

[gillo]

what about a trans women who is unable to develop breasts using hormonal treatments alone

I would be asking whether that makes her any different to any other woman who is flat-chested. All humans come with nipples and some sort of underlying fat/gland structure to support them. Not all develop substantial boobs, whatever their gender of origin or affiliation. I'm not convinced that large breasts are anybody's right, or that it is appropriate to have surgery to construct them. I do see reconstructive surgery after mastectomy as different, in that it is replacing what was already there and thus limiting psychological damage from the cancer.

Whether this stands up to rigorous logical enquiry I'm not wholly certain.

[steepholm.livejournal.com]

Just to make it clear, we're - or at least I'm - not talking here about NHS work, but whether breast implants should be allowed at all. (I don't think there's a national policy, but in general PCTs don't in fact pay for breast implants for trans women.) Personally I don't see that anyone has the right to forbid other people to have that surgery, if they are willing to pay for it and are competent adults, any more than they have the right to forbid them to drink a bottle of whiskey or smoke a cigarette, neither of which seems to be on the political agenda.

Nor am I talking about large breasts, however you'd like to define them. There's a good deal of misinformation in the form of lurid redtop headlines about the costs and normal procedures in this and other areas related to transition, and also who pays for them, with sexualised references to "large knockers", etc. all being part of that discourse. If you're interested, I can point you to an up-to-date piece of research on the actual costs of transition (both ftm and mtf) in the UK, published within the last month.

If you're going to make an exception for psychological damage in the case of reconstructive surgery, you might also want to consider the psychological effect of implants in the case of trans women, who differ from flat-chested cis women in having a lifetime of being told that they aren't women at all, and whose condition is even now treated by the medical establishment as a psychiatric one (although this is controversial). I don't say it's a knock-down case, but then I don't think knock-down cases are to be had in this area. Drawing up the criteria for a panel to decide which women were worthy of being allowed to have breast implants, and which should be denied it on the grounds of vanity, would be a very difficult thing to do. As I don't believe in making other people's choices for them, however, I'm glad to say it's not my problem. :)