There is an ongoing debate about whether women should be allowed to receive silicone breast implants for breast augmentation. They definitely should be allowed to do so–preventing women from receiving implants that over a million women have received and only ruptures in 4% (Angell) of cases would be an overstep of paternalism from the FDA.
For starters, even though a breast augmentation is not technically a treatment of a disease, many women feel that it helps them live the life they want to live and it vastly improves their quality of life. Speaking from personal experience, and I bet the experience of most people, having a body part that stands out to other people or makes you uncomfortable consumes people’s lives. When there is a feature that is constantly attached to you, you can’t help but obsess over it and do anything you can to change it. For some, surgery is the only solution to live a normal life and regain their confidence. Doctors and the FDA should not be allowed to prevent someone from being happy and satisfied with their own body.
An overstep like preventing the use of silicone implants is a violation of paternalism. Like the well and good case involving patients in clinical trials, if patients are informed of the risks of a procedure and still wish to go ahead with it, then they should be allowed to do so (Thomas 256-258). Patients can easily be informed of the risk of the implants rupturing, and make an informed decision to continue or not. Especially because the risk of the implants rupturing is such a low percentage, I don’t think that such paternalism is justified. Another issue regarding paternalism is involved in weighing the costs and benefits. I believe that it is the role of doctors and the FDA to conduct studies and inform the public/patients of the risks, costs, and benefits of a procedure. However, I don’t believe that it is the role of doctors and the FDA to decide if the benefits outweigh the costs and risks–they serve to inform the patient but it is ultimately the right of competent, autonomous patients to decide for themselves what to do. If doctors and the FDA begin to overstep their role and not allow patients to use silicone implants, doctors will not respect the autonomy of a patient’s. Especially in an era where patients are given more and more choice, extreme paternalism is unacceptable and should be stopped.
Finally, even if the FDA did indeed have the right to prevent the use of silicone implants for breast implants, it makes no logical sense because there are so many other procedures that have higher risks and extremely lower regulation. For example, with body piercings, another form of body modification that has no medical benefit but is still common, studies show that there is a “22 percent infection rate for body piercing overall and a 34 percent infection rate for cartilage piercing” (Eisner). This infection rate is so much higher than the chance of a breast implant rupturing, and it also affects a much greater percentage of the population because many more people get piercings than breast implants. However, despite the high infection rate, the FDA hasn’t prevented people, or even children (I got my ears pierced when I was only a few months old) from getting piercings like they have with breast implants. And they shouldn’t, because it would be a violation of autonomy and a case of extreme paternalism. People should have the right to make their own informed, competent choices, even if it does mean a risk of rupture or infection.
Works Cited
Angell, Marcia. “Breast Implants–Protection or Paternalism?” The New England
Journal of Medicine, 18 June 1992, www.nejm.org/doi/full/10.1056/
NEJM199206183262510.
Eisner, Robin. “Body Piercing Can Be Life-Threatening.” ABC News, 27 Sept. 2016,
abcnews.go.com/Health/story?id=117058.
Thomas, John E., Wilfrid J. Waluchow, and Elisabeth Gedge. Well And Good: A Case Study
Approach to Health Care Ethics. N.p.: Broadview, 2014. Print
Hello Tori,
You made some really interesting points and I agree that it is insane to think that FDA can regulate what modification one can make on their own body. You make an excellent point when comparing between the infection rates of piercings and breast implants. While reading your post it reminded me of a model what wanted surgery so that she would look more like her favorite heroine. Granted this was seen off facebook, so not the most credible story, but the lady has had 17 surgeries, including 6 rib removals, four boob jobs, a Brazilian butt lift and labioplasty.(https://www.thesun.co.uk/archives/news/1216404/this-woman-has-had-six-ribs-removed-to-look-like-her-cartoon-heroine/) She was able to get all her surgeries to look like Jessica Rabbit, but do you feel like she made the right choice? Do you think her doctors should have said no?
I had a few questions for you after reading everything:
1. What are you idea about breast reduction surgeries so alleviate pain?
2. I thought in 2013 the FDA allows the use of silicone gel-filled breast implants?
(https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm064461.htm)
3. Is the damage from a piercing comparable to damage inflicted from a silicone implant?
Hi Alex,
In the case of the lady trying to look like Jessica Rabbit, I think doctors should first determine if she is competent and of sound mind. This becomes somewhat controversial though, because it may prevent people from being autonomous: at what point of incompetency can you prevent someone from receiving a unnecessary procedure? If this woman feels like she wants to look like a cartoon, then maybe she should even if she is not necessarily competent. But also, I wonder how dangerous some of these procedures are. For starters, there is always the risk of surgical complications from the use of anesthesia. Joan Rivers is someone who comes to mind in this situation–she had a endoscopy on her throat because she didn’t like how hoarse her voice sounded (https://www.washingtonpost.com/news/arts-and-entertainment/wp/2015/01/28/what-went-wrong-with-joan-riverss-last-medical-procedure-lawsuit/). This surgery had some complications and she ultimately died from those complications. Though this isn’t technically a cosmetic surgery, it certainly wasn’t necessary. In the case of the Jessica Rabbit woman, she had much more major procedures, including a rib removal, that had higher chances for complications. At what point can a doctor justify possibly violating the principle of non-malifience to respect a patient’s autonomy? Personally, I think it would be justified to perform these procedures on the woman because doctors should respect her autonomy. We shouldn’t prevent someone from having cosmetic surgeries just because the requests of these surgeries aren’t the norms of most requests. Just because she is the only person who wants to look like Jessica Rabbit doesn’t mean this wouldn’t benefit her and make her life feel more “normal and right” for her.
Here’s how I feel about your questions:
1. I definitely think it is valid for women (or men) to get breast reduction surgeries to alleviate pain. People have many reasons to get reductions: mostly for upper back pain, but also for things like body confidence, inability to exercise, and even extreme chafing and indentations from bras. In fact, many insurances will even pay for the reduction if the patient and doctor make a strong enough case for this. If there is a definite medical reason for a cosmetic surgery, it’s definitely justified. I have a lot of personal experience with breast reduction surgeries because I have had family members receive this procedure (I may be bias, then).
2. In 1992 the FDA banned silicone implants, and then later re-approved the use of them. The article written and meant for discussion in our class was written in 1992, during the time the FDA banned the implants. I wrote the post referencing the FDA’s past decision to ban, not their updated decision to repeal the ban.
https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm064461.htm
3. I’m not sure how you would compare the damage of a piercing to the damage of a bursted implant, but I imagine the implant damage would be much worse because it’s not a superficial wound. Still, the incidence of damage from piercings is six times more common than an implant rupturing, which I think is something worth noting. Would a minor injury that happens 6 times more often than a major injury be comparable? I’m not sure.
Tori
Hi Alex and Tori,
Tori — I really enjoyed your post as it brought to light some issues facing women in the world of healthcare today and policies that, to many of us, simply don’t seem right.
Alex — your comment did a great job of digging deeper into the issue and bringing new instances and cases to light. I Googled the “Jessica Rabbit Woman” and some alarming pictures came up, but I believe that this woman was fully justified in requesting the surgeries if she met some conditions.
If “Jessica Rabbit Woman” truly was sound of mind and her doctors agreed to the surgeries, then I see no problem in her requesting a transformation to her favorite cartoon character. A major issue I see in this case, however, is who paid for it. Did her health insurance cover the surgeries if it was purely cosmetic and non-life-threatening? I can’t imagine that it would unless she could spin it as some sort of way. If her health insurance didn’t cover it and she paid out of pocket, were her doctors truly looking out for her best interests or were they looking to simply make some money off of a unique case? I haven’t yet found any sound statistics on the estimated percentage or number of doctors really in the business for a higher than average paycheck (most of them come from fairly biased websites), but I can imagine more than we would like to think. People should absolutely be able to make their own decisions about their body with little interference, especially from government rules and regulations, but sometimes they are there to protect patient’s best interests. If used and viewed in the right way (as a mechanism to inform and ensure patients’ safety), they are justified. When they prevent people from seeking relatively low-risk procedures for personal purposes, they become a burden.
Thanks again!
Elisabeth Crusey
Hi Elisabeth!
I completely agree with you. I see no way that the insurance would pay for a purely cosmetic surgery. In order to get a breast reduction done and have your insurance pay for at least part of it, for example, your doctor must refer you to a surgeon for a number of reasons such as back pain, shoulder indentations, and poor posture. Then the surgeon has to take measurements, pictures, and for some cases, insurance may require the surgery to remove at least 500cc from each side to pay for the surgery. Because of the numerous hoops for a reduction surgery, I seriously doubt insurance would pay for these cosmetic surgeries.
I also agree with you that doctors have crossed a line at some point with this woman. I can understand maybe one or two cosmetic surgeries, but she has gone through almost a dozen and a half surgeries. It makes me wonder if doctors that do these surgeries are in it for the money, because going under anesthesia that many times can be dangerous, and the surgeries have a lot of risk for complications and infections. I do not think this many surgeries would be in the best interest of the patient. In this case, if this woman goes to a doctor seeking an 18th surgery, I hope that the doctor would refuse in the interest of non-maleficence.
source: https://www.plasticsurgery.org/news/blog/reduction-of-the-female-breast-obtaining-insurance-coverage-of-reduction-mammaplasty
Hi Tori! I just wanted to say that I agree that the FDA preventing women from having breast implants is an overstep of paternalism. Agencies like this should not be ablate control what women do with their bodies, especially if they are (usually) fully informed on the risks and still choosing to go through with it. It is like saying burn victims cannot get reconstructive surgery because it has a lot of risks. Or even further, and more closely related with this article, saying breast cancer patients who have undergone a mastectomy or even a lumpectomy cannot get breast implants to restore what they have lost. I understand that there are serious risks for these types of surgeries, but, in my opinion, they should not be regulated and prevented.
Hi Tori,
I enjoyed your post on breast implants, and I agree with your arguments against the past regulations made by the FDA. The principles of autonomy largely outweigh the principles of beneficence in this case. Usually, an argument to overrule patient autonomy is the negative impacts of the patients’ choices. Negative impacts pertains to a third party or others who suffer from health consequences. In this case, there are little to no harms done to a third party by an individual choosing to receive breast implants.
The FDA lists the risk of breast implants:
1. Additional surgeries, with or without removal of the device
2. Capsular contracture, scar tissue that forms around the implant and squeezes the implant
3. Breast pain
4. Changes in nipple and breast sensation
5.Rupture with deflation of saline-filled implants
6. Rupture with or without symptoms (silent rupture) of silicone gel-filled implants
None of these risk involve a harm to others, which is why I believe that past regulations against breast implants is unjustified. Although the FDA implemented the ban with good intentions (attempting to prevent harm to patients), the patient still has the power to make good and bad choices for their health. Like you said, the patient can be informed of the risks and make a decision based on her own understanding.
-Sylvie
Citations
Center for Devices and Radiological Health. “Breast Implants – Risks of Breast Implants.” U S Food and Drug Administration Home Page. Center for Devices and Radiological Health, 21 Mar. 2017. Web. 28 Mar. 2017.
Hi Tori,
I really appreciated your post, and agree with all of the arguments that you outlined! In my opinion, paternalism is not justified in this particular case—the FDA should not prevent the usage of silicone implants for cosmetic surgery, as the risks to the individual are significantly low.
This policy is not only paternalistic, but sexists as well. In fact, the FDA is “perpetuating cultural biases concerning female beauty and women’s rights to control their bodies” (Parker 1993). The policy segments the treatment population into reconstruction and augmentation candidates—by treating these populations differently, the FDA suggests that “women’s views about their beauty are unimportant, if not irrelevant” (Parker 1993). Essentially, this policy denies women the opportunity to make choices about their bodies. This may create a slippery slope, as other policies may emerge that restrict women’s’ choices and access to medical care.
Reference: https://muse-jhu-edu.proxy.library.emory.edu/article/245671