Health: Storm in an A-cup

Last week, a 12-year-old had a breast implant on the NHS. So what's the big deal?

Say you had a young child, maybe 12 years old, and that child had a congenital abnormality, so severe that he had to wear a prosthesis under his clothes and was afraid to undress in front of other children. No one would question the wisdom of operating, if possible, to correct the abnormality. If the operation was not available on the NHS, it's the sort of thing people would fund-raise for; not a life-saving operation maybe, but a worthy cause.

But make that child a girl with Poland's syndrome (the same condition Jeremy Beadle has - which, along with an underdeveloped upper limb, can mean absence of chest wall structures including the breast), or perhaps mammary aplasia (complete lack of one breast) and suddenly a whole new twist is put on the story.

So instead of "Surgeons battle to give little girl a normal life", last week we got "Twelve-year-old girl has boob job on NHS". Technically speaking, the headline was correct. The age was right, and she was having a breast augmentation using NHS time and facilities. It was seemingly going to cost the taxpayer pounds 1,000, and even the "quality" press were calling it a "breast enhancement operation". Nor was the surgery life-saving - it was purely cosmetic, in the way that much plastic surgery aims to improve appearance more than function. But does that justify the sort of coverage afforded this little girl and her surgeon last week? The consultant, Douglas McGeorge, who practises in Chester, was forced onto the defensive in the media, when most other paediatric operations which do not include the word "breast" in the title, result in nothing but automatic praise for all those involved.

The story comes at a time when rationing in the NHS is more of an issue than ever. As usual, it's the unglamorous or the supposedly non-essential procedures that bear the brunt of criticism and cutbacks. Plastic surgery techniques can usually be found in the non-essential group, being associated in most people's minds with vanity. And if you really want to stir things up, just mention the words "tattoo removal": this is guaranteed to make medical managers squirm, especially when there are so many little old ladies waiting to have their hips done. (Thanks to this attitude, one patient who had himself tattooed with a full-facial spider's web while suffering from acute schizophrenia found it impossible to get it removed on the NHS once he had recovered and started to look for work.) While cosmesis, or a nice result, is the aim of all operations carried out by cosmetic surgeons, the benefits that can flow from a good outcome are far more than simply a pretty patient.

Take these sensitive political considerations, add the fact that the operation was on an "immature" girl, and it's easy to see why the story was pounced upon. Then there's our complete inability in this country, thanks to the influence of Sid James, Barbara Windsor and the rest, to discuss anything about breast sizes (too big, too small, or one of each) without a degree of giggling prurience.

Mr Chris Khoo, a consultant plastic surgeon in Berkshire with a special interest in breast reconstruction, takes a different view. While he has not personally performed surgery of this type on a girl of this age, he can see how it is completely justified, and necessary. He sometimes carries out breast reductions on girls younger than 16, with a condition bearing the self-descriptive name of gigantomastia. It can blight a girl's life completely, making it impossible to run, lie on her front, or even stand up straight. Breast reduction in these circumstances is far more than merely "cosmetic". He is impressed that the health authorities in Chester chose to pay for the procedure on the 12-year-old, indicating that they, if no one else, recognised its merits.

It seems as though the girl probably had two distinct problems - one breast was pathologically large for her age, and the other was pathologically small. Similar breast asymmetry occurs in up to a third of the female population, to differing extents. There is a little more involved than simply taking tissue out of one side and transferring it to the other, although along with increasing the size of the underdeveloped breast with an implant, an adult with this condition may have the larger side simultaneously reduced to balance things up.

A special type of "tissue expander" is used to augment the abnormally small or non-existent breast. These devices are also used by plastic surgeons to slowly stretch areas of flesh later employed in a separate operation to cover defects left by the removal of a tumour, or by a severe burn. Rather than an implant that is already of the desired size (which would be too big to insert straight away), an empty sac is placed in the breast attached to an injection pod just beneath the skin. Over time, saline is injected at intervals to increase the size of the sac, and when breast development is finished, the injection port can be removed, leaving the saline-filled sac as a permanent implant. As Mr Khoo points out, puberty is starting in girls at younger ages than ever before, and at 12 it is by no means unusual for breasts to be quite well advanced in their development. So in someone with a discrepancy this marked, the chances of her simply "growing out of it" are nil.

Of course, less contentious cosmetic operations are carried out on children every day, such as correction of "hare- lips" and prominent ears, or removal of conspicuous birthmarks. All are provided by the NHS even though, as in this ease, they are hardly life-threatening or even detrimental to health. But nobody would consider forbidding these operations simply to save money.

The other worry expressed was that this may represent the thin end of the wedge, and before you know where you are, kids will be getting tummy tucks, and tots having liposuction. Chris Khoo and his colleagues working within the NHS have very firm views on this. He regards the thought of even so much as a breast augmentation on a girl under 16 with small but equal-sized breasts as "completely irresponsible". Nor would any of them consider doing it in their private practice. Which is not to say that it is impossible for such surgery to be carried out in this country; some less scrupulous people will do anything if you pay them enough, and it would not be illegal for them to do it if they had the correct certificate on the wall.

But this is all far removed from what happened last week, when a brave little girl had a clever operation to correct a physical deformity. The details of the decision are something between the girl, her family and her doctors. Maybe the fact that it was performed on the NHS is of legitimate concern for some - hopefully many others would also be able to see it as money well spent.

Have you tried new the Independent Digital Edition apps?
Arts and Entertainment

ebooksNow available in paperback
Arts and Entertainment

ebooks
Arts and Entertainment

film
Arts and Entertainment
Chvrches lead singer Lauren Mayberry in the band's new video 'Leave a Trace'

music
Arts and Entertainment

music
Arts and Entertainment
Home on the raunch: George Bisset (Aneurin Barnard), Lady Seymour Worsley (Natalie Dormer) and Richard Worsley (Shaun Evans)

TV review
Arts and Entertainment

TV
Arts and Entertainment
Strictly Come Dancing was watched by 6.9m viewers

Strictly
Arts and Entertainment
NWA biopic Straight Outta Compton

film
Arts and Entertainment
Natalie Dormer as Margaery Tyrell and Lena Headey as Cersei Lannister in Game of Thrones

Game of Thrones
Arts and Entertainment
New book 'The Rabbit Who Wants To Fall Asleep' by Carl-Johan Forssen Ehrlin

books
Arts and Entertainment
Calvi is not afraid of exploring the deep stuff: loneliness, anxiety, identity, reinvention
music
Arts and Entertainment
Edinburgh solo performers Neil James and Jessica Sherr
comedy
Arts and Entertainment
If a deal to buy tBeats, founded by hip-hop star Dr Dre (pictured) and music producer Jimmy Iovine went through, it would be Apple’s biggest ever acquisition

album review
Arts and Entertainment
Paloma Faith is joining The Voice as a new coach

TV
Arts and Entertainment
Dowton Abbey has been pulling in 'telly tourists', who are visiting Highclere House in Berkshire

TV
Arts and Entertainment

TV
Arts and Entertainment
Patriot games: Vic Reeves featured in ‘Very British Problems’
TV review
Arts and Entertainment
film review
Arts and Entertainment
Summer nights: ‘Wet Hot American Summer: First Day of Camp’
TVBut what do we Brits really know about them?
Arts and Entertainment
Dr Michael Mosley is a game presenter

TV review
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
SPONSORED FEATURES

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    A nap a day could save your life - and here's why

    A nap a day could save your life

    A midday nap is 'associated with reduced blood pressure'
    If men are so obsessed by sex, why do they clam up when confronted with the grisly realities?

    If men are so obsessed by sex...

    ...why do they clam up when confronted with the grisly realities?
    The comedy titans of Avalon on their attempt to save BBC3

    Jon Thoday and Richard Allen-Turner

    The comedy titans of Avalon on their attempt to save BBC3
    The bathing machine is back... but with a difference

    Rolling in the deep

    The bathing machine is back but with a difference
    Part-privatised tests, new age limits, driverless cars: Tories plot motoring revolution

    Conservatives plot a motoring revolution

    Draft report reveals biggest reform to regulations since driving test introduced in 1935
    The Silk Roads that trace civilisation: Long before the West rose to power, Asian pathways were connecting peoples and places

    The Silk Roads that trace civilisation

    Long before the West rose to power, Asian pathways were connecting peoples and places
    House of Lords: Outcry as donors, fixers and MPs caught up in expenses scandal are ennobled

    The honours that shame Britain

    Outcry as donors, fixers and MPs caught up in expenses scandal are ennobled
    When it comes to street harassment, we need to talk about race

    'When it comes to street harassment, we need to talk about race'

    Why are black men living the stereotypes and why are we letting them get away with it?
    International Tap Festival: Forget Fred Astaire and Ginger Rogers - this dancing is improvised, spontaneous and rhythmic

    International Tap Festival comes to the UK

    Forget Fred Astaire and Ginger Rogers - this dancing is improvised, spontaneous and rhythmic
    War with Isis: Is Turkey's buffer zone in Syria a matter of self-defence – or just anti-Kurd?

    Turkey's buffer zone in Syria: self-defence – or just anti-Kurd?

    Ankara accused of exacerbating racial division by allowing Turkmen minority to cross the border
    Doris Lessing: Acclaimed novelist was kept under MI5 observation for 18 years, newly released papers show

    'A subversive brothel keeper and Communist'

    Acclaimed novelist Doris Lessing was kept under MI5 observation for 18 years, newly released papers show
    Big Blue Live: BBC's Springwatch offshoot swaps back gardens for California's Monterey Bay

    BBC heads to the Californian coast

    The Big Blue Live crew is preparing for the first of three episodes on Sunday night, filming from boats, planes and an aquarium studio
    Austin Bidwell: The Victorian fraudster who shook the Bank of England with the most daring forgery the world had known

    Victorian fraudster who shook the Bank of England

    Conman Austin Bidwell. was a heartless cad who carried out the most daring forgery the world had known
    Car hacking scandal: Security designed to stop thieves hot-wiring almost every modern motor has been cracked

    Car hacking scandal

    Security designed to stop thieves hot-wiring almost every modern motor has been cracked
    10 best placemats

    Take your seat: 10 best placemats

    Protect your table and dine in style with a bold new accessory