Four out of five cosmetic surgery firms 'inadequate'

<b>Jeremy Laurance</b>: Inquiry finds many surgeons have too little training, experience and back-up

Cosmetic surgery is being carried out by "have a go" surgeons prepared to attempt procedures in which they have little experience or training, with inadequate equipment and back-up, an inquiry has found.

Four out of five clinics offering complex surgery carry out too few operations to maintain their skills. More than half of those providing breast reduction, for example, perform less than 10 operations a year.

The damning report by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) says the true situation is almost certainly worse as half of the 760 clinics surveyed refused to take part or failed to respond, despite their statutory obligation to do so.

It called for the Care Quality Commission (CQC) to tighten controls on the clinics and set "minimum requirements for surgeons... and surgical teams to be considered competent". It cited the example of Singapore, where regulators stipulate the minimum number of cosmetic procedures to be performed by individual surgeons.

Alex Goodwin, clinical co-ordinator for NCEPOD and a consultant anaesthetist, said: "Cosmetic surgery is far too dispersed, with too many teams prepared to 'have a go' at procedures that they rarely perform. And failures in monitoring patients after surgery are a recipe for disaster."

Demand for cosmetic surgery has boomed in the last decade as the use of artificial means to improve appearance has become increasingly accepted. But as a lifestyle choice rather than essential treatment it is almost exclusively done in the private sector.

The market analyst Mintel estimated in June that the market for cosmetic surgery was worth £2.3bn annually, of which three-quarters was accounted for by non-surgical procedures. Figures from the British Association of Aesthetic Plastic Surgeons, who do a third of all surgical procedures, show that demand doubled between 2004 and 2009, from 16,000 to over 36,000 operations. Nine out of 10 are carried out on women.

The lure of big profits has created an industry driven by marketing, with frequent special offers and breaches of guidelines on advertising, according to the report. Dr Goodwin said: "This may put undue pressure on those considering cosmetic surgery."

The lack of psychological assessment of patients increased the risks in those "who may be vulnerable or have unrealistic expectations, before they consent to treatment". Only a third of clinics did routine psychological assessments and just a third operated a two-stage consent process, allowing patients a 'cooling off' period, before going ahead with the surgery.

The inquiry found that less than half (44 per cent) of operating theatres were fully equipped for cosmetic surgery, and almost a third of hospitals with in-patient beds did not have a consultant anaesthetist on duty for emergencies at all times.

Bertie Leigh, chairman of NCEPOD, said: "The regulation of cosmetic surgery remains poor. The CQC should insist that those it regulates are properly equipped and adhere to appropriate standards."

A spokesperson for the CQC said it was "unacceptable" that some cosmetic surgery providers did not have basic standards in place. "From 1 October, we are introducing a tougher new regulatory system that will mean more inspections and greater powers to take action," the spokesperson said.

Case study: 'I've paid twice for breast implants. I get a lot of pain'

Sarah Neale, 29

Ms Neale had implants inserted to boost her bust size from a 3B to a 3DD. But problems developed after the implants were placed too high.

She said: "I was never truly happy with the shape, but more worryingly, last year, I found quite big, hard lumps in my breast. I was told the lumps weren't cancerous, but probably a result of the implant rupturing and silicone leaking. I went to see several plastic surgeons but didn't feel confident that any of them were giving me the right advice." Finally she found a surgeon who reassured her and she had a corrective operation. Ms Neale, a nanny from Surbiton, added: "All in all I've paid out twice for breast implants. I've had to give up certain types of exercise and I get a lot of breast pain. I don't regret having breast enlargement as it's given me a confidence I never had, but I wish I'd been better informed."