Thousands of women have come forward worldwide to complain against the now-bankrupt French company Poly Implant Prothese (PIP) after it was discovered its products had a higher than normal rupture rate. But how serious are the chances of those who undertake preventive breast implant removal surgery succeeding in a compensation claim for psychological injury?
The question lawyers and experts alike will have to consider is what medical evidence is appropriate. It is likely that, from a medico-legal point of view, both medical or surgical and psychological opinions will be sought to clarify causation, diagnosis and prognosis of difficulties and ongoing health problems of those women requiring implant removal.
The starting point before proceedings are even considered will be an examination of the main diagnostic factors in assessing psychological injuries.
It is crucial part of the evaluation of any claimant who has had an implant removed or is contemplating this, to consider a wide range of possible opinions and to differentiate between occasional, variable and mild psychological experiences from psychological symptoms that are consistently present, moderately severe and disrupt the claimant’s social or occupational life. The presence of more pervasive psychological disorders will often be backed up by evidence of GP or hospital attendance.
A key step is to determine which primary DSM-IV mental disorder best accounts for the presenting symptomatology. The decision tree on the right provides some of the main points of differential diagnosis, and is based on the notion that one diagnosis best fits the available evidence.
The main psychological disorders that arise in relation to breast surgery are likely to have been triggered by medical complications arising from the breast implant and its removal, or the stress of the whole process involved, irrespective of any actual medical ramifications. This includes, for example, worry about the implant, fear of surgery pain, etc. There are 11 key diagnoses to consider and one default opinion of ‘no significant psychological disorder’ (see diagram).
The psychological expert will obtain evidence from self-report, other medical experts’ opinions, GP and hospital records and, where appropriate, occupation health records to ascertain which of the range of opinions listed is consistent with the claimant’s psychological injuries.
Research indicates a complicated relationship between body image and plastic surgery with retrospective studies indicating that breast augmentation patients are more likely to experience distress and depression and at times feel suicidal than women who have had other cosmetic procedures.
Research also indicates that between seven and 15 per cent of cosmetic surgery patients meet the criteria for the body dysmorphic disorder cited above and that surgery does not alter this condition. The implication of these and other research findings is that great care must be taken, as in all medico-legal assessments, to differentiate between the psychological effects of breast implant removal and associated effects, and what a claimant’s pre-implant removal mental state was.
Psychological assessments of breast implant removal claimants requires a comprehensive history of pre-implant removal factors as well as post-implant removal distress. Providing the court with this thorough picture will allow optimum clarity of compensatable distress and anxiety, as well as identifying what appropriate psychological interventions are required to support and help those women who have undergone stress and trauma associated with faulty implants and their removal.
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