Jeremy Laurance: Cosmetic surgery - welcome to choice

Performing operations only occasionally is unacceptable practice. Not in cosmetic surgery

Twenty years ago the people of Oregon, US, provoked a public outcry when they ranked cosmetic breast surgery above treatment for a thigh fracture in a list of health priorities. Some dismiss cosmetic surgery as the vain, misguided pursuit of physical perfection but this was a reminder that others regard it as essential treatment for physical imperfection.

Two decades on, in the era of patient choice, demand for cosmetic surgery is soaring. But with high demand go high risks. Cosmetic surgery is not like other areas of private medicine, which supplement NHS provision. It is exclusively provided in the private sector and that presents special challenges in terms of regulation.

Anyone reading the NCEPOD report cannot fail to be alarmed at the cavalier manner in which some clinics – and surgeons – treat their patients. It starts with the hard sell – more than a quarter of clinics had offers and discounts – glosses over psychological assessment (just a third provided one) and the consent procedure (a third had no "cooling off" period) – and ends with a surgical team attempting operations in which they have too little training to be safe.

It is now recognised throughout medicine that performing operations occasionally is unacceptable practice. Not, apparently, in cosmetic surgery. More than half of centres surveyed carried out fewer than 20 a year of the most commonly offered procedures, with the exception of breast augmentation.

You would be unwise to have a heart operation from a surgeon who did less than 20 a year. So why a breast operation? NCEPOD's website offers questions for patients to put to clinics when considering cosmetic surgery. The first should be: How many operations has the surgeon and their team performed?

www.ncepod.org.uk