In my recently published book, "The Biopolitics of Beauty," I question the idea that humanitarianism is the driving force of plastic surgery in Brazilian public hospitals.
Burn victims and individuals with congenital deformities were once the main beneficiaries of plastic surgery in these hospitals. But at many of the clinics where I carried out my research, nearly 95 percent of all those surgeries have become purely aesthetic. I documented hundreds of instances where surgeons and residents purposely blurred the boundaries between reconstructive and aesthetic procedures to get them approved by the government.
Since most of the surgeries in public hospitals are carried out by medical residents who are still training to be plastic surgeons, they have a vested interest in learning aesthetic procedures – skills that they'll be able to later market as they open private practices. But they have very little interest in learning the reconstructive procedures that actually improve a bodily function or reduce physical pain.
Additionally, most of Brazil's surgical innovations are first tested by plastic surgeons in public hospitals, exposing those patients to more risks than wealthier patients. Working-class patients are understood as subjects for inquiry, and I spoke to the small but significant number who were very unhappy with the results of their surgery.
Take one woman I interviewed named Renata. The medical resident who operated on her left her with deformed breasts and uneven nipples. She also developed severe infections that took months to heal and left significant scars. She considered suing the doctor, but discovered she would need a costly expert medical evaluation. She also knew that the Brazilian legal system would likely grant her very little in terms of damages. In the end, she settled for another free surgery, one that she hoped would provide a better result and leave her less unhappy.
This was a typical story among low-income patients that were harmed by plastic surgeons. Their lack of financial resources made it nearly impossible for them to find any justice if anything went wrong, so they assumed all of the risk.
Plastic surgeons, on the other hand, are eager to try new techniques if they seem promising, no matter how risky they might be. A technique known as "bioplastia," for example, consists of injecting a liquid compound called PMMA into the body in order to permanently reshape a patient's features. The compound, which is similar to acrylic glass, doesn't cause problems in most patients. But in a small minority it causes very severe complications, including necrosis of facial tissue. Yet many doctors I interviewed strongly defended the technique, claiming it was a phenomenal tool that allowed them to transform the human body. Risk, they argued, was inherent in any surgical procedure.
Around the world, Brazilian plastic surgeons are known as the best in their field, and they gain global recognition for their daring new techniques. During an international plastic surgery conference in Brazil, an American surgeon I interviewed told me, "Brazilian surgeons are pioneers… You know why? Because [in Brazil] they don't have the institutional or legal barriers to generate new techniques. They can be creative as they want to be."
In other words, there are few regulations in place that could protect low-income patients from malpractice.
In a country where appearance is seen as central to one's very citizenship, patients agree to becoming experimental subjects in exchange for beauty. But it's often a choice made under duress, and the consequences can be dire.
Commentary by Alvaro Jarrin, an Assistant Professor of Anthropology at College of the Holy Cross. He is also a contributor at The Conversation, an independent source of news and views from the academic and research community.
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