Nip, tuck,profit

Luo Min, a 28-year-old woman living in Nanning, Guangxi Zhuang Autonomous Region, said she was "too nervous to sleep" in the days before her breast implant operation on Saturday. But she went ahead with it anyway.

Her concern was partly based on recent reports that French implant producer Poly Implant Prothese (PIP) Co has been using industrial-grade silicone that was not approved for clinical use and that could make rupturing more likely.

"The doctors recommended some British implants to me. Who knows whether these ones are safer than PIP's or not," said Luo, who paid 20,000 yuan for the surgery.

The PIP scandal has also caused a headache for Xing Gang, sales manager of Shenzhen Wei'enjie Co. Acting as an agent for PIP since 2009, Wei'enjie has sold 761 PIP implants in China, according to China's food and drug watchdog, the State Food and Drug Administration (SFDA).

"The media flocked to question the safety of our implants," Xing told the Global Times.

The SFDA said Saturday it was investigating the company, even though no complaints have yet been reported in China. It also said the sale and use of PIP implants had been suspended.

But consumers still have access to PIP products in clinics like the one under the PLA Second Artillery General Hospital in Beijing, local newspaper Legal Mirror reported on December 23.

The French Health Products Safety Agency said Friday that 15 breast cancer cases had been reported in women with PIP breast implants. Even though no link had been established between the disease and the implants, the agency advised women to have them removed.

Demand rising

Despite her fears, Luo had her breast enlarging operation Saturday. "I got sick during puberty and my breasts stopped growing. No one can imagine the suffering a woman with no breasts goes through," Luo explained.

Ding Xiaobang, an expert in breast augmentation at Beijing Peking Union Medical College Hospital, has been increasingly busy in recent years, with some 200 to 300 operations last year, compared with just 50 to 60 in 2009.

Even though most cosmetic surgery procedures in China relate to the face, breast operations are becoming more popular. Some of the patients coming to Ding are college students who feel that cosmetic surgery can improve their chances of getting a job. Others are people working in the entertainment sector seeking a competitive advantage.

But this growing market remains relatively under-regulated. In Beijing in 2007, 70 percent of the clinics offering breast augmentation and liposuction were found to be operating without a license, according to Beijing Municipal Health Bureau.

Wang Weiwei, a 23-year-old woman, died in a clinic in Dalian, Liaoning Province in July from an overdose of anesthetic during her breast augmentation surgery. The person operating on her turned out not to be a doctor and the clinic had no sterile equipment.

Polyacrylamide hydrogel, which can be used in breast implants but was banned by the SFDA in 2006 for its potentially serious side effects, "is still being used by some clinics," Zhao Qiming, a member of the Beijing-based Chinese Association of Plastics and Aesthetics (CAPA), told the Global Times.

Outdated regulations

China implemented two regulations regarding cosmetic surgery standards in 2002, but many aspects of the regulations have become outdated, partly because the sector has been growing at an annual rate of 20 percent since then, industry insiders said.

In November 2010, the Ministry of Health (MOH) announced it had authorized CAPA to revise the standards for medical plastics and aesthetics clinics and draft new regulations for chain clinics.

In August last year, the revision of the standards was concluded and submitted to MOH for approval, but the regulations for chain clinics are still being written, according to Zhao, who was involved in drafting the new guidelines.

Foreign players

State-run cosmetic surgery clinics dominate in northern parts of China, but private ones are more popular in the South, Li Bin, vice president of the Beijing Association of Medical Plastics and Aesthetics, told the Global Times.

Foreign firms have tried to cut their way into the Chinese market, but without a huge amount of success so far. In Beijing, there are less than 10 foreign cosmetic surgery clinics and as these clinics are mainly targeting foreigners living in China, they don't present a challenge to Chinese clinics yet, said Li.

SK group, the third largest conglomerate in South Korea, opened a joint-venture cosmetic surgery center in China in 2004, called Beijing SK Aikang Hospital. Six years later, the center was acquired by Bejing Ever Care Group.

Li, also the general manager of the Ever Care Group, told the Global Times that SK group withdrew because of "difficulties of localization."

"The group could not afford to hire only Korean doctors, and had trouble getting its Chinese staff to accept the Korean corporate culture and management," said Li.

But if they're small players in China for now, foreign cosmetic surgery clinics are making huge profits overseas. In 2010, for instance, the plastic surgery sector in South Korea contributed 4 percent of the country's national GDP growth, and 30 percent of the consumers were Chinese, Zhao said.

"It is time for our government to offer more support and stricter supervision of the sector, to boost its healthy and orderly growth," Zhao noted.