Environmental Sustainability of Breast Implant Supply Chains

Abstract

BACKGROUND: Sustainable procurement is becoming a critical benchmark across several industries, but it is rarely mentioned in healthcare. Few surgeons have any idea of the carbon footprint of performing their surgical procedures. Hospitals produce more than 4.67 million tons of waste per year, and operating rooms use 30% of the supplies for any given hospital. This environmental footprint is not only based on the resource utilization of operating rooms, but rather on the entire value chain of intraoperative products utilized. The purpose of this investigation was to assess the corporate environmental responsibility of two leading manufacturers of breast implants. METHODS: The sustainability practices of two leading breast implant manufacturers were investigated based on self-reported corporate environmental data. Data were standardized per $1 million USD in revenue. Recent corporate initiatives and their resulting sustainability impact were analyzed over the last three years, specifically within the categories of greenhouse emissions (in metric tons of carbon dioxide equivalent, MTCO2e), water withdrawal (in cubic meters, m3), solid waste (in metric tons), and energy utilization (in gigajoules, GJ). RESULTS: Regarding greenhouse emissions, Company A most recently reported 4.25 MTCO2e per $1M in revenue, while their competitor Company M most recently reported 9.0 MTCO2e per $1M in revenue. While Company M has over twice the greenhouse emissions, they have achieved an impressive decreased of 2.0 MTCO2e per $1M per year. Regarding water withdrawal, Company A utilizes an astounding 68 m3 per $1M in revenue, whereas Company M utilizes only 1.43 m3 per $1M in revenue. Nevertheless, Company A has been making improvements with a recent decrease of 4.3 m3 per $1M per year. Regarding nonhazardous waste, Company A only produces 0.09 tons of solid waste per $1M in revenue, whereas Company M produces 1.1 tons of solid waste per $1M in revenue. Company A was able to recycle 66% of this solid waste, whereas Company M was able to recycle an impressive 91.3% of its nonhazardous solid waste. Regarding energy utilization, Company A utilized 190 GJ per $1M in revenue, whereas Company M utilized 145 GJ per $1M in revenue. Most strikingly, Company A has reduced its energy utilization by 40 GJ per $1M per year over the last two years, compared to a decrease of only 8.5 GJ per $1M per year by Company M. CONCLUSIONS: There are substantial differences in the business practices between breast implant suppliers. Does the clinical benefit of one implant manufacturer truly outweigh the reality of that company having more than double the greenhouse emissions and twelve times the amount of solid waste? While digging into this data and its implications on changing our practice might be uncomfortable, physicians and administrators need to begin discussing responsible resource procurement. Future research will investigate every intraoperative supplier to analyze the supply chain footprint of each operative procedure, as well as the supply chain footprint of our plastic surgery department overall.