The PIP breast implant scandal might not have affected so many women if proper surveillance systems had been in place, health officials said.
The controversy exposed “woeful lapses” in implant quality, patient aftercare and record keeping, a review into the scandal found.
NHS medical director Professor Sir Bruce Keogh, who chaired the independent review, called for system to track all implants and devices put into both NHS and private patients.
“We need more data - we need data to define outcomes, we need data to identify problems accurately and early,” he said.
“I think if we had had that data we would have spotted that there were problems with the PIP implants and we would have spotted it earlier and we would have been able to trace patients.
“This is a pretty data free zone - with the PIP implants, not only did organisations implanting not really keep a good record of what they had done, they didn’t have a record of the outcomes either.
“The most important thing in my mind it meant that we had a faulty product on the market and we had no way of tracing the women who had PIP implants to notify them they might be carrying a troublesome implant.”
Around 47,000 British women are believed to have been given the implants manufactured by French company Poly Implant Prothese (PIP).
They were filled with non-medical grade silicone intended for use in mattresses and have been linked to rupture and swelling in the body.
This summer, health experts said the implants should not cause any long-term problems. The NHS medical directors expert group said the gel materials used inside the implants are not toxic or carcinogenic.
The review board also recommended that all people who perform plastic surgery in the UK should be on a register.
Sir Bruce said that some parts of the private sector do not conduct qualification checks on surgeons performing cosmetic surgery.
“That seems unfair to us because the citizens of this country should expect an equal standard of scrutiny of surgeons whether they go into the private sector or the NHS,” he said.
“That was further complicated by the fact that 50% or more cosmetic surgery done in this country is performed by surgeons who fly in and fly out from abroad.”
The scandal also drew attention to “widespread use of misleading advertising, inappropriate marketing and unsafe practices”, the review board said.
The review also called for people who have had surgery to be properly protected when things go wrong.
There was a furore over who should pay for the removal or replacement of the faulty implants.
In January last year, the government announced that anxious women given PIP breast implants on the NHS would be able to have them removed for free, with private firms expected to offer the same deal.
But it emerged that some private clinics no longer existed and others refused to remove the implants.
The DH announced that any woman refused help by a private company would be able to visit their GP and access NHS care, but the NHS will only remove the implants, not replace them.
More than 1,000 women had their faulty breast implants removed on the NHS.
Are you able to Speak Out Safely? Sign our petition to put pressure on your trust to support an open and transparent NHS