Health Committee on May 11th, 2023

[Nancy Pratt]

Yes, absolutely.

All breast implants bleed silicone and chemicals. You have that even if an implant is still intact. It's bleeding silicone. Sometimes a wearer might have their implants removed, but they have silicone uptake in lymph nodes or in surrounding tissue.

Then there's also the issue of rupture. If it's not diagnosed in time—and with no standard protocol of care in place, it's very often not diagnosed in time—silicone can migrate outside of the capsule that surrounds the breast implant and go into the body. I can speak to this because that's something I've experienced.

Just to draw to another point, yesterday there was a comment that silicone is inert. I guarantee you that anybody who has migrated silicone within them will not agree that silicone is inert. I have pain, as do they, in every place where that silicone has migrated within us.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Pratt.

Mr. Davies, go ahead, please, for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair, and thank you for being here. It's fascinating testimony.

Ms. McGregor, you used the term “true risk profile”. In your view, are Canadian women receiving from their surgeons, at the time they're considering implants, the true risk profile of breast implants?

[Terri McGregor]

There are very few absolute answers, but I can absolutely answer: Absolutely not.

As for the true risk profile.... We talk about slick marketing. I have a link to some board-certified plastic surgeons who are also on the executive committee as the thought leaders of their societies. When I read their professional websites today, it sounds like they're saying, “Don't worry, little lady; if you get cancer from these implants, it's not really a big deal. It is 100% curable, and no ALCL patient has ever needed chemotherapy or radiation.”

I can tell you that when I read that blatantly inaccurate misinformation last week, in 2023....

Quite honestly, patients are using these fancy, pretty websites with half-marketing, half-medical information. If I were a patient using that surgeon's website, I would walk away thinking that not only is that information false but also that it is dangerous. This is where patients have no power and no control.

I'm also not in a position to want to put myself in some kind of campaign and then be sued by plastic surgeons. In our social media support groups, we've already had threatening letters from surgeons who disagree with the harmed patients. We're just a lot of volunteers who, for some reason, are now getting letters threatening legal action.

[Don Davies, NDP, Vancouver Kingsway, BC]

Ms. Elliott, an August 20, 2019, article from Black Press Media noted that you said that “many plastic surgeons aren't trained to administer explants—a riskier, more complex surgery than implants—and even if they are, they don't always believe patient concerns.”

You were quoted as saying, “A lot of surgeons are trying to convince us—or themselves—that you don't actually need to remove your breast implants in order to get better...[They say] if you're sick, it's not because of your implants. It's everything else but your implants.”

How common do you think that situation is? What is the role of surgeons in this issue, do you think?

[Julie Elliott]

How common is it? It's extremely common.

Part of the problem is that when you get breast implants, you go to see a plastic surgeon. When you have problems after your surgery, most of the time you're not going to go back to see your plastic surgeon and say, “Hey, I feel sick.” If you have post-surgical problems and complications, of course you're going to go back to the person who did the surgery on you, but when the post-op healing period from the actual surgery is done, you're going to go back to see your GP or whatever specialist would be the one to give attention to your needs.

Most of the time, if you go back to see plastic surgeons, they're going to tell you that it's not your implants. It's anything else. You're going to see specialists. If you tell them, “I think my breast implants are causing this and this”, if it's not a mechanical problem caused by the implants—which most of the time is caused by capsular contraction—they're almost never going to tell you, “I think it may be your breast implants.”

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Ms. Pratt, in an April 2023 article from CBC News, you noted that a breast implant registry “shouldn't be limited to implants, but should also include other materials like mesh and clips that may also be placed inside the body during implant surgery.”

Can you expand on that?

[Nancy Pratt]

Absolutely.

Everything that's placed in the body should be recorded in the registry. What's happening now with the recall of textured implants is that many plastic surgeons are using smooth implants and they're using mesh, which is not approved for use in surgery in breasts. They're using it off label as regulators turn a blind eye.

Mesh has been getting coverage in the news for the difficulties that it has created. It's a high-risk device. It has complications. Now they're cavalierly using this mesh in patients, and often they don't know. Patients don't often have an understanding of what's going into them.

It's not appropriate to follow just the implant. Then later, if the patient has an issue that's mesh-related and there's a recall on that mesh, they can't be notified. They can be notified about the breast implant, but not about the mesh.

[Don Davies, NDP, Vancouver Kingsway, BC]

We had some witnesses earlier this week on Tuesday. There was a little bit of a difference of opinion, I think. One person was very clear that there were very concrete links between breast implant illness—BIA-ALCL—and autoimmune disorders from breast implants. With the other witness, I detected that he made it seem like it's not so clearly established.

I want to know your opinion on that. How clear is the evidence of illnesses linked to breast implants, in your view?

[The Chair, Liberal, Sean Casey]

We're out of time, but we'd like to have a brief response, please.

Who was that directed to, Mr. Davies?

[Don Davies, NDP, Vancouver Kingsway, BC]

It was directed to anybody who wanted to answer, but maybe Ms. McGregor can.

[The Chair, Liberal, Sean Casey]

Ms. McGregor, give a brief response, please.

[Terri McGregor]

I don't live in a litigious country, but what I can tell you is that the fear of litigation has not been discussed so far at this hearing. That's all I'm going to suggest.

The fear of litigation to these plastic surgeons is significant, serious and not being discussed.

[The Chair, Liberal, Sean Casey]

Thank you.

We have Mr. Jeneroux, please, for five minutes.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Thank you, Mr. Chair.

I want to bounce around a little bit, but first I'll speak about the litigation piece. Due to a lack of evidence, I would think, because there's no registry, I would hope that some of that would be mitigated. I'm sorry that you're going through that, Ms. McGregor.

I think Ms. Pratt made a very significant point that I didn't really think of until she made it in her testimony. It was the other items included as part of this, the mesh and the clips. Those are also things that we haven't heard yet at this committee and that I suspect would be important for us to consider as we write our report and recommendations.

Mr. Chair, we've had a lot of testimony here about the need for the registry. To go back to a point I've made before, this has been ongoing since 2004. It appears to me that this isn't a partisan issue at all. I firmly believe that a lot of us around this table are supportive of the registry. It's just a matter of where the registry is housed and the logistics of it. Some of this has been pointed to CIHR and to what the orthopedic registry is. We have yet to hear from CIHR. I'm not sure if that's worthy of another meeting or if it's worthy of asking them for a response to something like this. I'm just using my time to indicate that I think it would be very relevant to have CIHR indicate their capability to house something like this registry.

I want to get to medical tourism, but from you guys' testimony, it's scary to think that for the young girls right now, it's not on the reconstructive side but more on the cosmetic side. Where the heck do they go to get information? What do they do? Your organizations are doing good work in trying to get that information out there, but at the end of the day, I would think that the Government of Canada should have some resource or some role in providing a lot of the concerns that have been raised at meetings that we've had so far to someone who's considering going down this path.

On the medical tourism piece, if I have time to go to all three of you, that would be great, but I'll probably start with Ms. Pratt to help me circle this with the registry.

With regard to the tourism, let's say you go down to Colombia and you get the implant put in, and the implant has the problems or issues that we're discussing here at the committee. The registry, I would assume, from how it's being discussed, isn't necessarily tracking that implant in Colombia. Colombia doesn't have a registry. How does that then circle back to the registry that we would like to see put in place here in Canada?

[Nancy Pratt]

As I think Terri mentioned, there should be an option for them to register themselves, but there has to be awareness. Health Canada has to take a more leading role in making sure that this kind of information is available. Canadians should be able to get that information at Health Canada's website. There needs to be an outreach.

[Terri McGregor]

One of the things we haven't discussed is immigration. I've dealt with many immigrants who had their surgeries done in their original countries but have now landed in Canada. Again, for those patients, is there not an option somehow for them or for a physician to upload that data? When I have patients who are Colombians who are immigrating or are in an effort to immigrate, those patients are now deathly ill but, in my personal experience, they have to fly back to Colombia for their surgery.

I just wanted to mention that we have this immigration cohort that hasn't been discussed yet.

[Matt Jeneroux, Conservative, Edmonton Riverbend, AB]

Madam Elliott, you have about 10 seconds, I guess, if there's anything to add on that point.

[Julie Elliott]

On medical tourism, my opinion goes the same way as Terri's. When a patient comes back.... Right now, what's very trendy is that those women are going to Morocco or Turkey more than Colombia. If I'm talking about Quebec, those patients go to Morocco and Turkey. When they come back, a lot of them—I cannot give you a percentage—are coming back with complications.

The cost of it comes back to our health care system. They spend that money outside, which is okay, because it's medical tourism. It costs them $4,000, and they have a trip. They go sightseeing. They get breast implants and something else. They come back and they have complications. They're sick. They have breast implants that are unknown.

For the surgeons who have them under their care here in the medical system, it's a puzzle. It's a problem. There should be something.... I don't know how. I'm not a business person at that level. If someone comes back, there should be a way to track those surgeries to help the health care professional when they come back, and there should be a way for those women to have those implants tracked. If something happens in the country of origin of those implants, how will those women know what's happening with those implants if they keep them?

In my group, we have so many women coming in, because a few days, months or weeks later they have all kinds of problems with those implants. They have mesh inside. They have long sutures and have so many problems.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Elliott.

Next is Ms. Sudds, please, for five minutes.

[Jenna Sudds, Liberal, Kanata—Carleton, ON]

Thank you very much, Chair.

Thank you to all three witnesses for being here and for sharing your experience, your expertise and the work that you're continuing to do. It's obviously so crucial as we attempt to tackle this study.

I wanted to pick up on two things. The first thing I wanted to go back to was from you, Ms. McGregor. You had mentioned a list of three recommendations. The first one that I think I caught was adopting breast MRI surveillance. Can you speak a bit about what that should or could look like, and about the impact that you believe that would have?

[Terri McGregor]

I can tell you that my surgery was in 2009. My surgeon did say, “Terri, these should last around 10 years”, and I made a mental note saying, “Save another 10 grand, Terri, because in 10 years you may have to get these replaced.” I also know, as a Canadian woman, that every 10 years I have a different thought and belief system because I have evolved. I actually thought that I might just want them out because maybe in my 50s I won't want these things. I think I'm typical.

What is devastating to me is that nobody in Canada—whether it's Health Canada or it's the manufacturers' inability to get that information to Canadians, including my implanting surgeon—told me to do anything until I had a problem. However, that is completely contradictory to all the manufacturers, and I think there are four that are licensed in Canada. Their own label says that we are to get implant surveillance, and there's some debate on when. Right now, the FDA standard is that you should be having your first preventive maintenance after your fifth year of surgery. To me, this is no more difficult than with your vehicle. We have preventive maintenance for these implants, because these things—silent ruptures, gel bleed, and intracapsular and extra-capsular ruptures—could be identified sooner.

I believe it comes down to the fact that we have a lack of private MRI resources. I don't believe that our government should be paying for an MRI for an elective surgery that I had. I think the problem is that we don't have privately paid MRIs.

[Jenna Sudds, Liberal, Kanata—Carleton, ON]

Thank you very much. It's very insightful as we look to recommendations as the report is completed and written. Thank you for that.

I had another question in that vein, but I know I have limited time, so I'm going to go to my other point.

As all three of you were speaking—but particularly you, Ms. McGregor—what came to mind is the role of the plastic surgeon and the industry, so to speak, or the profession. You made the comment slightly offhand about it being half marketing and half medical. I get it. I've seen these sites, and you're very accurate in saying it in that way.

This leads me down the road of what should be done further—whether it's in regulations or whatnot, or whether it's at the government level or at an association or professional level—that could better keep track of and hold plastic surgeons responsible. I'm taking the registry slightly aside from that comment, because obviously that's under discussion, but there seems to be more. There's a bigger issue at hand here.

I'm wondering, and I'll open the question to others as well, what recommendations you have to hold these professionals to account and to a higher level.

[Terri McGregor]

That's a fantastic question. I've asked that question of the ASPS, the American plastic surgeon association, when I landed on websites that are so dangerous. They are literally dangerous to patients.

I will tell you that I sent off a request to ASPS to ask what we can do about this, because this doesn't represent your organization with any credibility. At the time—and it may have changed—I was told that since I didn't have an MD behind my name, I was not able to complain about any misleading information.

At this point, I would tell a Canadian consumer today, whether she's a breast reconstruction patient or an augment patient, this is “buyer beware”, and that very pretty, glossy half-medical half-marketing information is dangerous and is misleading through omission. It is literally a selection of omission and wordsmithing.

Personally, I spent three years on and off Health Canada's website. Health Canada's website was a major decision-making tool for me, and it is why Health Canada became a target after my diagnosis. It's because I wasn't an impulsive 20-year old but was in my forties, and the fact that Health Canada had chosen to withhold that information was unacceptable to me, because I thought that was my oversight safety.

The first time somebody said to me, “Well, Terri, you never went to the FDA's website,” my mouth literally dropped, because it would never have occurred to this intelligent woman, as a Canadian, to go over to the FDA and to the States to read about breast implants. It didn't even cause me a thought.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. McGregor.

I'm now giving the floor to Mr. Thériault two and a half minutes.