Health committee  Thank you.

Health committee  The issue is to have a discussion with your patient about what you've found and lay out the options for them. There is not general consensus that even in the presence of a known leaking implant it is necessarily an indication for removal. So options are presented to women about observation; the likelihood of there really being a leak, even if it's been identified potentially on a mammogram, MRI, or ultrasound; and the options for removal and replacement.

Health committee  Thank you. That fact is not the least bit surprising. Breast reconstructive surgery is very complex and very difficult and very challenging surgery for the plastic surgeon, whether it is with the use of an implant or whether it is with the use of tissue taken from other areas of the body.

Health committee  No, it's not particularly long and arduous. I try to apply for special access only when I feel that it's very appropriate and when there's a specific indication for it. In those instances, when I've essentially pre-screened the process by not applying when there's not an appropriate indication, I have generally received approval.

Health committee  I can only speak for--

Health committee  I understand. I can only speak for my personal practice. I use every bit of time that's provided to me at Women's College Hospital for my reconstructive practice. Any time on top.... Thank you.

Health committee  My understanding is that if a procedure is to be covered as a medically necessary procedure, it would contravene the Canada Health Act for a person to be able to provide payment and have that procedure done quicker in a different method. That's my understanding.

Health committee  Thank you. Yes, through the special access program, I do apply for silicone gel-filled breast implants. I would estimate that approximately 40% to 50% are for reconstructive breast surgery for women who have undergone mastectomies or lumpectomies, and that the remaining 50% to 60% are divided between women undergoing implant replacement, who have likely had silicone gel breast implants in the past, and women undergoing primary breast augmentation with specific indications, such as an abnormal tuberous shape to the breast where defined devices that are presently available—i.e., saline breast implants—would likely cause significant problems and elevate the re-operation rate in those particular patients.

Health committee  We've just finished looking at our data in the first five years since I started using these devices in 2001. Of course, I would like and hope to have longer data as the years go by. At the present time, my re-operation rate for any indication—which would be for any patient, whether for reconstruction because a patient had changes to the breast because of breast feeding or for replacement on an implant—is 5.7% over the period of the study, and that could be for a variety of reasons.

Health committee  I will now complete my answer. Patients who come to see me with a concern that is medically related, where there is a medical problem, are only offered service in the publicly funded hospital, without a penny being charged to them by my office. If a patient comes to my office because she has implants that have been in through her choice for many years, there is no medical indication for their removal, and she wishes to have them removed, that is her choice.

Health committee  I do not know the answer to that.

Health committee  It is not, Madame Demers. There is no consensus to suggest that routine screening by MRI is appropriate. That is not the standard of practice in Canada, and that was not the recommendation of the radiologist who sat on our expert advisory panel.

Health committee  Yes. The present standard in Canada is regular monthly self-examination, and mammograms and ultrasound as required. MRI is used as a secondary or tertiary screening if a potential problem is noted to exist.

Health committee  Yes, I can, thank you.

Health committee  Thank you, Madame Demers. I must start by saying that you are quite incorrect in the information you have just requested of me. Those are absolutely not the facts as they exist, so let me please explain. I see patients on a very regular basis who come to me with concerns about their breast implants, or just to have them checked because their surgeon may not presently be around--is deceased, etc.