Alongside Michael Coleman, Professor of Toxicology, Aston University and Prabath Nanayakkara, Professor in Acute Internal Medicine, Amsterdam University Medical Center, Professor Carl Heneghan presented as part of the first panel. MPs on the cross-party committee, chaired by Labour MP Sarah Owen discussed issues relating to silicone breast implants, specifically the difference between PIP industrial grade implants and the superior medical grade implants used in non-PIP procedures. A second panel explored the regulatory framework for all cosmetic procedures both surgical and non-surgical.
The experts gave evidence that silicone implants have a tendency to rupture. Moreover, PIP implants have a higher chance of rupture, up to six times that of non-PIP implants, releasing silicones into women’s bodies that can be detected for years afterwards, and posing serious health risks. These risks include the leaked cyloxins/cyclosiloxanes D4, D5 and D6 stimulating the immune system, leading to health issues including increased autoimmune conditions and cancer risk, in particular cancer of the immune system.
They discussed the collation of evidence pertaining to women who received the implants, and that there is sufficient evidence to confirm the impact of released cyclosiloxanes D4, D5 and D6 on women’s health, and in particular, instances of the resultant BIA ALCL - Breast implant-associated anaplastic large cell lymphoma - a type of non-Hodgkin’s lymphoma which has caused deaths.
On being questioned about the lack of awareness amongst GPs regarding this evidence, Prof Heneghan commented that general practitioners are already over-loaded and stated:
'The key issue here is for the (UK) regulator to improve the post-marketing surveillance, and ensure the alerts are transmitted to all doctors and all trusts about what is going on, and we have to do that well here. What we should be saying is we are going to provide a safe system that’s world-leading in the evidence-base… there needs to be a change in how we view patient safety when it comes to implants. This should give women a clear idea of the risks and dissuade them from going abroad for procedures.'
Prof Heneghan, however, highlighted the lack of knowledge regarding the type of evidence available around this in the UK, including the fact that the NHS England data register containing evidence pertaining to these implants is currently stalled and has been so for 9 months. This means we currently have no access to information on how many silicone implants are still being used in the UK and also highlights in general the lack of stringency in our processes in the UK.
In addition, Prof Heneghan stated that in this country we are not mandated to produce an annual report around this, as is the case in other countries, so we don’t have a reliable data source to either inform patients or take an overview. This is also exacerbated by lack of knowledge of women travelling abroad for implants. Additionally he highlighted the lack of informed information given to women in the UK at the time of these implants for them to consent into having these procedures, and how after their procedure they may not know even know the type of implant they received. He mentioned that post-implant care should include regular MRI scans, but again this is not in place in the UK.
The panel heard that of the women who experience side effects post-breast implants, 84% of individuals’ symptoms improve upon removal of implants. In 2012 there was an NHS offer for women with the now-banned PIP implants to have them removed, but this only extended to those who had received them within NHS. The offer hasn’t been repeated since then, and Prof Heneghan stated that it should be. On his suggestion the committee agreed that there should also be a compensatory system akin to those rolled out for other victims of health treatments resulting in serious ill health or indeed death.
The professors also commented on medical misogyny and the evidence around women not being listened to in medical settings. They also acknowledged that this is an issue that affects transgender women. They highlighted the lack of viable alternatives to silicone currently available as even saline implants have silicone components, observing that the industry producing implants have not developed alternatives, as silicones have been seen as, and rolled out as the standard material for implants, due to the incorrect assumption that they are inert. However the professors asserted that in future implants should not be made out of siloxane polymers.
Committee chair Sarah Owen wrapped up the panel commenting:
'I want to say thank you to all three of you for your expertise, for your openness, for your honesty and for your determination to listen and to help women who have issues with their implants, whether they’re PIP or not, and to try and help us make better decisions in this place, and hopefully in healthcare settings across the country.'
The full evidence session touched upon the PIP implant scandal, the rise in cosmetic procedures, liquid BBLs (Brazilian butt lifts) and liquid ‘boob jobs’ and cosmetic tourism and can be viewed here.