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-[ Makda ] We're booking
appointments with three popular
doctors in Toronto.
-[ Makda ] But we're
not patients.
We're journalists
with hidden cameras.
-Are you guys ready?
-Yes.
Investigating what plastic
surgeons tell potential patients
about the most common
cosmetic surgery in the world...
Breast augmentation.
I started off with nothing,
like absolutely nothing.
Like I didn't have--
I couldn't fill even an "A" bra,
like nothing,
and I was bullied a lot.
-[ Makda ] Nikki Carruthers is
one of ten million with breast
implants worldwide and
the numbers are going up.
Maybe I'll get
bigger boobs, so I did.
-[ Makda ] It's over a
$1 billion industry,
fuelled by celebrities
like Iggy Azalea going public
about how they got their curves.
I love them,
and I'm super happy.
I would do it
again in a heartbeat.
It wasn't just one,
there's dozens and dozens.
Like all the celebrities
like Kendra Wilkinson,
um Holly, like all
those shows that you watch,
like every single
person had implants.
They're everywhere.
That's all I was
looking at for years.
-[ Makda ] Five years
ago when she was 23,
Nikki visited a private clinic
in Winnipeg and paid $6,300 for
her silicone implants
going from a 32AA to a 32DDD.
But about a year ago, Nikki
began feeling sicker and sicker
without knowing why.
So talk me through the
list of symptoms that you've
been experiencing.
Okay, so liver tumor,
I have a cyst on my spleen,
the H-pylori, the gastritis
which is from the H-pylori.
The ulcer disease,
the acid reflux,
the heartburn,
bleeding for three months.
Vomiting uncontrollably
for an entire month.
This sounds like a nightmare.
Yeah, like I'm only
halfway done the list.
-[ Makda ] She felt
all alone until she finds
this community online.
It's unexplainable how
much better I felt being there
because I felt like,
okay, I'm not losing my mind.
I'm not an insane person.
All these people are
going through the same thing.
Some people worse.
-[ Makda ] A support
group, over 50,000 strong,
dealing with ailments they
call breast implant illness
or syndrome.
These women are
medical orphans.
-[ Makda ] Dr Feng is a
breast implant expert.
She used to put them in.
Now women from all over the
world fly to her Ohio clinic to
take them out.
The capsule is
the scar tissue.
-[ Makda ] It's become
her specialty,
explanting implants.
Some people don't even
know that this could happen,
that this constellation of
symptoms and signs are related
to the implants.
There's no recognition of that
in the scientific community.
-[ Makda ] But are all
adverse symptoms caused by
breast implants?
Yes, yes.
I'm pretty sure because those
are the things that get better
when you take out the implant
and the capsules completely.
-[ Makda ] The FDA says there's
no evidence the illness exists,
but they are not ruling out
an association between these
symptoms and breast implants,
arguing more studies are needed.
I never thought that it was
the breast implants that were
making me sick.
-[ Makda ] And around the
world, women are speaking out.
Why are all these weird
things happening to my body?
Hair loss, vertigo,
shooting pains in my breasts.
Get these out of my body,
like I don't want to feel
sick again.
-[ Makda ] Reporting other
side effects they feel are
linked to their implants.
Every single thing, it just
felt like torture for my chest.
-[ Makda ] Pain, rupture,
multiple surgery.
Apparently my
breast implant popped.
-[ Makda ] Many say they had
no idea what they were really
buying in to.
If I had known this
was even a 0.1% chance,
never would have done it.
It was made to seem
like getting a haircut.
Like go get a haircut.
Who cares?
Like, everyone was doing it.
Wasn't a big deal,
didn't seem like a
big deal at all.
-[ Makda ] No big deal?
It's major surgery and
it's the doctor's job to ensure
patients know all the risks.
And that's why we're visiting
clinics to find out how are they
selling implants.
We picked three Toronto surgeons
who have a presence online...
Dr Kara.
Hi, everybody, I'm Dr Kara.
-[ Makda ] Dr Rice.
They just want to
feel good about themselves.
-[ Makda ] And Dr Jugenberg.
There's always options.
-[ Makda ] First up, Dr Kara.
It is the latest, fast,
and greatest implant ever made.
-[ Makda ] He has an office
in this Toronto building.
Watching with us,
Kerry Bowman,
University of
Toronto bioethicist.
He evaluates doctors' ethical
conduct including how they
communicate risks to patients.
Kara's big sell online?
24-hour recovery.
You don't need to understand,
that's what he said.
You don't need to understand,
we do this all the time.
I mean, I can--
yeah, and that would
worry me because you
do need to understand.
You really, really do
need to understand.
It's ethical.
It's also the law.
-[ Makda ] Next, we asked,
when is the soonest we can
get in to surgery?
We hear 24 hours,
four days, and then a few weeks.
So what are the rules?
There is no script plastic
surgeons are supposed to follow.
Ontario's College of Physicians
and Surgeons says, patients need
appropriate time and information
to make informed choices.
It's all about consent.
And, you know,
consent is not your signature
on a piece of paper.
Consent is the process you see.
Have I answered all
of your questions?
Do you fully
understand and appreciate?
-[ Makda ] Next, we
get our consent forms.
We get them right
away from Dr Rice.
-[ Makda ] Bowman says that's
exactly what should happen.
Same at Dr Kara's clinic.
-[ Makda ] But at
Dr Jugenberg's,
there seems to
be a price to pay.
Well, it's not good.
Consent forms should be
available on request and I would
argue even before request.
I'm not seeing any reason why
they couldn't be made available
online in advance.
-[ Makda ] But after
asking repeatedly...
-[ Makda ] We get the
forms without paying $2,000.
When we asked
Dr Jugenberg about why we were
initially asked to
pay for consent forms,
he said that
shouldn't have happened.
It was a misunderstanding
and in the future,
he'll make sure
there's no confusion.
Consent forms
can scare people.
They can say this could happen.
There could be an infection,
there could be this,
there could be-- and there's
risks with all surgery,
but that's no reason
to hold back on them.
-[ Makda ] Most breast
implant surgery is cosmetic.
90 per cent is done on women
who don't need it
for medical reasons.
So how many of them are
developing serious side effects?
No one really knows because
the government admits there is a
chronic underreporting problem.
Even so, we do know in 2018,
there were 359 reported
incidents related
to breast implants.
The most ever reported to
Health Canada in just one year.
It's a society that
desires big breasts.
It's the patient who, uh,
want to have...
want to have bigger
breasts to feel that
they are somebody,
somebody worthwhile.
It's the surgeons that want to
do it and makes a living
doing it.
It's a matter of demand.
-[ Makda ] Nikki's problems
became too much to bear.
Despite no clear diagnosis, she
believes it's her implants that
are making her sick, so she
decides to get them removed.
How are you feeling?
I'm terrified.
I'm really scared,
but it has to be done.
So I'm excited but
also terrified, scared.
I just have to hope I make
it through the surgery and
hopefully this will help.
-[ Makda ] That afternoon,
with our help,
she takes home her implants.
Ready to take a look?
Whoa.
It's like exploded gel!
Everyone kept telling me
I'm crazy and it's like,
obviously I'm not!
[sniffles]
-[ Makda ] What you don't
know about breast implants...
Undercover at
three Toronto clinics,
investigating how
breast implants are sold.
Nikki's implants are now
in the hands of our expert.
Meet chemist Pierre Blais.
He has a business
analyzing implants.
For 50 years, he's examined
over 15,000, warning people and
governments of their
potential dangers.
It's an implant which has a
very high probability of being
mechanically faulty.
These are Nikki's implants.
-[ Makda ] Is that a
normal looking implant?
No, that is not a
normal looking implant.
I look at it.
I see it's turbid.
It's kind of milky.
It shouldn't be.
-[ Makda ] What
does that tell you?
It tells me the inside
has picked up liquid
from the patient.
It's absorbed part of her.
Now, this represents
probably about half
of the implants we get.
Now, the right side is the
one that has a harder life.
-[ Makda ] That looks
nothing like the other implant.
Nikki's doctor acknowledges
there was a hole in the implant
but tells us it looks like this
because of the explant surgery.
Blais has another theory.
It broke in to four parts,
but it didn't occur
at the same time.
It started out at one place, and
as she moved and somehow did her
daily activity like
writing or exercising,
the break gradually spread.
-[ Makda ] Really?
When you look at the
instructions for use for a
product like this and
all the competitors,
it says "A rupture may happen."
It's not really right.
They should say,
"A rupture will happen."
It depends how long you have it.
-[ Makda ] Breast implant
manufacturers say many studies
over many years prove
their products are safe,
but Blais feels his experience
examining thousands of implants
proves otherwise.
You're saying every implant
will rupture at some point?
Yeah, those that
don't are exceptions.
-[ Makda ] So are you saying
if women get breast implants,
they should expect a
revolving door of surgeries?
Yes.
A lifestyle.
Not a episode.
-[ Makda ] We want to ask our
surgeons about how long implants
will last, but first,
we check out their websites.
Here's Dr Kara's.
Well, I see very glamorous
images of idealized kinds of
women as opposed to
here's a medical intervention
that we
can offer you.
-[ Makda ] Dr Rice's
site has a different feel.
Dr Rice would certainly come
closest because his website and
he himself is really
saying with evidence base,
he's talking evidence and
I think that's a really,
really good thing.
-[ Makda ] And the
risks are easy to find.
It even says there will come a
point in time that the implant
will need to be replaced,
and at Dr Rice's clinic,
his nurse seems to
have a different message.
-[ Makda ] It's true,
there's no expiry date,
but the FDA says up to 20%
will need to get their implants
removed within
eight to ten years.
On Dr Kara's website,
under myths,
it says you don't need to change
your implants every ten years.
But in person, a mixed message.
-[ Makda ] They don't
spread around your body?
But the FDA states,
once the implant breaks,
silicone gel can migrate
to other parts of the body,
and it's hard to remove.
On Dr Jugenberg's website it
lists breast implant rupture
as a risk, but then on
its YouTube channel...
We're going to be testing people
around Toronto to see who can
rupture it.
-We promise you
it will not break.
-[ Makda ] Check out this
video featuring his staff...
Seems like implants
are indestructible.
Confused yet?
Even in person,
it's not clear cut.
-[ Makda ] Forever?
Not according to the
FDA and Health Canada.
They state breast implants
are not lifetime devices.
The longer you have implants,
the more likely complications
will occur.
And when we continue
asking about long-term risks,
some mention
breast implant illness.
At Dr Jugenberg's clinic...
-[ Makda ] Breast implant
illness is not mentioned
on Dr Rice's website,
and doesn't come up in person,
when we ask about
long-term risks.
On Dr Kara's website,
under myths, it says there's no
link between breast implants
and autoimmune diseases.
Many researchers agree.
They dismiss any link,
and so does his nurse.
-[ Makda ] Different messages,
reflective of the debate about
whether breast implant illness
is real and whether doctors need
to warn patients.
An implant does not
leave you unscratched.
It's a permanent change to your
anatomy and a permanent change
to your physiology.
But that should be
made clear to a patient.
-[ Makda ] The implant files
continue on your "Marketplace."
Breast implants.
I'm really happy
with the way they are.
-[ Makda ] On the
market for over 50 years.
If you are a true woman,
you want to look your best.
-[ Makda ] And the risks?
I don't feel I'm
at risk at all, no.
It's safe.
100% safe.
I have a new pair of titties!
-[ Makda ] Today, many people
get the sales pitch online.
This is what they look
like 48 hours after my surgery.
-[ Makda ] They're called
testimonials and some show up on
surgeons' websites.
That's Dr Jugenberg with
one of his happy patients.
I got my titties done!
I got my titties done!
Hey, I got my titties done!
Oh, I got my titties done!
-[ Makda ] And on
Dr Rice's website,
there's a glowing video review
from a Toronto radio host.
I would definitely
recommend Dr Rice.
-[ Makda ] And you
probably noticed these.
Before and after photos.
Ontario's College of Physicians
and Surgeons calls photos like
these testimonials,
same as these videos of
patient experiences.
After the surgery
was done, I was elated.
-[ Makda ] And here's
the thing, testimonials are
against the rules.
Doctors aren't
supposed to use them in ads,
on their website,
or on social media.
What is the problem
with testimonials?
Because you may find patients
out there who say it gives them
more information about what
this process could be like.
It may, but testimonials get
mixed up with clinical outcomes.
So it's not a
controlled clinical study.
You don't know how people
were selected for testimonials,
and in many, but not all cases,
they are selected because
they're going to
say positive things.
-[ Makda ] Bowman argues
testimonials belong
in marketing.
They have no place in medicine.
Because of the impact they can
have on patients like Nikki.
You see all these people how
happy they are and you're like,
I just want to be
like that person.
So, I dunno, you keep shoving it
in your face forever, it's like,
okay, it's obviously safe,
why wouldn't I do it?
-[ Makda ] In 2017, the college
cautioned Dr Kara for using
before and after
photos in a magazine,
but they're still
on his website.
And for Dr Jugenberg, the
allegations get more serious.
He's charged with posting images
of a patient online without her
permission and pressuring her
to follow and contribute to his
social media accounts.
Dr Jugenberg
denies all allegations.
His hearing with the
college is still pending.
We asked all three
surgeons to come on camera,
but they decline.
Overall, our bioethicist
believes Dr Rice had the most
medical approach.
Bottom line?
Mixed messages on all our
visits and on the websites.
And mixed messages
from the Ontario College.
There are no clear rules
about how plastic surgeons are
supposed to
communicate risks to patients,
and they tell us doctors
could be penalized for using
testimonials, but are
they really cracking down?
Those ads are everywhere.
I'm thrilled.
For people to
see me and say,
wow, you look amazing.
-[ Makda ] For many, breast
implants were the right choice.
For others like Nikki...
If I heard one
thing saying hey,
your whole entire body is
going to not work anymore,
like, no way
I would have done it,
but there was nothing
like that, nothing.
-[ Makda ] If you want to know
more about breast implants or
any other medical device,
check out our database.
Our CBC data journalists fought
for years to get reports about
side effects from medical
devices from Health Canada.
Get informed.
[ ♪♪ ]
