Dr. Robert Whitfield explains how bacteria and fungi in breast implant capsules trigger chronic inflammation and immune responses. About 29% of capsules show bacterial contamination. He argues complete capsulectomy, removing the capsule intact, eliminates persistent sources of immune activation and is safer than leaving scar tissue behind.
Foreign.
So let me see if I can, I'm going to see if I can take that and sort of capsulate for everybody. So, so obviously you've been looking in the capsule, right? In the, the biofilms that are available from the infectious activity that you find in breast implant, you're using pcr, which identifies is a bacteria or fungus or something present. Right. And, and for everybody, that's, that's our current level of technology that's accessible commercially. The next one would be rna, which is then what are they up to? What are they doing? Right. If we have bacteria present that aren't supposed to be present, especially infectious bacteria, fungus and viruses and things like that, that's going to create infectious activity that then establishes innate and adaptive immune cell response. And then your body is going to create scar tissue, encapsulate it, and then there we go. And then we get an inflammatory response that's not only inflammatory, but initiating immune response constantly. And this is really the trajectory of breast implant illness. And we wouldn't be able to palpate it because it's under the muscle, because that's our current technology to do implants. Is that the, is that a pretty good sort of summation in real words for people?
Yeah. And I, I want to say, I'll add that when people take implants out and they don't remove the capsule, especially as I think about it, the debris or the remnants of the materials in the capsule that could be left in the tiss are ongoing sources of immune system activation. Obviously, you know my stance, it is necessary because basically 29% have bacterial contamination. So you wouldn't know that. You know, that's an after the fact determination. And then two, now your T cell has a receptor. Any of that material, which obviously is not your tissue, is going to cause a response. And your immune system is very effective at mounting a response. And so I've had patients who've had their implants removed contact us and say their symptoms didn't resolve. Well, I don't think it takes much to figure out why that didn't happen. So if 30, you know, we'll say 29% have bacterial contamination. So you're not removing that. The tissue's there. And technically, if you think about bacterial biofilm, which is like plaque on your teeth, it's not very easy to remove. So that's one problem. Two, if there's debris or rupture or gel bleed or we'll just say any contamination from the actual device of the, the shell, you know, configuration or the gel or whatever, you're going to have a T cell response to that. The arguments about not the encapsulectomy to me, make very little logical sense. And I mean, you could argue all day long with me and I'd still think what I just said is the, the more logical way to think about it from a microbiology standpoint and from a T cell activation standpoint with a foreign body exposure. So those things, you know, kind of lead me to always do a capsulectomy. And obviously there's different types of capsulectomy you'll hear about, you know, when you type in the Internet, there'll be N block. En bloc is a pathology term, you know, for tumor extirpation or removal, and that's with a margin. People get very, you know, animated about this from a society level. And so basically I just tell everybody, you know, we're doing a capsulectomy, we want to take it out intact if at all possible because of the aforementioned bacterial biofilm, any kind of, you know, rupture or leak. And many times I don't even find things out or ruptured until after the case is over. And we're examining things on the back table because I'm not opening things during the case to see what's going on. I'm trying to get them all out and, and, and, you know, get the patient taken care of. So those are the reasons why I always, you know, promote doing a safe capsulectomy. People say it's dangerous. It's not dangerous. Oh my gosh. So taking out scar tissue has been done all throughout surgery. So, you know, people say you're going to cause a lung injury. No, that's not a problem. In fact, J.J. watt, the guy who plays for Pittsburgh, he got a dry needle injury to his lung and that's why he couldn't play for a while. And that's with the little needle. So that actually poked a hole in his lung and that was the problem. So we don't do that. Anybody who operates understands that. And you shouldn't fear monger a patient because it is safe to remove the scar tissue. You can do it effectively and relatively smoothly. I've done several thousand of these cases. It's not a big deal. We published a bit bay experience of 600 and, oh gosh, 90 some ish patients for the study and do, you know, whatever, anywhere upwards of six or eight a week, pretty normal for us.
