Why Your Body Rejects Breast Implants | Dr. Robert Whitfield

You know, once we can evaluate that data and compare it to rsat, it will shed light on why the patients that we have have so much difficulty just with detoxification. Because literally, in our patient population, about 83% on audit have SNPs in multiple pathways. So people ask me all the time, can I have implants and be fine? Well, sure, yeah. If you detox. Well, yeah, of course. Right. If you don't have a lot of problems, like there's a genetic profile that basically puts you at risk for not just this problem, but all sorts of chronic inflammatory problems. I know. I don't think that takes a rocket scientist to figure out.

All right, Dr. Whitfield. So you're one of the only. I think, actually for really the only surgeon in the United States and probably even worldwide that actually performs explants and fat transfer at the same time for breast implant illness or breast. Breast implant removal. And I want to talk a little bit about kind of how you got into this world. You know, why do we see breast implant illness anyway? Because I think a lot of people don't realize that this is still a thing. You and I have talked about this before, but particularly how you come. Come about being able to do a method that most people don't even know exists. I think most women don't even realize if they're doing some sort of breast reconstruction after breast cancer or. Or they've had implants and they want them removed or they have illness that they can even do a fat transfer. So tell me a little bit about, like, how did you get here and. And how did you get to the point where you do something no one else does?

Well, thanks for having me on, Dr. Murray, and I appreciate that because it's a conversation that's not had with patients when they first get augmentation. Many patients who come to me who explant and I say, well, did have the option of fat transfer explains here. And many of them say no. Now you have to qualify by many of those patients where low BMI just begin with, and that's why they got an augmentation. So not everybody is a candidate, right? You have to have body fat in order to do a fat transfer. So when I'm seeing patients later in life and we'll say, you know, 30 to 55 is kind of the bigger area of. Of the group that I see. Many patients have had children already. Many patients are perimenopausal or menopausal, and they've gained weight. Now, sometimes what I try to do Dr. Murray is I ask everyone to get something that's usually readily available in their communities, which is a DEXA scan. D, E X, A scan. Now, I'm not getting it for bone density, but although with the abuse of GLP1s, I now feel it's incredibly important to have a baseline. And it's really. We can talk about that, you know, as well, it's a frustrating thing for me to have patients on drugs that affect bone density in my patient population without any baseline. So I'm looking for fat. Where is it distributed? We're looking at the abdomen, of course, the love handle area, the inner outer thigh areas. Those are the most frequently accessed areas that we would use for fat. But as you would expect, you know, patients don't want to have an explant and aesthetically be affected. So I try to do as many simultaneous transfers as possible. But you and I both know that if you don't prepare the patients properly, the chances of success or the efficacy or the outcomes are going to be more variable. So there's a great paper that I refer to and I always, I always thought about this in my mind, Dr. Murray, like, okay, if all things being equal, if you just transfer your own genetic material to the right place in the right space at the right time, it should work, right? That's how transplants work. So autologous, which is what we're doing, is transferring your own fat to the space behind the skin above the breast tissue. So that's where the fat lives. It doesn't live in the breast and it doesn't live where the implant was. Many patients ask why do it at the same time, just like you pointed out. And there are a lot of folks concerned about toxins. Toxins get stored in fat. So we look at a vibrant wellness total talks test pre op on all of our patients for having fat transfers and all of our patients having expat because we run a whole program based on my book the Short Method to really prepare patients in the most holistic way possible pre op, so that there's not as many of these things that we have to deal with post op. Fat transfers should work, you know, really, really well. I just shot some footage about hyperbaric oxygen therapy for improvement in fat transfers. And we have lymphatic massage from New Zealand with the flopresso and red light therapy and nanov therapy and all sorts of other therapies that probably can't remember my office. But just in general, that should work. Your own genetic material should work well when you're prepared properly.

So I would assume, obviously, you know, if somebody's going to any, really any surgery, because I'm going to ask about personal things in just a second. But you know, if, if you've already got trauma from the surgery. Right. You've got trauma from the explant because the explant was infected and all these other things. And if somebody doesn't do that preparation, I'm assuming you could get necrotic fat tissue and other things. If they aren't really prepared to do a fat transfer or even, even if they're, you know, not doing that, even if they were doing some other method, if they, if they haven't really done the pre op prep, it's not gonna come out as well as if they did.

Yeah, I think being prepared, you know, and we didn't talk about all the different factors, obviously there's emotional factors as well that go into this and working on yourself is, is, is principally and paramount. What, you know, one of the things that I find difficult to get patients to do as I imagine to do as well. And then we prioritize, obviously sleep and nutrition and quality of food and fluid intake. And you know, when you start stacking all of those changes, then you'll get a big difference. Right. Those tiny habitual changes will amount to a very large change in your, not just your, your well being, but in your preparation leading up to any surgical procedure. And so the sharp method works for whatever surgical procedure you want to run. And we talk about cosmetic surgery because that would be the, the next most logical place where people want to obviously get prepared and recover as fast as possible. And then regenerative medicine, space, cosmetic dentistry, orthopedic surgery always comes to mind because of my close association and work I've done with orthopedics. But you can really spread it across any surgical discipline.

Yeah, I mean, you know, looking at it personally, I think you and I have talked because you and I know each other, we're friends. And I have to have a hip replacement, but I also have torn like my gluteus medius, my gluteus, my hamstring tendons. So it's like it's a lot more than just a hip replacement. Like I've done full labral tear. And I was like, I got to talk to Robert before I do this because I got to make sure I'm doing the right thing to recover. Because, you know, even picking my surgeon, you know, I know people come from all over the world to see, you know, Right. Your surgeon matters. Right. Like, I waited to talk to this guy that I'm seeing for six months because he's one of the best of the best. And I was like, I want somebody to look at me like an athlete, not a woman that he's like, eh, you'll still be all right because you're in your 50s. Like, that's important.

Right? Yeah. You know, this is operation, the game, so to speak. Operation is better if, in fact, you've had a lot of repetitions at that game.

Yeah.

If you don't have a lot of repetitions. Surgery is not the sport of the sport for you. You should move on. So waiting does matter. I mean, I'm speaking to someone from Australia later today, I believe. And, you know, we have patients, you know, that, you know, do come from all over the world now. And it's very, you know, I'm. I'm very proud of that. Our team is excellent. Our stack is great. And, you know, basically the patients who, who come, you know, they're trying to get a different level of experience, just like you're describing, right. There's a level of surgical experience, there's a level of clinical experience, there's a level of team experience. And at every, you know, level of the organization, we have really, you know, drilled that into the. The team, so to speak. And whether it's, you know, I have my own tech who's done thousands of cases with me, and we're opening our own surgery center here shortly, like we've talked about offline, to better improve the patient experiences and the surgeon's experiences as well as, you know, all the things we have in the office that I mentioned before. The human regenerator, the hyperbaric chamber, that's vertical, so nobody has to, you know, crouch down. Just like, you know, for you. You wouldn't want to, like, lie down in a chamber after a hip transplant or hip replacement. I'm sorry, that would be. That would be awkward, you know, versus just stepping in and sitting should be fine. Right. There shouldn't be an issue with that. You know, we. We try to think carefully about and intentionally about what the patients have to experience and. And go through that's, you know, coming and spending a week in Austin is. Is the minimum commitment for in the United States and out of the United States. I've had people stay minimum of a couple weeks. I've had people stay a couple months and everything in between just so that they can take advantage of all the things we have in the clinic.

Yeah, yeah. So let's. So let's talk a little bit about this because, you know, if anything though, the women that listen to menopause mastery, you know, I tell everybody we, we associate or at least this is my perception and I know this is how I, I see it. I, I relate to JLo aging. You know, when people are like, you know, when, whenever you ask AI and I was like, give me a woman in midlife and they show somebody that looks like, you know, one of the golden girls that fits this me off. I'm like, I don't relate to that. I mean, I'm just being real. Like, I don't relate to that. I, I do not, I do not feel like I feel really great at 56 and I want to look that way. So even like cosmetically and other things, you know, I, you know, all those things are on the table for a lot of my listeners. And so, so let's talk about your Sharp method. Method in particular. So if a woman is thinking about cosmetic surgery or, or like me orthopedic or anything else or, or if they just want to feel better, this method is a way to prepare as if they were preparing for surgery. So tell me what Sharp stands for.

Yeah, Strategic Holistic Accelerated Recovery Program. So the way I was taught was you need a chest X ray to look and make sure somebody doesn't have, you know, pneumonia or there's, there's not something we're missing that's big, that's going to hurt them any kg. So we make sure everybody's got a normal, you know, cardiac rhythm, basic blood work to make sure somebody's not anemic and then electrolytes to make sure somebody doesn't have a really elevated potassium level which could, you know, potentially harm them while they were under anesthesia or when they were given, you know, certain drugs. And so that's how I was taught circa 19, you know, 92 to 96 for med school, 96 to 2002 for surgical training, 02 to 04 for plastic surgery training, and so on and so forth. But now I don't do really any of that. You know, I make some kind of basic assumptions and I hope you don't have a pneumonia, I hope you don't have a cardiac problem. Now all those things have to be worked up before, you know, you're ever going to come see us. When people, you know, some, maybe this happens to you, but people all the time will say, you know, I feel like I have palpitations. Well, if you say that, you're going to have to get that evaluated. Because I'm a plastic surgeon, not a cardiologist. So you need to get that checked out. That could be from a number of reasons why you feel that way. You know, anything, you know, from anxiety to an electrolyte abnormality. So, you know, just get it checked out.

Well. And it's a really common symptom with menopause, right? So I'm like, if you're not on estrogen, girl, girl, you got to be on. If you're not on hormones, chances are you could get what sounds like and feels like heart palpitations and is. But it's related to the lack of estrogen. Estrogen. Now, do you. I'm just curious, before we go kind of into your deeper thing, you. You probably recommend your patients, depending on where they're at, if they can be on hormones, they should be because estrogen helps collagen and. And elastin and all those other things, too.

Yeah, And I'm glad finally, the powers that be finally took the black box off of estrogen. So basically, you know, the way we did it, and because I. Patients come from around the world or around the United States, I don't manage their estrogen. I want that, you know, done. That's more nuanced, as you know. Now the way we work people up is looking at their functional genetics. So, like, detox pathways that are genetic. Look at a tox test to see, like, what is their level of a. Mycotoxin. So mycotoxin, if. If we can just go. There is. That's what comes from mold. And there's a whole list of these things. Aflatoxins can be found in nuts, and zin can be found in coffee and so on and so forth. And that's very common. In addition to your ochratoxin from black mold, which can be found in wine, it can be found in your, you know, bathroom, in the shower, whatever. So all those things affect each of us very differently. They may not affect Dr. Murray at all, but I know I get really sick if I get exposed to black moltres. I just don't detox it well. So that along with. And we do do a gut test, although, you know, Dr. Murray and I have talked about this. Man, those are really challenging. And I've done, you know, as a plastic surgeon, I think, way too many gut tests personally. But we've settled on the gut zoomer now. And then we do look at blood work mostly for just balance, not, you know, can't have anybody anemic, of course, and. And I have a bunch of folks who have parasitic problems just like you do in your practice. And so those have to be addressed. The thing we do always add and look at, as Dr. Murray was alluded to, is hormones. So if I have somebody come in who's completely out of whack, they need to get that addressed. We used to do quite a bit more temporary testosterone balancing, because testosterone is such a, a necessary hormone for recovery. We would add that a lot. But based on certain things at the centers we've been working at, we can't use that currently, so we do it in the offices. Now, that all being said, you heard the last thing I did was look at somebody's blood work. It wasn't the first thing I did because that's not really where you're going to find most of the problems and the things that you need to, to look at. So we'll take our fat transfer patient who's coming from, we'll say Florida. Florida's got tons of trouble in terms of mold from the moisture, the natural disasters of flooding and hurricanes and all the things there. So if I have somebody, which just happens pretty routinely, who wants simultaneous fat transfer, they'll call up and say, okay, and we'll get their test and it'll come back and it'll have a whole litany of, you know, mycotoxins in it. And, you know, just like you, Dr. Murray, I have to sit there and go, okay, now you're not a good candidate for this. So that being said, the thing is to do or to go through a, a protocol, and there's lots of them. I'll. I'll give you how we think about it. We utilize hyperbaric oxygen pre op. So for everybody listening, hyperbaric oxygen increases the level of oxygen in the tissues. So tissues that are hypoxic or have low oxygen levels are infections, or we'll just say, you know, problems lie. So increase in oxygen level tensions always improves those, you know, tissues. Secondarily, we put people on something medically that's an antifungal. So there's antibiotics that treat bacterial infections and antifungals that treat fungal infections. We treat these with itraconazole, typically, and then we also use a medical grade binder and basically cholestyramine because the mycotoxin binds to the bile acid and your body wants to resorb the bile acid, doesn't want to lose it. That's part of the intrahepatic circulation. So basic. And, you know, Dr. Murray's got a PhD in the gut. She knows all about this. So anyway, you have to take that out. If you just treat somebody but don't take that out, you're not going to eliminate it unless, you know, you're super fortunate, which my patients are not on the super fortunate side almost ever.

Yeah, I'd like to joke that that's my lotto. Yeah, I won that lotto. I don't, I don't do those well.

And then, you know, we like to repeat that test and make sure those levels are coming down and then we adjust based on that. There are always other homeopathics that you can use or pretty aggressive with that upfront protocol. And then if everything's going according to plan, they're dropping their levels. We can proceed with, you know, the, the procedure and afterwards. I've had people have the best results by staying very aggressive in that protocol afterwards. Especially as it relates to hyperbaric oxygen therapy once again, after. Right, so surgery decreases blood flow. It doesn't increase blood flow. The only surgical procedure that increases blood flow is cardiac surgery where they revascularize because there's a blockage that improves physiology. There is no other surgery that does that outside of that, you know, procedure. So everything else causes, you know, hypoxia or decreased oxygen levels in the tissues. So if you typically operate, operate Tuesday, Thursday, the day after, everybody comes here for hyperbaric therapy.

Oh, awesome.

So they'll get that. They'll get red light, they'll get some lymphatic massage with nanov therapy, and they'll get the human regenerator, which helps decrease their sympathetic activation. Because everybody's cortisol is way up. Right. Rob's the number one producer of cortisol in the world because he operates on people for a living. So I cause cortisol dysregulation, basically, for a living. After that, you gotta keep your nutritional support up. There's all this, like, kind of waxing and waning about, I'm gonna get big and bulky if I eat proteins. Weird. I don't know where that came from. The other thing is the, the most recent studies that you can, like, look at and really glean something from show that if your BMI drops a point, your fat transfer result may suffer up to, you know, 50 to 60 to 70% loss. If you can keep your BMI at the level it was pre op. Remember, I use a DEXA scan, so it's not easy to, you know, fool the dexa. If you put in the weight properly, you can't Fool. If you put in the weight right afterwards, if you can keep it level or go up a point or two, you can keep almost 80%. So I used to. And I still espouse the same thing. This is not a technical challenge, Dr. Murray, it's a behavioral challenge on the patient side. There's a lot of work that goes into it for them and to maintain it. And people ask me if this is going to last. Well, you do perimeter menopause and menopause for a living. Everything is going to change, right? You know, unless I freeze you the day after I do it, it's all going to change over time. So let's just be realistic about expectations. And I'm very transparent about that. You know, I, I don't over promise anything. I can do the exercise of acquiring fat, processing fat and placing fat back in the correct, you know, places with the proper preparation. And then patient needs to heal that and maintain that level of, we'll just call it, you know, well being, you know, as it relates to nutrition and sleep and quality of food and fluid intake, but maintaining the bmi. So I really discourage, and I'll, you know, you can argue with me about it, but I do not like hit or interval or cycling or running as a way to maintain a fat transfer result. In fact, if you do any of those things, I tell you you're not a candidate for that procedure because that's the polar opposite of what I need you to do and what you should be doing as a perimenopausal or postmenopausal or menopausal woman, which is maintain strength, increase muscle mass, and add healthy fats into your diet. Those are like core things that it's somehow like going over everybody's head.

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This has already happened to me. I've had people, you know this microdosing bullshit. There is no microdose. There's a dose. That's what's approved. When you quote, unquote, microdose with a compounded drug. There are a lot of variables there you don't really understand. Right. One, you got it off the Internet. Typically, there's no qa. There's no quality of that. So quality can. I'm sorry, Q water control. So you could have a elevated dose or low dose. And if you interview people as you have, you'll hear, oh, this vial was different than the other vial. And my favorite is one patient recently said, oh, and sometimes if there's more in the vial, I just increase the dose. You know, like leftover.

Yeah.

And I said, oh, I'm just curious, if that was a heart medication, would you increase the dose just randomly like that?

Yeah.

And they of course look at you and go, no, I know that's wrong. But intrinsic fat, fat, they think this is okay to destroy. And it's really not. I've had patients, patients that are very prominent, high profile people give themselves facial fat atrophy. And I can't fix facial fat atrophy in patients. Not because, you know, there's not a solution for that. But when you're taking that drug and the solution is to put fat back. So you got fat, you got a foreign substance, which I, I basically avoid putting foreign things in people. It's not part of my, my program, but it's gonna create a bunch of funny looking people.

Yeah. Oh my goodness. Yeah.

So prematurely aged people would be the better way to describe it.

I mean, I, I don't know about you, but I get all these Instagram ads because I obviously own a clinic and then I've got my telemedicine company doing hormone replacement and now I'm getting ads on Instagram about devices that help with, with skin tightening because of the, because of the GLP craze. Like that is the marketing message. Like people are going to have slack skin because I lose weight too quickly. And then like you said, you know, on your face, facial atrophy like that, like that, I would assume that would look scarred and God knows what. Right.

It just looks drawn in. It looks prematurely aged, especially around someone's mouth. You can take somebody who is naturally very beautiful with high, high cheekbones and they misinterpret their, you know, vision in the mirror as being somebody who's maybe fuller faced around and, and they're really not. And then when they use that drug and everybody listening needs to understand those all work. They all work. And the ones coming work way better than ones that started. So the efficiency with which these things are gonna creep up to, I think one Recent one was 34% effective on fat reduction. I mean, that's just shocking.

Yeah, that one's on its way out. Yeah. To the market.

I mean, when that comes out, I mean, I have a very strict policy of patients, like within six months, any procedure, they can't be, you know, taking a GLP one. And the thing is, you know, there's not a good way like to check. So we have no idea before or after what they're actually doing. And it's a frustrating thing because, you know, there's only so many avenues I have to, you know, get people really prepared properly and, and then go through a procedure and then rely on them to, you know, make these modifications in, you know, lifestyle and behavior and maintain these results. And then somebody, a year and a half later will go on and write some crazy stuff about Me on the Internet and I'm like, oh, okay. So that day I forgot how to do what I know how to do. I find that hard to believe.

Yeah, I mean, I think the accessibility, particularly of the compounded forms online, where people can just order and buy whatever, you have no idea what that stuff is. You know, could be bacteriostatic water all by itself and that's it. And you just paid 200 for the vial. You know, it's, it's, it's worse.

It's actually something three times as strong as it should be.

Right, true. Yeah. Because it's, there's no control over it when I think about it, you know, like you said, whether it's breast implant illness and, and their getting an explant or particularly cosmetics, because that definitely comes up in my age group because we start, you know, picking apart what we don't like, as, you know, you want your best possible outcome. I mean, really, honestly. And why undo all of that work that you went to the best surgeon for and had the best experience for, you know, by chasing some sort of extreme. That happens to be the aesthetic today on TikTok and, and Instagram.

Right.

You know, like, it's just, it's just a mess. So we talked a lot about kind of the sharp method and preparing and then, you know, as somebody comes out of surgery. So, like hyperbaric, obviously great for oxygenating the tissues and helping particularly like in my case, orthopedic surgery, like, there's a lot of risk for infection. It's terrible. It's terrible. Blood flow to the bone. You know, hyperbaric would be extraordinary, right?

Yes. For you, that would be something that, especially with a vertical chamber like we have. You know, I had people ask me how many times a week. And the old studies, if, if you look at how aggressively they treated like diabetic foot ulcers, the kind of worst possible scenarios, I mean, those are literally like five days a week. Well, okay, let's be realistic. Two to three times a week is, is adjunct. And that's how I view it. Right. I mean, it'd be great to, you know, have the ability to stick every person in there an hour a day. Okay, well, let's, let's be realistic. So I try to get people to do two to three times a week. Like, it's a lot to just come back and forth and spend, you know, a couple hours at a clinic.

Yeah.

So for sure. Especially with you as busy as you are.

I know I have, I have toys in my house and I Don't always get to use them. Okay, so for. So for someone else that might be going through surgery, what would you say are the top things from your Shart method that they should think about to help make sure that their recovery is best?

I feel those baseline tests we mentioned, so genetic tests, understand your genetics, understand your toxicity burden. That's going to change too. Like, these are all giving you, like, Kodak moments and a gut test. Similarly, as you know, a Kodak moment, especially depending on how. How the method of evaluation is used and food sensitivities and hormone balance. Like, it's one of those things where you're trying to craft as big of a broad of a picture as you can at one time to help patients better understand, you know, what's happening. Because blood work is. Blood work hasn't changed, really since the 50s to me. I mean, there may be some biomarkers, obviously, but is it really that dramatically different? I mean, overall, I don't make a ton of clinical decision making off of blood work. I mean, I look and see if someone's anemic and for that matter, like, there's this great, you know, post the other day I saw, like, okay, so in oncology, what is the most important aspect of a blood count? It's lymphocyte count, but it's also the one that nobody actually pays attention to because there's no drug to affect it.

Right?

Right. You can't take Neupogen or Epogen or any of these other drugs to affect those cell counts. But the natural killer cell count of the lymphocytes is what actually protects you from cancer. So if you could just augment that, there wouldn't be, quote, unquote, we'll say cancer, but that's not got a drug, and so not really an advantage there. So, you know, we try to be as deliberate and intentional about explaining, all right, here's your genetics. So maybe you don't have a really good glucuronidation pathway. Maybe you don't have a good methylation pathway. Everybody's heard of, I hope, of MTHFR at this point. It's become like, you know, part of the vernacular, so to speak. But it's just one of many methylation genes. And the antioxidant pathway ran by, you know, SOD two. If. If someone has tons and tons of fatigue, they usually have a pretty poor SOD two, you know, pathway in our experience. And then for immunity, the vitamin D pathway, it's, you know, constantly a problem with our patients. Is the majority if not like, all of my patients basically have a poor vitamin D pathway. They either have mutations in GPX or bdr. So those are just, you know, our going from, you know, activated to absorbed and all the different things we, you know, deal with with vitamin D. And it explains a lot why people have just chronically low levels, because it doesn't, you know, you can get all the sunlight in the world and then not be able to utilize your vitamin D. So, like, there's a lot of, like, basic things that, you know, we could be doing better with as, you know, groups of providers explain to the patients because they're out there typing the stuff into whatever AI, you know, thing that they, they use, whether it's chat or Gemini or clone or whatever. And, you know, that's still not clinical experience, but. And I'm glad we brought this up so we have an IRB to look at our patients genetics versus the welderly study done by Eric Topol, because they lived to the, I want to say, seventh, eighth, ninth decades without any evidence of chronic disease. So, no, like kidney disease, lung disease, Alzheimer's, cardiac. And so I'm sure you would hypothesize that those folks detox well in addition to probably not participating in a lot of things that would affect them. But I, I feel like, you know, once we can, you know, evaluate that data and compare it to our set, it will shed light on why the patients, you know, that we have, have so much difficulty just with detoxification. Because literally in our patient population, about 83% on audit have snips in multiple pathways, the ones I mentioned previously. So. And people ask me all the time, betty, can, oh, can I have imprints and be fine? Well, sure. Yeah, if you detox. Well, yeah, of course. Right. If you, if you don't have a lot of problems, you know, that's, that's basically what we're talking about. Like, there's a genetic profile that basically puts you at risk for not just this problem, but all sorts of chronic inflammatory problems. I don't, I don't think that takes a rocket scientist to figure out.

Absolutely. I can't wait to see the outcome of that study. You know, it's part of the reason why we're building the Minerva technology platform is to democratize women's health and allow women to capture their own data. But it's also to do comparison studies against data like that because, you know, why is it some women get breast cancer? Why is it some women get autoimmunity, like Alzheimer's, dementia, Cardiovascular. All those things have to do with how we are genetic, genetically predisposed, and then obviously the environment is the big trigger. But we just don't have good data, you know, And I had an argument with a, with a clinician the other day that was like, well, we, you know, we don't have data on that, so we're not going to do it. I'm like, well, you can't get data if you don't look, you know, so at some point, somebody has to, like, woman up and do the work. Right. Instead of waiting for it to happen in some sort of gray area. Because we haven't studied women in 22 years, especially around hormones because we quit treating with them. Right. So, yeah, I'm excited to look at that because I think that kind of data will help us then understand how to individualize medicine for women, you know, so.

Well, we published the study last year. Oh, gosh, now It's September of 24 because we've moved on to a new year. Yeah. That showed that in our, you know, female patients that when you explant them, the scar tissue has 29 bacterial contamination. So whether you feel like that's a frank infection or not, you know, both Dr. Mer and I know that the actual data on infections was done with urinary tract infections, and it was done in the 50s.

Yeah.

So I get a little put off by, you know, people who are rigid about that kind of Data. So since 2019, we've only looked at PCR data on our explant specimen, scar tissue capsules, because although it's not, you know, the RNA data, which shows you, like, what's alive at that time, the DNA data shows you what's there. So even if it's very, very small amounts, it just takes one copy to be there. So I trust science. I believe that that is the currently the best methodology to show me what is there. So if I explant somebody and that PCR data is positive, we don't treat anybody with antibiotics. I, I treat it as. Oh, okay. Well, this was a patient who clearly had this amount of immune system activation because the biofilm, the bacterial biofilm, can interact with the fatty acid in the breast called oleic acid. That fatty acid oxidizes and becomes, because of oxidation, oxyl, the fatty acids of lipin, a lipid. So oxyl tin home has been studied and been shown to be in elevated amounts in patients with more symptoms of chronic inflammation who have underwent explant. So, okay, so you have biofilm, you have a oxidized Fatty acid. Ultimately that leads to macrophage polarization and, and increased symptoms. Okay, so that's a cause and effect, you know, pathway. And if you have a genetic predisposition and you have that problem. Well, I would, I'll go as far to say as I presume you have more symptoms. The final and more interesting component was published recently in a paper out of Denmark and showed that the tissue, the scar tissue around the implant that the patient produces is acting in a way like it's rejecting an organ. So it's increasing. Not just a T cell response, which is normal. Yeah, it's causing a B cell response and a plasma cell response. So if, if, you know, I were to donate a kidney to Betty and our blood types match, that would be the first level of match.

Right.

The second would be the HLA match. And if it was a negative cross match, then she could have the kidney. But she would need drugs to prevent what I just said.

Yeah, like a cell sub kind of anti rejection drug.

You're gonna create antibody, you're gonna create a rejection. And that is what they're seeing now. And so that, you know, imagine someday I can do an RNA test because that's a transcriptome test. They're looking at rna and so if I could just send off a piece of tissue and get an RNA transcriptome analysis, wouldn't that be nice?

Wouldn't that be amazing?

Yeah, I mean, you know, that's why just like molecular techniques are, are probably, you know, and should be utilized more and more and more. But like, we're still stuck with like, people, you know, using Q tips and swabbing stuff. I mean, it is kind of ridiculous, but that is just the nature of people don't move on, they don't adapt. There's all sorts of reasons why. But I find it super, you know, frustrating when these things are, you know, brought forth and really interesting, you know, types of studies now that are being done. And I often say, like, I went back and I looked at all the papers about capture contracture, which is tightness or firmness of the scar around the device. It was really common when it was above the muscle. And that was where implants were first placed in 1962 by Cronin and Giraud in Houston. And so when they do that, they. Nobody understands why they're using like steroids. They're using antibiotic solutions. They're trying to get this capsule to stop forming. It won't stop. And then magically it goes down. The capture contraction rate goes down. When they put it behind the muscle. Now, Dr. Murray, I'm pretty convinced as I think about it and as we discussed, that really didn't change how scar forms. It just changed how you can examine something. So it's like a slide of hand maneuver. Right. We just put the device behind more tissue, which made it harder to feel by, by me and harder for you to tell me that it's tight, it hurts because it's not closer to tissues that you can now compress and feel easily. And when I take these things out, I, I see how tight and firm they are and I'm like, man, this is surprisingly thick or, or tight or hard to deal with because you can't tell on exam because the muscles over it.

Yeah.

Breast tissues over it, you can't palpate. Yeah, it's very hard to examine. So, and when I reviewed all of this for a show that I didn't release yet about capsulectomy, and I was just like, yeah, I don't think this has anything to do with a decreased in, in the actual rate. It just makes it more difficult for the patients to tell us there's a problem and for us to examine and determine there's a problem on, on their exam.

So, 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 got 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, 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 tissue are ongoing sources of immune system activation.

And they leave the capsule in.

Yeah. So the, the scar tissue capsule is left in now because they feel it doesn't resolve. And not in my opinion, but this has been espoused by others that it's not necessary. So I, I think, you know, from listening to our discussion, 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.

Yeah, because the tissue's still in there.

The tissue's there. And technically, if you think about bacterial biofilm, which is like plaque on your teeth.

Yeah.

It's not very easy to remove.

No.

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 shell, you know, configuration or the gel or whatever, you're going to have a T cell response to that 100%. The arguments about not doing capsulectomy, 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 en bloc. 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 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 bay experience of 600. Oh gosh, 90 some ish patients for the study and do, you know, whatever, anywhere upwards of six or eight a week. You know, pretty normal for us.

Yeah. I mean, to me it seems crazy that there would be an argument to not remove the capsule like anytime. Like in general surgery if somebody's going in and you know, like a really good example, endometriosis tissue. Right. Leaves a lot of scarring. And if somebody does repeated tissue, part of the process is to remove some of that scar tissue when possible so it doesn't exacerbate the problems, you know, So I was like, to me, that just seems crazy that we were like, oh, let's just leave that in there because, you know, it's behind the muscle and you can't really feel it. I don't know. That's crazy. So you have a book out about the sharp method. Right. And you have capacity for people to kind of, whether they're getting plastic surgery, explant surgery, or in my case, orthopedic, or they're preparing or they're doing anything where they're going to need reconstruction, recovery, that whole method goes through how to prepare and then how to kind of take care of yourself on the back side. And that book's out, is out right now. So we can get it in bookstores or online.

Yeah, it's available online and bookstores. And the point being is, you know, we have an advanced recovery. Like, patients always try to figure out ways to recover better. Regardless of what I say, you would go out and say, all right, you know, I'm going to take these supplements, or I'm going to try these changes in habits, or I'm going to do X, whatever X is. And. And maybe it's from another provider's guidance or from a friend. You experience the same thing. So what we've tried to do is really level the playing field, explain it as simply as possible through, you know, your genetics dictate how you detox. Look at your toxicity burden, look at your gut health, your food sensitivities or hormone balance, your blood work, of course, and then you have a better understanding of where you're starting from versus, oh, I go through surgery, I stay swollen longer, I feel really run down longer. I'm not really, you know, recovering like my friends do or loved ones have, like, why am I different? Well, everybody's biologically different, right? Unless you have a identical twin, you're still going to be different genetically. So that's the difference. Right? Joseph Murray, Dr. Murray. Joseph Murray did the first kidney transplant between identical twins. And they did it by first transplanting a piece of skin because skin is very immunogenic and skin did not get rejected. So they're like, oh, we can go ahead and do a kidney transplant, of which the transplant technically is not difficult. Obviously. Dr. Murray became a plastic surgeon actually afterwards and hooked up the artery and the vein and the ureter, and it worked for over a year. Patient passed away from other problems, but. And then the next step was to provide a level of immunosuppression when they did cadaver kidneys, of course, and that's azathioprine and prednisone, and that's really how, you know, transplant came to be. So when I think about autologous transfer of fat, I always think back to Dr. Murray showing that obviously if you transfer the same genetic material, which in an identical twin it is, it should heal properly, given the factors we've discussed.

Yeah, Absolutely. Absolutely. Well, Dr. Whitfield, man, you helped. You helped elucidate a whole bunch of just different steps people could take to improve surgical outcomes. And then obviously, a little deeper dive in kind of breast implant illness for my listeners, you know, that may. I think a lot of women in my age group had them put in years ago for aesthetic reasons, and now they're like, you know, I think this might be part of my problem. So thank you so much.

Especially in your area of Dallas.

Yeah. We like augmentation. We do. We do. And I, I mean, and I'm honest. I I get stuff done to my face. Like, I have Botox. Like, I wouldn't, you know, I look angry without it. But, you know, yes, we have to be we have to think about those things and what the impact may be. So I totally get it. So thank you, Dr. Whitfield, for being on with me today and educating population. So thank you, everybody, for listening or watching to Menopause Math Mastery, of course, on YouTube or on your favorite podcast station. And then we will be back next week.