19: Are Implants Safe After Breast Cancer? with Dr. Rob Whitfield

Hello and welcome to the Kenya breasts podcast with Dr. Jen. The show dedicated to empowering women through knowledge, tools and resources to take control of your breast health journey. I'm your host, Dr. Jen Simmons, and I'm thrilled to have you join me on this insightful and inspiring journey. As a breast cancer surgeon turned functional medicine physician, I'm on a mission to empower women to live their breast I need best lives. This podcast dives deep into all topics related to breast health, including prevention, diagnosis, treatment, and holistic approaches to support overall well being. You know what I say, Breast health is health. So no matter who you are, a breast cancer survivor, newly diagnosed in treatment, living with metastatic disease, or you're simply seeking to improve your breast health, this podcast is for you. Join us on this transformative path towards better breast health and a thriving life. And now, let's get to today's episode.

Welcome back to another episode of the Keeping a breast podcast. I'm Dr. Jen, your host. I am super excited to have our nation's breast implant illness doctor here. He is an expert on breast implant illness and an expert on explantation, and he has a breadth of experience that I know you're going to completely appreciate during today's discussion. So without further ado, welcome Dr. Rob Whitfield.

Oh, thank you for having me.

Dr. Jenn, it's so great to have you here. I know your background, but I don't know that everyone knows your background. So can you share with us how you came to be in this space?

Sure. I trained in general surgery and plastic surgery and then focused specifically on oncologic reconstruction and aesthetics. So after I completed training after nine years after medical school, so total. For all those folks who are counting after college, when I get asked about that a lot, it's quite a bit of time. I went into academic practice and mostly did 75% oncologic reconstruction for head, neck cancer, breast cancer and sarcoma. And then I did aesthetic surgery as part of the training program there to help the residents learn aesthetics and ultimately transitioned into a group private practice in 2012 in Austin. And I did basically the same things. And then a breast cancer patient in 2016 relocated from Georgia and retired here in Austin, Texas and came to me actually to take down her reconstruction maker flat, which happens from time to time. And I reviewed all of her history. She didn't have anything on examination, no physical findings, no capsular contracture, hadn't been radiated. And it was a pretty straightforward surgical plan. Took care of her because of a Medical condition. She was just watched overnight in the hospital. And so at a week, we traditionally follow up with everybody and review all the laboratory findings. So when we take down a reconstruction, I had always from training just take them down the same way. We would do at that point what I would term a total or complete capsulectomy. And we would always swab the pockets and make sure that we sense everything off for pathologic evaluation.

And just so everyone understands, whenever we put a foreign body in someone, the body just naturally wants to protect you. So it forms this capsule. So that's what you're talking about. You're talking about the capsule that the body forms around the implant. You would remove that in its entirety.

Your body naturally forms a scar around it. And that's just. It doesn't matter what kind of implant it is. It's a knee, hip, breast, dental. Your body's always going to scar everything. Correct. And so we send that for examination and we make sure that there's no residual cancer or recurrent cancer. Those are just standards that we followed. And when I saw her in follow up, of course pathology is number one. Make sure there's no evidence of recurrent disease. And that was clear. And then on her information to really look at any microorganisms. So bacteria, fungus, mycobacterium, things that are contaminants. She had an E. Coli. And for the audience, so the E. Colis or any substance that's on a surface could. That's a contaminant is reported a certain way on the report. And this was reported as an infection, so greater than 10 to the 6th, so greater than 100,000 units. And I was like, well, how did I miss an infection? That was a little perplexing to me. So I went back and I looked at her photos and went through my notes. And her main symptom just was fatigue, which is very common in patients who've had cancer treatments. They have a lot of problems with bone bone marrow suppression and are just. They have a lot of chronic fatigue problems. That wasn't a new finding.

Especially those that have been treated with chemotherapy and who are on aromatase inhibitors because it has profound effects on our mitochondria, which are our energy building units of the cell.

So that was the only thing she had. That was it.

Out of curiosity, why did she want her reconstruction taken down? Was it fatigue?

No, no. She just wanted to be flat.

That was related.

She just wanted to be flat.

Okay. Was there a problem with her reconstruction? Like in. In retrospect, could there have Been something somewhere along the line.

No, she. She had a pretty uncomplicated history without any revision. So it wasn't one of those things where usually there's, you know, a sequence that leads to that problem. But she didn't. She didn't have a sequence that was evident. And fatigue was her, you know, number one issue, but had no alterations in blood work or any abnormalities that you would suspect from an infection. So I treated her based on the sensitivities for the E. Coli, and her fatigue resolved to a much, you know, different degree. And I believe it was her who put me on a message board or something related in social media. And I just had patients start coming to me for explants. And I was a little concerned that we were missing things here that were potentially infected because, you know, sensitivity of the techniques we're using. So if you. For the audience, the technique I used was basically taking a sterile, what you would think a culture swab looks like a Q tip, and just swab the area and then you put it in a vial and hand to the. The team in the or, and then that goes to the lab, and the lab then wipes that on a little agar plate, which. A plate filled with gel, and they put in the incubator, and then that grows if there's bacteria on it. We did that successively and did not send quantitative cultures. I'm in a private practice environment here in Austin, Texas. There's not an academic center to really do quantitative cultures, and I'm doing these at surgery centers. So there's some limitations on where. Where we're operating. So fast forward, I was doing that for the first couple of years where I had sporadic amounts of clients coming for this. And then in Q4 of 19. I'm sorry. I'm sorry. Q4 of 18, I had a patient come from New Orleans to Austin for an expat because she had family here, wanted to stay with her family and have her surgery. Her background was she was an ICU nurse. And you and I both know what kind of exposure risk that puts you in. When you've been in nursing for a.

Long period of time, you basically see everything.

Right.

And get exposed to everything.

That is a very worrisome client for me to get because they've been exposed to all sorts of things.

Yeah.

And she had a lot of fatigue. A lot. And so I presume she was infected based on that previous experience, plus her occupation and what she was describing. And no laboratory abnormalities? No. No change in her white blood cell count for the audience. Because we always look for that.

But these people aren't coming in with pain necessarily. Right. Because when we think of an infection, we think of, like, red, painful, swollen, all the things that go along with what we know to be infected. Right.

I'm glad you're teeing this. I'm glad you're teeing this up for me so I can explain.

Yeah, yeah, Right.

So these people don't look infected, they don't act infected. They're. They. They're in the prodromal phase of infection. So they're before infection. So I took this patient to the or did her explant, and she had just a slime layer on her implant. And so for the audience, you'll hear things called gel bleed, which is implant material that's silicone leaking out or the destruction of. We'll say the shell is just disintegrating, but this is actually bacterial biofilm. So the same process was followed where you do the culture swabs and send things off. There's no evidence of cancer. But her cultures came back nothing. And at that point, in my experience, I was using a drain tube on each side, and her drains were putting out over 100cc's of fluid per day per side. So that's an infection, and until proven otherwise. So you can do a couple things. You can culture the drain fluid, as you know, and that can be fraught with all sorts of red herrings. You can do empiric antibiotic therapy, which means, based on Dr. Jen and my experience, we decide what we should try to treat with based on what we see in our communities and our experience. And that's what I did. So slowly but surely that drain output diminished per side.

But you knew immediately when you saw this that this was infected. Like, this one was obvious, right?

Yeah, this was biofilm. I mean, it's not a ruptured implant. That's very different. So the. Oh for the audience, too. So implants after, we'll say 2006, have more cohesion, so they're more like jello gelatin versus syrup. So this was a cohesive implant which would not leak like syrup, so it wouldn't have that kind of slimy feel. And I was so upset by this because I went out and told her husband, I'm like, this is infected. She's going to get better. And then the results came back, and of course it says nothing because the standard culture technique I was using, because of the biofilm protecting the bacteria, it could not grow on an agriplate. So for everybody listening, certain Types of bacteria readily produce biofilm, which is, think of it like a sugar coating, like a little goo coating that protects the actual bacteria from your immune system, attacking it and killing it. So it's easy to get these on implants because implants are foreign bodies, they have no blood supply, so your, your body can't actually do anything with it per se. And certain bacteria readily form these, and they're bacteria in our skin, et cetera. So at that point I was like, okay, we're going to stop and rethink what we're doing here. So I switched to quantitative PCR analysis for all of my patients. So pcr, now everybody understands a PCR because of the pandemic, it was used to identify the virus. So we use quantitative PCR. So we get sequencing of about 150 different types of bacteria, fungus and mycobacteria. So we'll just use numbers. So in my practice, I have over a thousand consecutive quantitative PCR cases where I know what's on the surface of a breast implant after it's been taken out, because I've done that many using quantitative PCR. And so about 30% of the time in our practice, there's an identifiable microorganism and it's a bacteria. And the post dominant bacteria is Cutibacterium acnes, which used to be called propion bacteria. And it's found in the highest concentrations in your face, shoulders and chest. Doesn't explain how it gets in. People ask me, oh, how's this become a contaminant? So Dr. Jen and I, if we put an implant in, it can happen when we get it from the staff who give us the implant in the operating room. It can happen when we place it in the operating room, in the patient. And then the most common and by far the most poorly understood way is hematogenous spread. So if you got a cold or a urinary tract infection, if you had somehow any bloodborne skin infection, whatever, that's how you get bacterial biofilm after the fact. And that's by far in our environments as we exist today. The most common way that I see that we get this.

So you said 30% of the implants that you explant grow, you find that they have organisms by pcr. Right. So is that why we're seeing so much breast implant illness? Because there are all those unrecognized infections?

Well, there's about 360,000 implants placed per year. And so times 10 years, 3.6 million 30% of those, that's 1 million. As the profile is raised by your show and other shows I've been on, and more people explant and discuss it. I just look at breast implant illness as a very specific in game of chronic inflammation. The medical device is one component of it. But as you know, there's lots of reasons to have chronic inflammation. And you can be someone who genetically just doesn't detox. Well, that's one component. You can have lots of different exposures in your environment, your food, your air, your water that creates a toxic burden. You still have to detoxify that. You can have a terrible diet. You can have hormonal problems. There's just a lot of things that go into chronic inflammation. A mold exposure, a Lyme disease.

Right.

We have a lot of mold in Texas. So I basically deal with that routinely now and look for it. So you miss 100% of the things you don't try to find.

Yeah, for sure. So do you think that what's happening is there's a bed of chronic inflammation and then you put a foreign body on top of it, and it. It is kind of the straw that broke the camel's back in that the. We kind of exceed our ability to deal with the allostatic load or what do you think's going on?

Well, you have bimodal distribution. So you have. People get implants when they're young. We'll say 18 to 25 or something like that. And then a second bump will be when somebody's done having children and they want to do a rejuvenated procedure for their. Their breasts after breastfeeding. So those are just very different people.

Yeah.

Younger people will have much, much different, you know, hormones, lifestyle, rest patterns, eating patterns, metabolic rates. And then obviously, somebody who's a mom who has one or two or three kids has a much, much different set of hormones, rest patterns, diets. And, you know, based on how you picked your parents genetically, that detox pattern that you can, you can run through for vitamin D, metabolism, methylation, glutathionation, and antioxidant pathways. Those really dictate, you know, how much more can you put into the bucket before it runs over and you can no longer manage the toxic burden you. You have. And then where you live, the air you breathe, the water you drink, the food you eat certainly makes up a big component of the rust.

So you're talking about things that most surgeons don't talk about. Right. Because most of the time, when you go to a surgeon, they're not talking to you about detoxification. Pathways and methylation pathways and those kinds of things. Can you just describe your approach to someone who comes to you wanting explantation for whatever the reason?

Sure, yeah. Most of the folks who initially would come to me were more purely suffering from a lot of symptoms related to breast implant illness and, or as we think of it now, chronic inflammation. And now I have people coming with really two mindsets. They just want to lead a more holistic lifestyle. They don't want to have implants anymore. And they found that much to what you just described. Our program's a little different. We try to look at everybody and we have a pretty rigorous preoperative program where when you and I trained, it would have been you check somebody's blood count, you look at their electrolytes, you look at their chest X ray and an EKG if they're of that age, and then they're either fit or unfit for surgery, needed to see a heart doctor or not heart, whatever. And now, although we, we obviously take all that into consideration, I'm more interested in the genetics and toxicity burden someone has to start off with. And then how can we modify their diet and level up their supplementation so we can help them get into a better position for surgery? Because I can obviously do the, the, the cases and take care of everybody, but that's just one component of how that's really going to be effective. And we use cell core for phase one detox for a lot of our patients undergoing fat transfer, because a bunch of people come to me specifically for that simultaneously as I do an explant now, I will say for fat transfers, there's a lot of, you know, myths about them, like they don't work or you lose half the fat, or. So let's just put most of that to bed now.

So, yeah, let's talk about that.

If somebody comes in their 20s or early 30s, we'll say and says, I want you to put fat in my butt, which is a Brazilian butt lift, or I want you to put fat in my, my breast area, which we just affectionately call it the Brazilian boob lift around here. The, the thing is, in those groups, hormones, metabolic rates, sleep patterns, diet less of an impact on them than when they're in their 40s and 50s and 60s. So metabolically, like, what's the challenge is trying to identify what toxic burden they have, adjust their hormones so that they have enough hormone to actually recover from a surgical procedure and get them on the right track on their diet and their air and their water intake to, to a point, where you feel like, you know, we're looking at a average 30 year old instead of a average 50 year old. So I feel like, you know, the, the, the process for fat transfer to me is very easy. I've done several thousand fat transfers since 1998. That's not, that's not the problem. The problem is who keeps changing in front of me, who's having a fat transfer? And so I'm trying to make sure by a really quality driven process that we're looking at all the different parameters and however we can help. And I'll tell people they're a no go or I'll tell people like, you need to do this program before we embark on this so that you get your best possible outcome. I don't want to do anything that's, I don't feel like we're going to be able to put them in the best situation.

Yeah. So who would be a no in that? What leads to that 50% fat loss that people talk about after a fat transfer?

I think it's who you would suspect. It's somebody who's got a high tox burden and you don't know it. So maybe they have a big triclosan exposure, maybe they have a bunch of insecticide exposure. So they've all just got this per capture acid metabolites and those all. It's high level. But anything that leads to stem cell deactivation or any kind of limitation in that, you know, setting is going to affect a fat transfer. Because a fat transfer is taking fat and its associated cells. Some of those are the stem cells, some of those are the vascular degenerative cells that are connected like a cluster of grapes. And you move it over so it's dead until it's healed. But if the healing process is not able to be, you know, we'll just say activated properly and initiated like it would at a young person, then it's not going to happen or it's not going to be the way you anticipate it happening. So that's, you know, without giving you a more detailed explanation. That's how I think of it. Yeah.

So I, I totally get it. But I will ask you for a little bit of details in that you mentioned getting their hormones right in order to heal from surgery. What does that look like? What are you referring to there?

Oh, you can imagine. I have a lot of people with estrogen dominance. So if you have estrogen dominance and you have bad detox, you're even more difficult to take care of. So you have to Help get them balanced out. Some of them need just a little bit of a substance to help lower their estrogen. We just do that through supplementation to help them because that increases anxiety and other problems that are associated with this. But when you combine all that, it just makes them, you know, they're the kind of worst case scenario really. Estrogen dominance, high estrogen metabolic in the, in the talks. I'm sorry, not in the talks, but in their testing. And then you have really poor genetic detox. So then you're trying to get them and, or coupled to a bad gut. So then you're trying to get them to eat better, you're trying to give them supplements, you're trying to get their, their hormone balance better so that you can make them or position them to be in more physiologic shape for you for surgery. So that's the hardest kind of group to deal with. And that's a lot of them. And if they have mold exposure, that's more complicated. It's a lot.

Yeah, but this is clearly a process. Like you're not just meeting people and saying, oh, you want your implants out, let's put you on the schedule.

Yeah, it's not easy to get on my schedule anyway. But to get on the schedule to do a transfer, you have to go through a program. I'm not going to put anybody through their paces just for an exercise and in surgery. I've done surgery for over 20 years. We just want everybody to have the best possible outcomes. And we understand the gravity of removing implants and changing the esthetics. I always try to couple that when I can to a fat transfer if it makes sense for the clients and we can get them in a good position. Because I can reshape a waist. I was, you know, I make the comments. I can take people from 6 to 4, 4 to 2, 2 to 0, 0 to minus 2 dress size and then help offset the change with removing the implant with a fat transfer. And you know, had, had many of my clients been offered something like that to begin with, they never would have gotten implants.

Yeah, yeah. I do believe that this is the next wave of what we should be talking about in the breast cancer space. But the problem is all these things that you're taking into consideration and all of these preparations that you're doing before surgery, they're not happening in mainstream medicine at all. I mean, do you know any of your colleagues that are doing this?

No, this, this is. I remained curious about genetics and kept looking at different ants, you know, I. I had ideas about this, but our testing was limited, you know, even as low as five years ago. Now, I think you would agree that testing. And we use the DNA company for our testing is. Is. Is moving and moving at a higher rate now. And we get a lot more quality, not just information, because the number of genes has grown that they're looking at, but the. The functionality and, you know, what can we do to help? I think that's, you know, probably the most impactful. And then understanding that depending on where you live or where you work or who's taking care of you, if you're younger, you're getting a lot of different exposures environmentally, and you just don't know it. And that's. That's the big. Like you can get mitochondrial dysfunction, which is the energy production of. At our cellular level a multitude of ways. And I've suffered this myself. I've been exposed to mold in Austin. So we're acutely aware in my office, and there's like a air filter, like, every five minutes around here because that is critical. Like the air you breathe or, you know, the water you drink. You drink your purified water not out of a plastic bottle, but out of a, you know, we have yeti here. So everybody's got a yeti or a glass, you know, bottle. I. You know, these are things that we have to tell people and educate them about because of phthalates that are in plastics, which are what are used to harden plastics, they affect a woman's endocrine system. So those are all, like, common things. Glyphosates, organophosphates that you find in foods. So just trying to make everybody aware that these are things that you have to pay attention to, and they're important, especially to a woman who is estrogen dominant and who has poor detox. I mean, that's just a bad situation.

It's true.

But oftentimes it doesn't get recognized until they get a breast cancer diagnosis. It's not being recognized early enough. And when those people are turning up with difficult periods, they're getting placed on the pill. When they're getting turned up with infertility, they're going through infertility treatments, and nowhere is anyone really intervening. So. And even at the time of breast cancer diagnosis, most people aren't intervening. And what happens is these. These women are rushed to treatment, right? And they're told. They're told to get genetic testing, but the genetic testing they're getting is they're checking for broccolines and. And, you know, and, and genes that are not necessarily relevant in the context of them getting better. And so, you know, the genetic testing that you're talking about is all actionable. And I would argue that, you know, BRCA1 and BRCA2 are actionable in that if you live your life in an anti cancer way, it's unlikely that you can influence the outcome of those genes. It's not your destiny. But when people are getting a diagnosis and rush to treatment and not given these options, it's a problem. So, you know, they would never wind up in your office as a first choice.

Now even when I did oncologic reconstruction, I was always the last person to be spoken to, which was always a little hard for, for us because people obviously come in at a very difficult moment and then we're supposed to be able to kind of discuss all the different options in that situation which may not be aligned with what their breast surgeon told them. I'm sure you've not always been in alignment with what a plastic surgeon wanted to do. I was a microsurgeon, so I was not a implant favored surgeon in terms of technique. And that's, you know, people self selected to come see me. So I wouldn't see that many patients anyway.

I mean, when I was doing that, most of my patients had a deep flap reconstruction. So I, I, you know, I was working intimately with my microsurgeon and I.

Which is not the case around the country.

I know it's not, but the, but that's because the availability of microsurgeons is still not, they're, they're still not readily available. They're. Everyone, not everyone has a microsurgery program.

Right.

So maybe talk about the different reconstructions a little bit. But, but mostly I want to make the point that people have time to like do their investigation and really make a decision that's right for them.

Yeah, they're always, you know, based on their timing and you know, all, all we can do from, you know, my perspective was discuss what options we could provide. And that included of course, a, you know, a version of an implant based reconstruction. If that's the decision. The, the thing is, you know, what does that look like? Because sometimes you don't know what therapy ends up being until obviously afterwards.

Yeah.

With, with, after breast surgery and discussion about radiation therapy after that. And that always leaves a lot of other questions, but we would try to lay out the options and then always leave the door open to have a delayed reconstruction with a deep flap. But I preferred to do them immediately whenever Possible because I didn't like the delay because of the difficulty trying to get the tissues to do what you want them to do after they've already healed and, and scarred down. Sometimes it was. That can be complicated. So, you know, we tried to always be very clear about the. The first time is the best time.

Yeah.

And immediate. If we can always provided safety, which was the number one thing for the patients. And then, you know, we would help however the patient would be best served in the end game by that. If it was delayed, that was great. But for overall aesthetics, we chose to work more with folks who did skin sparing more. That would allow them to do immediate reconstruction. Because there's always going to be a group of providers who's more interested in that.

Yeah. I mean, in my experience, if you're not ready for surgery and that if you're not healthy enough for a reconstruction, you're probably not healthy enough for the initial surgery either. And that's. That's a big. Yeah, that's a bigger problem. Right. So if you're saying to someone, well, you're okay to have a mastectomy, but you're not okay to have a reconstruction, there's something wrong with that thinking. And I would keep looking.

Yeah. We were very efficient, too. We had done over a thousand surgeries, a thousand deeps, with a 95% success rate, usually under four hours for bilateral. So we had done so many. Just so the audience understands, obviously this is something that requires a level expertise and repetition and working with provider like yourself. So it's a lockstep. It's not disjointed. It's a. There's always a flow to doing everything in the operating room.

Yeah.

And that's best for the patients.

Yeah, for sure. But don't call me because I don't do surgery anymore.

Right. And I don't do deep flexion. Call Dr.

Rob because he doesn't do reconstructions anymore.

Not anymore.

But, but the point that people should take their time, know their options, because, you know the consequences down the road are great. Right. And if you rush into a surgery and you accept a lesser option and you have an implant reconstruction, this is something that is going to have a profound effect on your health for the rest of your life. And you. You see a lot of that. So can you. Can you talk a little bit about breast implant illness and what that looks.

Like as it relates to the cancer patient?

I mean, anyone really. But. But certainly anyone who has had implants placed for any reason. What does breast implant illness look like, and why, why should people be thinking about it?

Well, I think I look at it now as a recognition of symptoms. So that an allopathic physician, your gp, would, you know, you'd come with a series of complaints, headache, visual changes, and they'll consider something in your central nervous system. If you had pain in your joints or nerve pain down your leg, they'd be thinking something in your musculoskeletal system. If you had something stomach upset and abdominal pain and constipation, you know, something obviously in your GI tract. So pretty much at any given time, I have somebody show up with all of those complaints at one time and they have breast implants. So basically, if you do and check the boxes for just symptoms, as a physician, all of my patients check almost a box or two or three in every single category down the body. And that's how I look at it. It's chronic inflammation. How we deal with it for the cancer patient or the cosmetic patient doesn't vary as much. It has to do with. It has to do with.

The.

Explant is part of the treatment plan, of course, but where are they starting from? And then we do our testing, which is part of our holistic accelerated recovery program. Check their genetics, their toxicity profile, their gut microbiome, their hormone status, and look at a food sensitivity test to see what triggers can we take out of their day to day that will help reduce their inflammation right off the bat and adjust their diet and take gluten out and take dairy out and processed foods and decrease sugar. All things that are just coming, you.

Know, more commonly, quite frankly, if you have a breast cancer diagnosis, those things should be out of your diet anyway.

Right? Yeah, that's, I mean, those are the things that, you know, we start off with. So, you know, before I used to do explants and the, the whole thing after that was what happened. And about a third of them would get better right away within a few weeks. And then month over month there'd be changes in the other, the other groups. And now, you know, thinking back, like, those are just people who had more problems with detox, they had more toxicity to deal with and, or problems. So the, the issue for me became how do I adjust these things and get them, you know, so that each person's kind of having the same, you know, recovery program afterwards.

Yeah.

And, and that's basically, that's why we do what we do pre op, so that at the end we have a better idea of all their drivers to the best of our ability. And then I Don't have somebody recovering two years after surgery. But, you know, we're trying to get everybody on a month over month, quarterly basis to look the same the best we can. Of course there's going to be variables, but it's, it's a lot more even for us now. And the patient experience is better.

So I would assume that there are some patients who are unwilling to make changes. And to them you would probably say no because you're very results driven.

Yeah. If they're not willing to put in the work, either with our detox program and or testing program, it's probably not the right fit for you to be in our patient population, because we're really interested in doing the work to get you the best results. And I know for doing this for over 7 years now, what are the drivers that contribute to the problem? The implant's just one of them. And if you don't address the other drivers, you're still going to be struggling with things potentially down the road based on how you detox genetically or what toxicity you already have, or maybe you live in a home that has mold, or there are just all these other things that if you don't take into consideration, you're going to have a prolonged recovery or not recover in the manner we see normally.

Yeah. And we do still hear stories all the time about people who had suspected breast implant illness and then they went and had their implants removed and they didn't improve. And so I guess what you're saying is that there are other factors happening there and the implant is just a part of it, but that you have to address all these other things.

Right.

So how do you feel about implants in general? I mean, do you think that everyone should have them removed?

You know, I have a group of patients who come and see me just for advisement about this. So they'll ask me like, what, what should I do? And you know, we'll go through a review systems. But invariably when someone's like that and they're not having symptoms, you can imagine their genetics make it so they don't have as many problems with detoxification. So the answer is really in their genes, not even having surgery. So if someone's having symptoms, they're going to funnel into me eventually. I think there's a whole group of people that detoxify and lead a lifestyle that's as you mentioned already, just like if you were given a, a diagnosis, you could adjust it, and they're already living that way. So whether they have a hip, knee, breast implant, Dental implant, neural implant. I mean, I've taken care of everybody's implant problems.

Yeah.

So that's just one component. All the other things we're talking about play a huge role.

And then what do you think about lifespan of implants? Do you think that people should be removing them electively after a certain period of time, exchanging them? What do you think about that?

Yeah, this is, you know, before when we did, you know, mainly cancer, I had really close surveillance of patients and we always worked on the guidance that after 10 years, a half percent per year, the rupture rate increases and we'd always look at addressing those with really early surgical interventions, especially in our cancer population, which I carried over to cosmetics. So it's more about seeing those patients. I would see everybody annually and make sure there's an assessment. And obviously in the breast cancer patients, if they needed an ultrasound or. Mr. That was done and we would evaluate those results. I see a lot of people come in. I just operated someone last week with 34 year old implants all ruptured and leaking and they knew about it on Mr. And I was like, okay. And the recommendation was what? And their doctor knew me. So they, they came, flew here and saw me. It's like, yeah.

And you're obviously talking about a silicone implant because a saline implant would just deflate.

Right, right. That's, that's always the case with this is like I don't understand the follow up because it's so anti, you know, how I would see and take care of people. So I didn't differentiate a breast cancer patient from a breast cosmetic patient because I can't have two protocols and follow up. That doesn't make any sense.

Right.

So I would always see them in the same, you know, like annual follow up. And if obviously anybody called with a problem, we'd see them and, and assess them and go from there. So basically I don't, I don't know how you get to this point if there's, there's follow up. I try to follow people closely, especially when I'm doing these cases now, but I always have had a pretty, I guess, aggressive follow up pattern and I just didn't see that.

But you wouldn't, you, you wouldn't just exchange someone because of a time 10 years or 15 years or 20 years.

I did in the past.

You did just, I did my cancer patient because of the age of the implant.

Yeah, that was our, we kind of got to that 10 year frame and many times during that process they had already needed another procedure. And you may have already exchanged the device, especially if they were radiated. So it was just a much more aggressive surgical program. And when you do and look at studies evaluating breast cancer, reconstruction with implants, they always have more operations than somebody who had a deep flap.

Yeah, for sure.

So that's. That was always going to be. And I, I don't want to Maintenance. It was just part of the program.

Yeah.

And I didn't really differentiate. I would tell the cosmetic patient like, okay, you're getting close to 10. You know, this is how I manage this. Normally we would exchange these and, you know, that was always, you know, obvious. There's lots of factors that go into that, but I would always counsel them that this is not a lifetime device.

Yeah. And now, knowing what you know and seeing what you've seen, how do you feel about elective implant placement, both in the general cosmetic population and in the cancer population?

Yeah. I get asked, like, can I determine, like, who's going to get this problem and what can I help them with up front? And if I know your genetics and your toxicity profile and your other parameters, I can give you a pretty good summation of what I expect. But just like, you know, if you adjust these things ahead of, you're not going to get into many of those problems. So can I give you the genetic profile? Sure. 100%. I can tell you that this is what I would expect, but that doesn't more itself out. So I. People always ask me, you know, would you let your daughter get implants? Well, my daughter's a Leo, so I know how she detoxes. But you're not going to tell a LEO what to do. That doesn't happen. I'm a Leo, so that's fine. You can give people the best information they have to decide for themselves what they want to do. You just want to give them informed consent in a manner that makes the most sense for them. And you know, to me, I think of it as understanding your genetics, your environment, your food, air quality, water, and then you can make a decision.

Yeah. But you're not inherently against them because I, I mean, I'm. I'm guessing. I don't want to put words in your mouth.

I haven't put a device in and over, you know, I guess it's almost four years now. But it's, it's not because they, you know, for, certainly for cancer, I put them in because in some patients that's what they could have. And, you know, you're still from a, you know, whether it's a Hip, knee, breast, whatever implant, there's still going to be a role for that. And, and you have to do the best surgical procedure for the patient who either wants, desires, or needs that procedure done for them. So for aesthetics, you know, I would prefer to do a holistic transformation with fat if I could do that for them. And I don't put in implants anymore, so I'm not the person to come, you know, get advice about that. I'll, I'll. I'll guide you on what I think, but I, I haven't placed the device in a long time.

Yeah, yeah. And so I just want to end with. For the people that are currently. They, They've had implants either for cosmetic purposes or as breast reconstruction, what should they be thinking about right now? Like, where should they be putting their energy in terms of, in terms of their health and the longevity of this?

Yeah, I, you know, we have this chat a lot because I have people come in from all over the country and they want to know should they get these out or, you know, what options are there? And I say, you know, looking at your results of testing will help guide you. And once you're armed with enough information to make an informed decision, then you can decide. I think the problem is, and what people get frustrated by is they don't feel like they have enough information to make an informed decision or a shared decision like we've done in cancer cases and other complicated surgical cases. And that's all. We've tried to build out the best program we can to give you the breadth of information you need to make an informed decision about it.

Yeah. And, I mean, I have a patient in mind who is just a wonderful person who's really tried to clean up her environment, eat differently, move differently, think differently. We ran her DNA and she really wants to keep her breast implants, but she's not getting better. Do you have experiences with someone like that?

Right. You can't make anybody want to do something. So, you know, we all know that if you're going to get, you know, a patient who's reluctant or has reservations about surgery, I don't offer them surgery. They have to arrive at their conclusions. That's why the program exists the way it exists.

Yeah.

And if they sit in front of me, I'll give them a very plain explanation about what's going on and what I have seen in my experience over seven years and 1600 explants. So I'll. I'll give them the best set of, of guidance and advice that I can give them, but you're always going to have a patient who's reluctant because it's a big body image change, psychosocial change affects, you know, their relationship with their loved ones. So there's all sorts of things in the atmosphere that can create problems for them that lead to them not wanting or refusing, you know, to do something that may be in their best interest.

Yeah. Well, I love your holistic approach. I love how you really help to create health in every way possible for women who are struggling with this. And I'm, I'm just so grateful that you do what you do. How can people find you?

So you can follow us on Instagram at Breast Implant Illness Expert. And then I have a website just for this for information purposes where you'll learn more about it and what we're doing. Latest things in our clinic, breast implant illnessexpert.com and the same for our YouTube channel, Just Breast Implant Illness Expert. So we try to give all the information in whatever format you find best to use so that we can just give you really what I've learned over seven years that I feel is going to help you the most in your journey.

Yeah. Amazing.

Dr.

Rob, thank you so much for being here.

Thanks for having me.

It's Dr. Jen.

Thank you for joining me on this episode episode of the Keeping a breast podcast with Dr. Chen. I hope you found the discussion informative and empowering. Remember, breast health is health, so by staying informed and taking proactive steps, you have the power to optimize your well being. My team and I encourage you to apply the knowledge gained from today's episode to make positive changes in your life and share what you've learned with others. If you enjoyed this episode, please subscribe to our podcast and leave us a review. Your feedback and support mean the world to us and help us to reach more people who can benefit from these conversations. Stay connected with me on social media where I share additional resources, advice, updates and announcements related to breast health. You can find me on Facebook, Instagram and YouTube. Dr. Jensimmons. And remember, my Jen has two N's. So until next time, remember to stay proactive and informed and confident in your breast health journey. The key to your health is you.