#143: The Reality of Breast Implant Illness with Dr. Robert Whitfield

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Hi, I'm Dr. Tabatha, the Gutsy Gynecologist. I'm a triple board-certified OB-GYN and functional medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey, and I'm super excited to share my wisdom and unique perspective as it pertains to women's health. After caring for thousands of women, I've come to realize that your gut health determines your gyn health and your overall And it's a super gutsy thing for me to go against conventional gynecology practice to bring you the truth. No more Band-Aid medicine, ladies. We're talking root cause resolution on this show. So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, insomnia, you name it, then you've come to the right place. And I want to be your gutsy gynecologist. So welcome.

Hello.

Hello.

How are you guys? So I keep getting a lot of requests to talk about breast implant illness, BII, and it's not that well known, but essentially what we're finding is women with breast implants, some of them go on to develop chronic medical conditions, most often fatigue, brain fog, joint pain, hormone imbalance, premature menopause, all of these things. And it's driven by inflammation, inflammation from your body continuing to react to the implant that's in your body. Um, and there are certain women who are more susceptible to developing this reaction than others. Some Some women get breast implants and feel amazing and never have any issues. And then every so often there's a woman who, they got breast implants and their health started to decline after that, or they developed an autoimmune condition, or their autoimmune condition worsened. And so you're not crazy if this is you and you're wondering. Are my implants making me sick? For some women, it makes them very sick, and for some women, they develop cancer. Um, and so it, it's a real thing. It's often dismissed in conventional medicine, and unfortunately, we're doing women a huge disservice by dismissing their complaints because it's a real thing. And so I'm really excited about my conversation today with Dr. Robert Whitfield because he has been dealing with patients experiencing these issues for decades. And I love his story because he actually started out in the oncology realm. He was doing reconstruction after breast cancer patients were diagnosed. He was doing mastectomies and reconstruction, putting in implants. And, and now he does explant surgery, which is the removal of the implants. And so he has seen firsthand over the, you know, almost decade of doing explants, a lot of women who feel better and this was contributing to their issues. So breast implant illness is real. He is a real conventionally trained MD surgeon, and he has the data. He has taken care of thousands and thousands of women, and he has studied them along the way and learned so much. And now he's sharing all of this information, which is super important, you know, going to the FDA and sharing his findings and help changing the conventional medical system because We really don't understand what we do to our bodies. You know, we, we go and we have things implanted and we assume everything's going to be fine. And it might be, but it might not be. And it turns out that it matters what type of implant is placed, not only silicone or saline. Now we are understanding that textured implants are very dangerous. And those were popular for quite a while. Um, and he also talks about fat transfer as another option in place of implants. So I've had women ask me about fat transfer, and it's a great option. So he's going to talk about that a little bit too. So if you know anybody struggling with this issue or questioning it, he's an amazing resource. So let me just sing his praises a little Really quickly, Dr. Whitfield is an experienced board-certified plastic surgeon. He completed 6 years of surgical training at Indiana University Medical Center. He remained there to complete his plastic surgery residency. After completion, he chose to gain additional training in microsurgery and aesthetic surgery by completing a fellowship in Las Vegas, Nevada, under Dr. William Zamboni. He's an active member of the American Society for Reconstructive Microsurgery, the American Society for Aesthetic Plastic Surgery, fellow of the American College of Surgeons, and the American Medical Association. Dr. Whitfield focuses on providing clients with nutritional guidance, nutraceutical advice, personal genetic predisposition screening, non-invasive or minimally invasive, and surgical treatment options For all over the body. He's completed over 4,000 breast surgeries since 2004, including over 500 implant removals. He has the largest series of explant specimens with PCR testing in the country. While serving as president-elect of the research foundation, he gave testimony at the FDA hearings in 2019 regarding the bill. So, Dr. Whitfield's philosophy statement: choosing to have surgery is a major life choice. He's personally been involved in helping women make decisions about surgery since 1992 when his sister was diagnosed with breast cancer. He says each patient has to know the risks and benefits so they can make an informed decision. With the proper plan and meticulous attention to detail, each patient has the best opportunity for a successful outcome in his hands. So patient safety is incredibly important to him and at the forefront of his surgical decision-making. And he says after spending so many years of training and practicing, he just wants to provide the safest, most appropriate surgical care for women. So I'm really excited that there's a conventional surgeon out there who is addressing Functional medicine. He's addressing all of these core pieces of getting your health back and, you know, having your body function before he asks it to undergo such an extensive situation. And I just think that makes an incredible difference in outcomes. So I'm really excited for this conversation, and I know you're going to get a lot out of it. So here we go. All right, well, welcome, Dr. Whitfield, to the Gutsy Gynecologist Show.

Thank you for having me. It's been quite a while since we tried to get this done, but I'm excited to be here.

I know, it's like trying to coordinate 2 super busy schedules is a huge feat. So thank you so much for coming on today. I'm really excited for this conversation.

Well, we've talked about breast implant illness a lot off the record at different meetings, so now we can talk about anything you want on the record, as well as my new recovery program for it.

Yes, I'm excited to talk about that. And this is all very timely because the news just came out with something, didn't it?

Yes. So I rolled into work as usual, and I was, I was getting a lot of little messages that morning. So the FDA and one of the societies released a joint statement about a new cancer that forms around the capsules of implants, and it's a squamous cell carcinoma, which Is a little unusual for me to think about because it's not to get too in the weeds, but it's an epithelial cancer. It's not something you would commonly find around a device. So I don't know what really that portends. It's a really low number at 16 worldwide with 2 more cases, I believe, working in the United States. And, and then we have anaplastic large cell lymphoma, which is still more prevalent by far, 1 in 2,000 cases. And if you have a BioCell textured implant from Allergan, it's 1 in 100 cases. And then I have 1 of 8 cases in the world of a primary B-cell lymphoma. So there's all sorts of things that are problematic. You still need to be surveilled and see your surgeon. And if obviously there's any changes, then please see someone, you know, feel free to call us or see your local surgeon.

Yeah, I think We don't want to freak women out, but we need to understand that there are consequences to having breast implants and there are more risks with certain types of implants. So I would love to talk about all that, but I just would love to hear your backstory of how you even got into breast implant illness, because I think for a lot of people, they're still thinking, is this real? Is this true? You know, we, we all kind of just want to stick our head in the sand and pretend that everything's fine, right?

Well, it's, it's certainly been quite the journey. My sister was a breast cancer survivor. She had an implant-based reconstruction when I was a first-year med student. So I got a call like 2 weeks into med school that she had breast cancer and she wanted me to figure it out, which of course I had to get some help because I really didn't know anything 2 weeks into med school.

Right.

But, you know, her brother, her little brother's a doctor, so she wanted me to sort it out. And fortunately, It was very timely. Hematologist oncologist was giving us a lecture that day, and I went to him afterwards and I said, I have a big problem.

Yeah.

And he called one of his colleagues where my sister was living because I was not in the same city anymore and facilitated an introduction for her, and she got taken care of. She unfortunately did get doxorubicin toxicity and a mild CHF from it, and she recovered, but she had breast implants for a long period of time. And then ultimately had them removed, not because of BII, but a separate issue. And I went on to become a plastic surgeon, even though I wanted to be a heart surgeon. I changed in surgery training and became a plastic surgeon because I really fell in love with doing microvascular reconstruction. So my background is mostly cancer-based. And when I was hired for my first academic post, You know, the, the, the whole thing was, hey, we would need you to come do these types of reconstructions and do this amount of cosmetics and try, you know, train, you know, residents and everything. So basically about 70 to 80% of my time was always microvascular reconstructive surgery to correct breast cancer, head and neck cancer, sarcomas, which are tumors of extremities or fat or muscle. So I've had this, this kind of Like very focused career for a long time. And then I traveled with my family. We moved to Austin in 2012 and I joined a private practice and I basically did the same things that I did in academic practice. Obviously I didn't teach anymore, but I still did breast reconstruction, head and neck reconstruction, and sarcoma. In fact, when I came to Austin, there was a really famous sarcoma surgeon here, an orthopedic oncologist. And he was very excited that I was coming because I had all this experience doing these types of reconstructions, which are really there for rare, rare tumors and cancers.

Yeah.

So I basically just changed zip codes and was doing the exact same things I was doing before for the most part. And then in 2016, I have I mean, like a lot of surgeons, they'll have patients relocate to their areas who had surgery by another practitioner in a different state or city or whatever. And she was unhappy with her breast cancer reconstruction. She just didn't want it anymore, which from time to time I've had clients want that. And obviously I always think back to my sister and she had hers taken down and for reasons that are really not important to me or you, sometimes for just personal reasons and they don't want to have reconstruction anymore. So I did her exam as I did everybody's, and I still do everybody's in-person examination, went through her history and her labs and everything. And she only had one thing. She complained of just chronic fatigue. And I mean, I've done cancer care for a long time. People who've had radiation therapy, chemotherapy, they do have problems with fatigue. I mean, that's, that's, that's not an uncommon complaint. So to me, I didn't really do anything else, you know, based on her oncologic follow-up and everything we had had. I mean, I didn't, I didn't think to look any anywhere else. So I did her case and my standard operating procedure in those cases is always to take everything out intact. Especially in a patient who had cancer so that if they had a recurrence, then you didn't obviously spread a recurrence or anything like that. So those are just fundamental oncologic principles. And she had asked me to do what's called an en bloc capsulectomy at her consult. And I was like, now why would a person ask me to do an en bloc capsulectomy? That seems like a really odd request.

Right.

And I said, yeah, I can do that. I've done a lot of cancer surgery. That's without saying that's what I normally do. I mean, that's basically what I normally did. And, uh, so I said, yeah, you know, there's limitations to that. Depends on the capsule thickness, something, you know, there'll be some things that prohibit that.

And for my listeners, explain what that is. It's like trying to remove something without disrupting the surrounding.

Right. So in tumor surgery, so like sarcoma surgery especially, you never want to spill a sarcoma because then your chance of recurrence goes, skyrockets basically. So the people I worked with, They were excellent surgeons and they— I mean, I would come in and there would just be these cavities they created because they excavated this out without disturbing the actual tumor. And they had all the MRIs up in the OR and they're like, okay, we can't go here and we can't go there. So when you do it for implant, basically you want to take the scar around it, which is your body's natural reaction, and remove that intact. And that's the whole— that's what it On-block resection is basically you're taking it out like a tumor. And that can be challenging because many of these implants are placed behind the muscle, up against the ribs. That was standard from 1996 to even present time because we had to switch from silicone to saline because of a moratorium on silicone breast implants. And it was easier to cover, provide better aesthetics and it, leave it less palpable. So that was the kind of standard practice in the United States. And so when I did her removal, I took out everything intact and I, I always do the same things. I would culture the pocket where I remove this from because you never know who's got, you know, problems with residual bacteria. Like I said, you always check for a cancer recurrence. Because you've got to know that, especially, you know, an underlying recurrence up against the chest wall. So these were just standard things I always did. Check cultures and everything for the pathology, make sure there's no recurrent cancer. And so when I, when I get her back to the office at a week, she's doing fine. She's a little, you know, as anybody is post-op, she's tired, has some pain, but nothing, you know, out of the ordinary actually. She's feeling better than she did prior to surgery. And then we review her results and there's no evidence of a recurrent cancer, which is obviously paramount. But she has E. coli in her cultures and not just a little bit of E. coli. She has greater than 100,000 colonies, which is infection.

Yeah, exactly.

And so I looked at the computer, I'm like, What? I looked at it, I was like, wow, okay, well, I missed this. So how did I manage to miss an infection? Because growing up and the people who trained me, like, you did not make errors like that. That would be something you would not live down at Morbidity and Mortality Conference. And for everybody in the audience, the way I was trained prior to 2002, there were absolutely no work hours restrictions. I worked all the time.

I was there.

Yeah. Every other night call or every third night call for my career. And they changed the work restrictions the day I finished general surgery. So every Saturday morning we'd have rounds, grand rounds or ward rounds or morbidity and mortality, whatever. When I saw that, I was like, oh my God. All I could think of was I was getting up in front of that group again and I was going to try to explain how I missed the fact that a lady had an E. coli infection.

Mm-hmm.

Because, you know, that would've been picked to present because they've been like, how does Rob miss this? And so I said, okay, with, for the audience, traditional labs like this, it's a CLIA-based lab system done in a hospital. So it's a Q-tip, swab the pocket, it grows in a Petri dish in an incubator, and they check sensitivities to different antibiotic discs. So it may be penicillin, vancomycin, all these things. And according to her sensitivities, I treat her and of course she gets better because she had an infection. She's better already because I took it out. And back then I would drain everybody and do these standard practices that I've modified over time. So I presume she put me on a message board for breast implant illness because all of a sudden I had people just start showing up.

Mm-hmm.

And desiring an explant. My office at the time was like, Why do they keep calling and asking to have their breast implants taken out? And these were cosmetic patients. Now these weren't cancer patients. So she had to go into a Facebook group and post something about what I'd done.

Well, I think it's really amazing that she had the innate wisdom of asking you to do that en bloc procedure. Like she knew something was not right. And what was she getting dismissed by other doctors and just told she was fine?

And No, I mean, she, she didn't say that. Now, I mean, that would have definitely piqued my interest had she told me that. But it was never like portrayed that way to me, which of course, after her, I had plenty of people come and say that.

Yeah, because that's what I keep hearing from my gynecology patients is, do I have an issue with these breast implants? I keep getting told everything's fine, but I've done all the tests, everything else, and I don't feel fine.

So Well, right.

Interesting.

Right. That's the issue, right? So everybody now messages me, emails me, do I have a test to determine whether or not they have breast implant illness? And I don't have a screening test for breast implant illness. I mean, the thing I could help you with the most is if I had your genetics, I could give you my experience with seeing genetic problems that then I've found in my patients. So I don't cross the bridge and say, I know how to test for this, to screen for it, and then Tabatha can go have implants. I don't have that information. Forensically on the back end though, I can tell you who really can have a problem because they don't detox well. We can talk about pathway issues and things of that nature, but those are the things when combined with a poor diet, Hormonal imbalance, mold exposure, you know, microbiome dysbiosis. I mean, you can imagine how everybody's not doing very well who shows up to my office. And I used to only do explants 'cause that's basically, I was a surgeon and that's what I knew to do. And I worked with some functional medicine practitioners who are friends of mine and nutritionists who are friends of mine. And I kept saying like, what do we need to do to help these folks? you know, get further along and they would say, you know, check their hormones or send them to me and I'll work with them on a diet. And so basically that's evolved into what's called my Holistic Accelerated Recovery Program, where we do tests upfront to check for food sensitivities and disturbances in laboratory values like your lipid panel, your insulin levels, your IL-6 levels, your hormone levels, especially And I'll go into that a little bit later. But mold mimics breast implant illness. Lyme mimics it. So you have to look. I have basically a rule, like, if you live in Florida or along the coast or in Texas or Hawaii, you have to prove to me that you don't have mold.

Right.

Because I assume that you have mold or have been exposed to it. And if you're susceptible to breast implant illness, that means in your detox pathways, genetically, you don't detox Well, so you don't clear that, and it's almost comical now when I go back and and the conversations that I've heard, you know, over and over and over again now with folks who have problems with brain fog or problems with light sensitivity or sound sensitivity, fatigue. Now it's just like bells go off in my head. So I think the problem with, as your audience will understand this, like doctors. need to experience just like we did in training patterns of disease or processes that they become familiar with. So when they hear the stories, they can then add up what they should do about it. But this is not a simple thing to understand. And when you have 5 different, you know, levers involved with it and genetics, I mean, we've gone beyond the scope of anything you or I were ever taught in school.

Right, exactly.

So we're not, we're not quite caught up yet.

So you are recommending to women that they take a comprehensive approach to look at all aspects of their health to see, are we missing anything? Do we need to uncover and look under a rock before we go and take out your implants? Because that's the cause. Is that what I'm hearing? Yeah.

So initially, you know, as you imagine, I got, after that 2016 experience, I was inundated with people wanting to do explants and I've done over 600 explants. So the issue's not, you know, whether or not I can do it for you. Of course, of course I can do that for you. And I always tried to tell people the same things early on is like, I believe in 2/3 of the cases, there's some kind of biofilm, which is a low-grade infection. And that's the real generator for the immune response. And then I said, in the other third, I think it's genetics, but I have no idea because at that point, testing was not like I have now. We had little SNP things we would send to different companies and try to have them evaluated. And a SNP is a single nucleotide polymorphism for the audience. And it's When you get your 23andMe report, you know, you learn how much Neanderthal you are and they try to give you some health reports, but it's like, that's like using spell check on 150 words. And even though the spellings, you know, may not be correct, you could read the document. Now the testing I do now is very in-depth. It's a 55-page report. It goes over everything from your, your tendencies, you know, mentally to your behaviors, to your cardiovascular, Your system, your immunity pathways, your— it's— and we, the company calls it the playbook, but it is your specific playbook. And based on how you picked your parents, if you weren't lucky, you've got their issues as well. So, you know, when you look at it, it's pretty obvious. And yesterday I had a lady in the office and she's going through and you listen to her story and you're like, yep, You don't methylate well and your antioxidant pathway's bad and you probably don't convert vitamin D well. I mean, it just becomes super obvious like when she speaks about what's wrong and she's, and I go, are you really sensitive to mold? And she's like, oh yeah, we went to our daughter's, you know, daughter goes to UT actually. And they went to her dorm and they're like, there's mold in the building, in the apartment. And she goes, I can't even go in there. I just start to get sick. It's like, yeah, I mean, you're going to have to have your daughter checked too because she's going to have the same problem. So I think it's a really underappreciated problem is toxic mold exposure. Because now I see it and the mental kind of issues people get from it, it's super upsetting to see and it's really underrecognized. And it's not the simplest thing to treat either.

Right, exactly. And so you're saying that people that have these mold sensitivities, these issues with their detox pathways, so their body can't really handle things or their immune system overreacts, those are the people that are probably going to benefit from explant surgery more than regular?

I mean, they're super susceptible, as you would imagine, when you look at who's got the most problems. I didn't have all of this testing in 2016. Had I had all this, I, I could have a very clear discussion about percentages that have this problem in the pathways and what I see in terms of BII, because it, it becomes like more and more obvious. Problem is like I'm getting information. It's like the Genome Project, right? The Genome Project took forever because the computers were too slow.

Right, right.

And now this project is taking me forever. It's over 6 years now, I guess, 7 years now, because the testing with genetics is just catching up to basically the problem. I didn't have the answers before. You know, I'd get picked on professionally for, you know, this kind of issue. But I mean, if you knew back then what I know now, it would be very obvious what you would correlate with. I just, my data is not complete. I submitted a research proposal just recently to look at all the biofilm analysis because things are being published that aren't accurate to me because they're too small sample sizes. And sample size changes everything. So for the audience, like I said, it's 1 in 2,000 for ALCL and it's 1 in 100 for ALCL if you have a Biocell textured device. So what does that mean? That means if you report a study with 50 people per group, you're never reaching the N necessary to identify anybody who has it. And so if I tell you I've already had a couple cases with cancer, am I lucky? No, I just have a bigger sample size.

Right, exactly.

So if you don't have a large enough sample size, you can't and should not make Blanket statements about anything in science. We all know better than that.

And publish them. Like, they shouldn't even be published, but they get published. Yeah. So you're, you're essentially in the middle of a very long research project. It's ongoing. You know, it maybe happened accidentally, but now you're like really embracing this and you are trying to figure out for women how to handle this scenario that is all too common. I mean, how many women in the United States have breast implants? Any idea?

Oh, they do about 300,000 a year. And there's 330 million people. But just in general, like, and it's very— I don't want to say it's predominantly going to be Western, us, United States, because of how bad our food is, or how bad our water or our environments are like, I have this very basic thing with people now. I'm like, you've drank bottled water for how long? How long have you been fed that bottled water is the thing to do? Like, I can guarantee you that your air is more important than your water. You breathe contaminated air and you'll get sick quick. You breathe mold spores all night long in your bedroom, you're going to get sick. And so one of the main things I do is I really, I beg people to get air filters and put them in. And that's how we resumed practice after COVID because obviously there were no vaccines and I didn't even have masks. I had to borrow masks from a friend of mine because we had donated ours and she gave us some N95s. Then I went on eBay in the black market and I got more because you couldn't get any. And I bought all these freestanding HEPA filters and I just put them in every room and I turned them on high. And we never got COVID from a patient. And I had several call us after they had seen us and go, oh yeah, I have COVID. Can you check that for me?

Yeah, I know the air is so important and you are definitely in a place of high mold. I hear that often from Texas and Florida, like you mentioned. So It sounds like there are certain patterns that women should be on the lookout for. So if they have chronic fatigue and they have breast implants and they've done all the standard workup with functional medicine, or if they haven't.

Well, that's something too. You can tell, for the audience, allopathic physicians or your regular GP is going to have a tough time with this.

Yes.

Seeking out a functional medicine provider, depending on their knowledge of it, it should improve your access to testing, dietary, nutritional counseling, supplement options, et cetera. I am just now starting to get people sent to me that their allopathic provider or their functional medicine provider are recognizing this as an entity, breast implant illness, And looking, saying, hey, you should probably go see somebody about getting an explant. And so every time I hear that, I'm like, oh, well, that's good. I mean, it's kind of getting better. And I'm going to give a talk at A4M in December about my experience. So A4M, for the audience, is a large functional medicine conference. And I feel like those providers are going to be most tuned in, most interested in that. information I have to provide where I don't know that my group's quite ready for that. They may never be ready for what I have, but that's okay.

No, we have to keep making progress and shaking up the broken system. That's all we can do, right? And the work that you're doing is super important. So for my listeners, do you have any specific patients that it was life changing for them to have their explant surgery? Or is that pretty— is it common for women to just all of a sudden flourish after that surgery?

No, it's very different. You know, I thought, you know, uh, and I'll caution the audience, like you'll read things on Facebook, um, and Facebook is not a trusted source for medical information. So, um, neither is Google, uh, Instagram, TikTok. I do all these things just like Dr. Tabatha does to help like provide information. But I will say that the epiphany and the wake up and recovery and everything is perfect is— that's not accurate.

Mm-hmm.

So this is not a small surgery and I never represent it like it is. I treat it like it's a really important thing to do and to do properly. So waking up, I have a more proprietary way to handle pain control in the OR. So I do intercostal nerve blocks with Exparel, which is liposomal bupivacaine, and it'll last about a week in most patients. And we are just used to providing a very specific wake-up program. So I'll wrap people up even in ice. And so when they wake up, most of my people are probably 2 out of 10. So I don't ever have anybody getting Dilaudid in the recovery room just to survive. That's what leads to post-op nausea and vomiting from women. Everybody starts the program the night before. They take gabapentin, Celebrex, a little Zofran so that the next day is easier. It's calmer protocol-wise. Everything's driven by protocol in the OR, how we operate and how we instill pain medicine and how we wake up and then what we do in recovery so that you're able to get home and get comfortable. And for the most part, if I've done my blocks really well, which I normally do, you don't really feel chest discomfort that's sharp or anything like that, especially with people, like, underappreciate the value of ice, right? So watch any sporting event. Doesn't matter who it is. If they get injured, what do they do? They all get ice.

Yep.

Still the cheapest, most important, best anti-inflammatory known to man.

Yeah, exactly. Women in obstetrics, they love their ice. We know that all too well. So it's not necessarily that you're going to have explant surgery and just be a changed woman and all of your problems have resolved, right? I mean, that's kind of what I've seen with my patients that have had it done. It's, you know, they've, they've gone through the journey, they've healed themselves as much as they can, they've done all the work, but Their antibodies don't come down, their inflammation markers don't come down. There's just something smoldering underneath that's preventing optimal health. And what I've seen is that improves, you know, and their fatigue improves, but it's not, I guess because they've done the other work, maybe it's not so dramatic.

Correct.

Would that be correct?

So the people that get sent to me after doing months or years of functional medicine work, don't improve rapidly because they've already did all the other things. Just imagine. So for the audience, I will typically get somebody 5 years ago who came in and I would put them on a gluten-free, dairy-free diet. We would have some supplements for them, we would do their explant, and it would, that would be like magical. But if you have somebody who's already, you know, been on an elimination diet for 2 years, taking supplements, trying to do everything correct, hormone replacement therapy, like it's all dialed in, they're not going to magically wake up and it'd be okay. But about 3 to 6 months out, it will be.

Yeah. Okay. That makes total sense to me. Like, you've already done all the work. You've supported your body's systems, which have been struggling because they've been fighting this fight over here all this time with these low-grade stealth infections or just the inflammatory response from those breast implants. And so it's not as dramatic. So what would you— if women still want breast implants in this day and age, what is the safest way to do it?

Well, so the audience knows, I've done, oh gosh, a little over 5,000 breast cases. I used to take care of breast problems or breast implant cripples is what I would refer to it as, because I had done so much reconstructive surgery. I knew all the tips and tricks to solve a malposition or a capsular contracture or some kind of displacement issue or painful issue. And just because I can do it doesn't mean I should. So I stopped because ultimately those people all need to get the devices at 8 or 10 years switched out or removed or whatever. And it finally just, you know, I have this thing where growing up in surgery, like it was just one of these things where I thought I could solve all the problems. That's why I became a reconstructive surgeon. And I would do things that, you know, make jaws for people, get their legs working, just make it so they could survive and function. And that was why I did all the things I did. This is like being I loved solving difficult problems, but that problem I don't need to solve anymore. I have a holistic way to do it with fat. So I offer, you know, what I call a holistic mommy makeover, which is just a fat transfer, which most of your audience will have heard of fat transfer. And if they spend too much time on Facebook or Google, there'll be these negative reviews of fat transfers. So just so everybody who listening understands this, a fat transfer has been around for over 100 years. It's the first and foremost natural filler there is, and it works just fine. Otherwise, nobody would do a Brazilian butt lift or facial augmentation with fat. Right?

Right.

So, but somehow when it comes to the breast, oh, nothing works. It gets cysts or it gets necrosis or I lose half of it. Well, okay.

That's what I hear.

You are super bright. So I'm going to explain to you exactly why that is not the case. So if I have somebody 35 and under, and we'll just say they have no hormonal abnormalities, it's a mom, they've had 2 kids, they've went up and down in size, they come in, they've gained weight, they can't lose it. Blood work's fine otherwise, just, and they don't want implants, they just want a larger, more full breast that doesn't look deflated. They want me to, you know, basically reshape their waist. Thighs. And so if you do that, in that case, whether that's a breast augmentation with fat or it's a butt augmentation with fat, you're going to get the same basic result. And the take rate should be 80-plus percent, even in like the most, you know, I would say average hands. That's not hard. Right. People used to say someone coming in like that wanting breast augmentation, that's a chip shot. Okay. That's, it should be simple.

Yeah.

So the, the gap group or the 35 to 55 group, maybe these people have already had implants, maybe they're on their second set of implants, maybe they're really scared by implants, then what should they do? So if you're coming to me to take 'em out or you're coming to me to get a fat transfer in that age group, You know what I'm going to check? I'm going to check your estrogen level and your testosterone level, and I'm going to balance it out because I know better. Because all my career I took care of breast cancer patients. So for the audience to understand, so a breast surgeon is trying to save someone's life by doing a mastectomy. So they're leaving a very small amount of tissue and trying to take about 96% of the breast tissue out. And that's what a mastectomy is. Now, no matter how good they are side to side, you know as well as I do, they're never even ever.

Right.

And so I'm the person who makes everything even in the end. And implants don't make people even, plastic surgeons do, and they use fat. And so I've done fat transfers from 2002 till 2019 at the clip of 100 a year, easy, because I took care of breast cancer patients. And so I had to even out their implant problems. I had to even out their flap problems. And we used fat. We didn't use anything else. And so when someone says fat doesn't work, if I could make it work in a breast cancer survivor, I can guarantee you it works in a normal person with average to normal hormone values. So the difference between my take rate and someone else's, I will look at the hormones. I'll make sure they're balanced before I do it. Otherwise, I won't do it. And I'll correct their diet and lifestyle. I just don't do things for the sake of doing things. It just doesn't make any sense.

Right.

You should know at this point in your career, food matters because it's the fuel for both how you heal something and how you maintain something. And if you don't have hormonal balance, well, it doesn't even— you don't even need to go do it because you're going to have a crappy result. You're going to take forever to heal. And so who wants that? Yeah.

Explain to my listeners why that's so important to have your hormones balanced.

Right. So in the gap group, 35 to 55, and certainly in postmenopausal women, of course we're always going to look, but estrogen goes down, but testosterone, it will be undetectable. And so for my patients who are having any elective procedure, whether they're coming to me for surgery or I have people reach out to me for my recovery program, You'll say, hey, we're gonna look at this and you can either come to Austin and I'll do your hormone balance, or you can find a, you know, provider there. But, and not everybody needs estrogen given back, as you know, you don't, it depends on how you convert your testosterone. Some people convert quickly and create estrogen, others don't. It goes straight to DHT. So you may need to give it back or not give it back depending on the, the person.

Mm-hmm.

So we'll just say, In general, we'll just say I typically defer to just doing testosterone and waiting and seeing the numbers and then adjust. So very rarely on a, a first-time placement will I ever add estrogen into anybody because I know you're gonna get it from the testosterone addition.

Right.

And women need about 1/12 the dose of a male. So that's why, you know, and I prefer pellet for women versus a cream versus a shot. I have all sorts of weird people getting shots around here with testosterone. And you know what happens? It's never the right dose. And then they get female genitalia problems that can't be reversed. So, but for recovery, we want to have that 3 to 4 month window where the balance is good in terms of testosterone, estrogen. I don't ever put anybody on progesterone. If they need or have problems with sleep, I have sleep supplements I use. I don't, I don't like progesterone. Side effects are not things I want. They increase edema, they increase abdominal distension sometimes, and I don't really want to have that in any of my post-op clients. So if they want to do that down the road, I have them do that later.

Interesting. Okay, so no matter what kind of surgery you're doing, you're evaluating hormones, you're trying to get those in balance for a more optimal outcome.

Yeah, I think I have over 9,000 female clients. And so if you're not looking at that, I mean, you're just going to walk head into a lot of problems.

Yeah, I love that. I love that you're flipping conventional plastic surgery on its head and you're doing it so differently. And are you getting any feedback from your conventional colleagues? Like, are they telling you you're crazy? Why are you doing this? Or are they Saying, hey, how do I do that? How can I incorporate that?

I've had a couple of people interested, but surgeons can be very myopic. And the goal is let's do surgery and we'll have somebody else take care of those things. And that's kind of— I was taught by a whole different group of people where you had to be a good doctor before you were a surgeon. And if you weren't, they really didn't like you and they made life really miserable for you. And The, I worked in a place and trained at a place that didn't have ER doctors, didn't have hospitalists, didn't have ICU doctors.

Mm-hmm.

If you were the surgeon, you were the ICU doctor. If you were the surgeon, you were the primary caregiver for the transplant patient. So I worked up heart attacks and strokes, and I intubated people in the ER for pneumonia who had transplants. So, I mean, I had a crash course in internal medicine just taking care of transplant patients. There's nobody sicker than a transplant patient. Or a burn patient. You know, when I was a plastic surgeon, we ran the burn unit and they still probably do for Indiana, but it was kids and adults and it was full throttle. I mean, all the time.

Yeah.

And so my, my experience is just different. And when somebody says like, Rob, why do you put plastic surgery patients on testosterone? Why are you doing that? And why, as a plastic surgeon, why would you do that? I have a friend, you'll know him as well, who, who's who's a little condescending on certain programs about plastic surgeons using hormones. And it's like, oh, okay, well, my experience is slightly different in terms of wound healing because we used to use testosterone in wound healing for pediatric burn patients. So, I mean, I used to have to write, you know, what is it to the pharmacy to get an exemption to use the product and all that stuff.

Right.

And I would do it on cancer patients because, as you know, If someone's in catabolism, which means they're burning all of their calories, they'll never heal. And one of the reasons athletes used to cheat all the time and use anabolic steroids is because anabolism means building, repairing. And so what does a plastic surgery patient or a severely burned patient need? They need to heal in order to survive.

Yeah.

So although it's a drastic example, I'm quite familiar with using anabolic steroids on patients. So it's, of course it works. It's just how you do it, how you go about it.

No, I think that's genius. And I love that you're pushing the envelope and just challenging the system because that's what we need. And I would say that the way you were trained is not the norm for most general surgeons, plastic surgeons. It's very much— I can't even count how many guys and women were like, I'm a surgeon because I don't want to do that other stuff. I don't want to take care of that. I don't want to see patients in the office. I literally just want to do surgery. And for me, it was like, that was why I loved gynecology, because I got to do both. I got to do amazing surgeries, but also have a relationship and take care of the patients. So I love that you've had that unique experience, and now you're, like, making it possible for women to have a better outcome because of it. So bravo, that's amazing. So tell me all about your program.

So it really was derived from our treatment of breast implant illness patients. So working backwards, we have this really 5-pronged approach that helps with our testing, which we do an Alcat 250, normally a food sensitivity test, and then just adjust their diets based on that, remove moderate and severe stimulators of inflammation out of their diet. I do a complete blood panel either with the laboratory, and most of it's to look for hormones, thyroid, sex hormones. And then I do look at Lp, IL-6, CRP, although CRP is a poor indicator to me of just inflammation. It's very not specific. We do the total toxicity test because I see so many folks with mold, but I also see a lot of people with environmental toxicity from BPA. I've had a lot of people with gadolinium from MRI. I personally have beryllium. Talk about that later. Arsenic's found in groundwater a lot. We know that groundwater is bad. Obviously, look at a place like Mississippi. They're going to have horrible times. Michigan as well.

Yeah, we have tons of well water, tons of arsenic, all of that.

And then we do a stool test because if someone's really having absorptive issues, if I'm super suspicious that they're not able to have what we would consider normal daily bowel movements, then they have to get it looked at and get their dysbiosis evaluated. And I'll put people on more fermented foods or dense starches or whatever's needed. And then finally, the genetic testing, which really kind of rounds everything out, should be the first thing you do because Lord knows it takes a long time to get some tests back. But that actually highlights what we can do in your immune pathways. It looks at your antioxidant pathways, your methylation, glutathione metabolism, and vitamin D metabolism. Those are the 4 main pathways we look at for immune system function. And then that's what I see most frequently are deranged in people having problems with breast implant illness.

Yeah.

But it's a whole series of tests with the genetic reports from mood, cardiovascular, Like I mentioned, immunity, hormone balance, and just nutrition. So we have a lot of people, I always default to put people on gluten-free diets anyway, even if they're not sensitive. I just do it because anything to reduce inflammation around the time of surgery or in the postoperative period, I try to do.

Awesome. And so they get guidance based on all those test results on what to do, how to support those systems to get back into balance.

Right. We have the diet plans and the bundles of nutraceuticals for the various problems that are encountered in the reporting. And so it's taken me several years to get all that organized, but I now do that through my store, Dr. Robb Solutions, and I have the bundles there. And shortly we'll be able to, for the patients who can't travel to Austin to have surgery, we'll be able to guide them more holistically from just an external approach that I'll do through a program.

Yeah, that's so cool. Awesome. Okay, so for you guys watching on YouTube, obviously it's up on the screen, but they can find you at Dr. Robert Whitfield. And, um, what is your website?

Yeah, it's drrobertwhitfield.com.

Okay, awesome. And people are welcome to come and travel and see you and have surgery from Is that a common scenario? People come to see you?

Yes, about 50% of my clients come from out of state. A lot of times they'll find me on our other portal system, which is breastimplantillnessexpert.com. And so you can fill out a quiz to see how many symptoms you have consistent with breast implant illness, and then you can get a complimentary discovery call set up with me.

Awesome. Well, thank you so much for being such an amazing resource. I'm just— women need you. So this is amazing. Thank you.

Thanks for having me on.

Okay, so that was a super important topic. We need to talk about this more. This conversation needs to continue on breast implant illness because it is a real thing. It's not, you know, gonna affect everyone with breast implants, but for the ones it does affect, it's a big deal. And these women need to be believed, they need to be heard, and they need to be helped. So I applaud Dr. Robert for all of his work and for really giving women a voice and saying, you know, what they're experiencing is real. Just because we haven't had the data in the past to understand it or explain it doesn't mean it's not happening. So I really appreciate that he is taking the time to research this. He is, you know, doing testing and swabs on all of the explants that he does, and he's really trying to understand the disease processes that are occurring in the women's body when this is happening. And so I just, I applaud his efforts. And if you feel like maybe this is somebody you want to see, you can Schedule an appointment and go see him. So the links are in the show notes. Don't hesitate to keep asking for help until you get the help you need, until you find the right person, because unfortunately it might take a few doctors or providers. You know, a lot of us have gone through that journey of trying to find the right person to help for the right situation. So if you think you might be struggling with breast implant illness, you should reach out to him. Okay, I hope you found this valuable or that you've sent this off to somebody that you know that needs it, right? So support all the women in your life and they will hopefully do the same for you. Let me know what you want to hear about. I do this for you, ladies. So go have an amazing week, and I'll see you back here soon. Bye-bye.