Breast Implant Illness Explained: Symptoms, Recovery, and Alternatives with Dr. Robert Whitfield

I believe in two thirds 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.

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. And there are certain women who are more susceptible to developing this reaction than others. 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. And so 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 now he does explant surgery, which is the removal of the implants. And so he has seen firsthand over the almost decade of doing explants, a lot of women who feel better and this was contributing to their issues of 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 we. 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. 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 right really quickly. Dr. Whitfield is an experienced board certified plastic surgeon. He completed six 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 Samboni. 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 were all over the body. He's completed over 4,000 breast surgeries since 2004, including over 500 implant removals. He is 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 of lot out of it. So here we go. 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 two 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 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 two 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, one in 2,000 cases. And if you have a bio cell textured implant From Allergan, it's one in 100 cases. And then I have one of eight 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 put. See someone. You know, feel free to call us or. Or see your. 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 all kind of just want to stick our head in the sand and pretend that everything's fine. Right.

Well, 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 two 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. Two weeks in med school. 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. And he, he called one of his colleagues where my sister was living, because I was not in the same city anymore, and facilitated, you know, an introduction for her. And she got taken care of. She unfortunately did get doxorubicin toxicity and a mild HF 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 from 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, had 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 neck reconstruction, and sarcoma. In fact, when I came to Austin, there's 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, 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 for reasons that are really not important to me or you sometimes are just personal reasons. And they don't want to have reconstruction anymore. So I, you know, I did her exam as I did everybody's, and I still do everybody's in person examination went, all of her, you know, went through her history and her labs and everything. And, 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 have 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 in block capsulectomy in her consult. And I was like, now why would a person ask me to do an in block 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 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 surroundings, 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 a, 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 an en bloc 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.

The.

That was standard from 1996 to even present time because we had to switch from silicone to saline because of 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 currents up against the chest wall. So these were just standard things I always did. Check, culture, send everything for the pathology, make sure there's no recurrent cancer. And so when I, when I get her back to the office in 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 a hundred thousand colonies, which is infection.

Yep, exactly.

And so I looked at the computer, I'm like, what? I looked at, 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.

Me too.

I was there every, 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, you know, rounds, grand rounds, or, or, 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 because, you know, that would have 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 you know, 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 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 as 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 interesting.

That's, 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, a screening test for breast implant illness. I mean, the, 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, you know, cross the bridge and say, I know how to test for this, to screen for it, and then, you know, Tabitha can go have implant. I. I don't. 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, you know, 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. 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 because 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 up front to check for food sensitivities and disturbances in laboratory values, like your lipid panel, your insulin levels, your IL6 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, that you have mold or have been exposed to it. And if you're susceptible, 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 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 of 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 five 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.

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, 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 two thirds 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 is 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. An apartment. And she goes, I. I can't even go in there. I just start to get sick. It's like, yeah, I mean, you're gonna have to have your daughter checked too, because she's gonna have the same problem. So, you know, 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, you know, it's super upsetting to see and it's really under recognized 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.

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 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 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 six years now, I guess seven years now because the testing with genetics is just catching up to basically the problem. I. 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 2000 for ALCL and it's 1 in 100 for ALCL if you have a bio cell textured device. So what does that mean? That means if you Report a study with 50 people per group, you're never reaching the end 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 cancer implants? Any idea?

Oh, they do. About 300,000 a year. And there's 330 million people. Yeah, but just in general, like, and it's very. I don't want to say it's predominantly going to be Western U.S. 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 gonna 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 resume practice after Covid, because we obviously, there were no vaccines, and I didn't even have mass. I had to borrow mass 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 this standard workup with functional medicine or if they haven't, you know, well, that's something too.

Like you can tell like 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, you know, 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 a 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 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 and conference. And I feel like those providers are, are going to be most tuned in, most interested in that information I have to provide where I don't know that my, my group's quite ready for that. 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, and I'll caution the audience like you'll read things on Facebook and Facebook is not a trusted source for medical information. So neither is Google, Instagram, TikTok. I do all these things just like Dr. Tabitha 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. 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, you know, most of my people are probably 2 out of 10. So I don't ever have anybody getting dilauded in the recovery room just to survive. That's what leads to post op nausea and vomiting from women. Like 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 know, 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 under appreciate the value of ice. Right. So watch, watch any sporting event. Doesn't matter who it is, if they get injured, what do they do? They all get ice.

Yep. Yeah.

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

Yeah, exactly. Women in obstetrics, they love their eyes, 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 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 five 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 that would be like magical. But if you have somebody who's already, you know, been on an elimination diet for two years, taking supplements, trying to do everything, you know, correct hormone replacement therapy, like it's all dialed in. They're not going to magically wake up and it be okay, but about three to six 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, you know, low grade stealth infections or just the inflammatory response from those breast implants.

Right.

And so it's not as dramatic. So correct. What would you. If women still want breast implants in this day and age, what is the safest way to do it?

Well, so. 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 capture 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. 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 understand.