From Implants to Insights: Unpacking the Truth About Breast Implant Illness

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I am so incredibly excited and honored to be joined today by Dr. Rob Whitfield, who is a plastic surgeon and has been practicing for over 25 years. He specializes in breast implant illness. You might have heard of him. He is referred to as America's breast implant illness expert. He specializes in breast implant removal and advanced cosmetic procedures such as his no cut facelift. In addition to his exceptional work As a surgeon, Dr. Robb is sought after for providing his strategic, whole holistic, accelerated recovery program or the Sharp method. The protocols of Sharp help to reduce systemic inflammation and assist patients who are both preparing or recovering from surgical procedures. Dr. Rob's skills dovetail into perfect balance of art and science and provide hope for scores of women looking to age gracefully or restore their health after bii. Welcome. So I am so incredibly excited that you are here today. I am. I cannot express how important this conversation is that we are going to have, especially for women in the thyroid community. So welcome. Dr. Rob Whitfield. Thank you for being on the podcast.

Well, I'm glad we were able to get this organized. I feel it's going to be a very pertinent discussion. I appreciate you and your audience and happy to share or work and help anywhere I can.

Yeah. So, you know, question right out of the gate. You are known as the breast implant illness expert. Tell me a little bit how you ended up like in this niche because obviously you come from a very different formal training in terms of your background. How did it evolve into this on your journey?

Yeah. For everybody listening, I had spent two decades, really mostly doing reconstructive surgery for cancer patients. There's a variety of cancers that I took care of. I took care of most of the sarcoma reconstruction in central Texas. I had neck reconstruction as well. And then because of the prevalence of breast cancer, the predominant reconstructive surgeries were performed were for breast cancer patients. It was a breast cancer patient who just sought out a consultation to become flat that ultimately asked me to do their explant. I did that and found that they had an underlying infection. And so that experience, you know, led me to question like, like most should do is how did you know our testing or pre op evaluation not identify that? And for everybody listening, the examination of the patient was normal, the laboratory analysis of the patient was normal. And from a physical symptom inventory, a complaint that the patient had was being fatigued. Which for providers who take care of patients who went through different cancer treatments, whether it's chemotherapy or radiation therapy or are using different agents afterwards, like a Tamoxifen agent. They can all suffer and have problems with fatigue. So that's a, a non specific type of, you know, symptom that for the most part I don't, you know, and now I, I, in retrospect that was the element, that was the, the tell. And you're always looking for, you know, what is going to, you know, lead you down to figure out something about a patient. And I simply assign that to a patient who's had a lot of treatment and had what most patients have, which is some level of bone marrow suppression, which leads us to have more problems with fatigue. And ultimately she had on the culture results. For everybody listening. I take things out like an Easter egg and try to keep everything intact. I don't want to break the shell, I don't want to spill what's inside, because if that's inside somebody who has an infection that's going to spread it, if it's got a cancer in it, which obviously in patients who've had cancer before, you don't want to spread that. So there's all sorts of things that are a checklist in my head that I go through when I take care of those patients. And now for explat patients, I run the similar checklist, if you want to think of it that way. That patient had on their culture results an E. Coli infection. And so people will say, well, how did you get that? Was that from the time of surgery? Or in reality, anybody who does a medical device placement, whether it's a hip, knee implant, a dental, a breast implant, all sorts of precautions are taken at the time to avoid the initial contamination of a device with bacteria. And so it's typical that that doesn't happen, but it can. It's just far less likely if you look at the span of someone who has a device over their lifetime, they'll have different problems with infections. Maybe it's a skin infection or maybe it's a GI tract infection, maybe it's a urinary tract infection, which if you have to think why a woman could be more at risk to have that problem, that's one of the more common types of infections that would lead to an E. Coli, you know, type contaminant would be. And then like, how does that get in your bloodstream? Well, anytime you have irritation of an organ or a system that can lead to getting bacteria in your bloodstream, that's how it can contaminate an implant. It doesn't matter if it's a hip, knee, breast, dental or anything like that. So if you had a skin infection and you didn't treat it and it got red and inflamed. That bacteria can get in your bloodstream. And because a implant is not alive, it can't be protected, it can't be surveilled. So it's far easier for bacteria to attach to and contaminate an implant. And when you have colonization, you can create this colony, this biofilm. The biofilm can produce a coating, if you will, that makes it hard for it to be eradicated by your immune system. So our body's very good about surveilling us for infections and cancers and things of that nature. It's doing that all the time, but it can't do that on a device.

How interesting. And I would have never, one, I never would have known that that is how bacteria lands on implants definitely was very, very far from what I originally thought. And two, how fascinating that you're training already led you to the way and the mechanism of which that you take out and remove implants as a whole unit. I didn't realize that it makes perfect sense in cancer cases, et cetera, you have to do the same thing. So how again, didn't know that. You're enlightening me. And I know we've had lots of conversations offline about the same topic. So fascinating.

Well, on the cancer side, if someone were to have a. The most common form of breast reconstruction in the United States, and I'll preface it by our country's enormous right, so Spain can fit in Texas, where McCall and I are at. So from a land mass perspective, that just helps you understand what we're talking about. The city sizes dictate a lot of your care. So I always worked in, trained in big tertiary medical centers. I never really as a surgeon, have practiced in super small settings. And that led to a very specific patient coming to see me. And so if you just think of, well, in Texas alone, once you get outside Austin, San Antonio, Dallas, Houston, the cities get really small, really quick. And that leads itself to a different type of or level of care. And a plastic surgeon who is trained can perform an implant based reconstruction because they would have been taught that in training, they can execute that without the need for specialized care from the nursing staff or the operating room staff. And so that will be by far, if you think of it, this logic will follow. That's the most dominant form of breast reconstruction in the United States and the world for that matter. Because of that. Yeah, so that's always going to be the case because it's A size, it's a care, it's a, you know, an access thing. Spash. All the specialties that have to be involved with what I'm talking about, not just the surgeon's skill. Like I needed a, you know, half a million dollar microscope basically to do an operation. You just don't get that everywhere.

Right.

And the staff and everything and the instrumentation and.

Yeah, I mean it's not same for thyroid care. Right. Like, right. The chance of you in small town Texas getting access to real good and good thyroid care is small too. I'm sure that's amplified when it comes to knowledge and surgical technique and access to machinery, etc. Of course, yeah. Can you tell me, I know you've been doing this a long time, what are the most common. You mentioned fatigue earlier as you know, a telltale sign of some things. Can you tell me the most common signs or symptoms that you see with patients struggling from BII or breast implant illness?

Yeah, I think for the listeners you have to define it on systems. And if you just think of systems, it can affect every system. Every system can have acute and then it becomes chronic inflammation. So acute inflammation is we step off the curb, we twist our ankle, it swells up our body signals that it's hurt, the healing process begins. Pain, swelling, all the things. And then eventually that signal turns off, you're healed, the swelling's gone, the pain's gone, you're walking, all the things. If that signal can't be turned off, you get chronic inflammation. Chronic inflammation is what I deal with and it affects every system of the body. So in your central nervous system, just think of like your brain, your hearing can be affected. So it can be very sensitive to sound, sensitive to light, you can have headaches, you can have brain fog. This and brain fog to me was a very like nebulous thing. When I first heard about it, I didn't understand what it meant. So I just was asking patients, what do you, what do you mean by brain fog? And it's to me more characterized by short term memory loss, like you can't remember where you put your keys or you know, very disconcerting things like you can't remember your kids names. Sometimes you may not want to remember their names, but sometimes you can't. And then every, you know, other aspect, like your musculoskeletal system, you can have joint pain and muscle pain. I just saw a patient a few minutes ago who had all these symptoms. Your cardiovascular system can be affected. You can have or feel like you have a racing heart, even Though when you're put on an EKG machine, you don't. Pulmonary symptoms, you know, symptoms from the pulmonary system can vary and some of it has to deal with. Can't take a deep breath.

I know that one. I hear a lot. They feel like chest almost weight or compression.

There is a lot of scientific evidence behind that specific problem. If you think of women who had, you know, just throughout their life, developed very, very large breasts even in their teenage years and had a breast reduction, there are plenty of studies that show that once you do a reduction, decrease the breast size, you'll improve their lung function, they'll be able to take a deeper breath. And so this has been borne out. I mean, none of this is new. So if you have somebody that you. You take even a 250cc implant out, which is just a little bit above a cup size, you'll improve their lung function. The other thing that's not really probably understood really well is the restriction of the rib cage caused by scarring. And that's probably a more. I don't know how much it contributes, but that's another factor that contributes to that. The things that are really odd are the skin manifestations. They can seem like. And you'll get this commonly is atopic dermatitis, which is just basically a skin inflammation slash rash that doesn't go away. Nobody has an explanation for it. Can also look like psoriasis, can have total body cystic acne. I mean, if you can think of some weird thing, I've had it show up. And GI problems consistent with every thing known to man. Swelling and pain and cramping. Even when you drink something as simple as water, constipation, diarrhea, all the things from a system perspective that don't make a lot of sense that are super disconcerting. Intractable bacterial vaginosis, UTIs like, I mean, right?

You know, it's interesting. I didn't plan on sharing this, but I will. I've actually had a consult with Dr. Whitfield myself. I had implants put in in in April of 2018, and within four months I got SIBO Complete Food Intolerance. Anytime I ate, I looked seven or eight months pregnant, like out of the blue. Literally never had these issues, never was bloated a day in my life. And I was like 36 at the time, 37. So that's a long time without bloating. All of a sudden, like overnight it happened. I still have pictures. It's crazy. So the GI thing really, really resonates for sure. And I hear other people just say general food intolerances too. Absolutely. Is there a way to. Have you found a system and a way to analyze and predict people who might be more vulnerable to BII compared to people who wouldn't? Or is it like, look, we just.

Don'T know the Sharp method, which is, you know, our book about our process. It helps clarify things because, you know, each of us gets trained a certain way. It doesn't matter if you're a naturopath or a chiropractor, an md, it makes no difference what your credentialing is, nps, pas, it doesn't matter. You get trained a certain way and in that training, probably the biggest deficit in training is functional genomics and understanding toxicity. So everybody has a pair of jeans, you can't outrun a bad diet and you can't pick your parents. So like those things are, you know, for us, non negotiable. So you have a set of genes now you can flip some things on and off as you know, but just in general you can only do what your genome will allow you to do. And obviously people have heard of things like mthfr, which is a very common. It's a snp. So a SNP is just a mutation. We'll just say that it's a different set of base pairs and that mismatch creates a problem with how you methylate. I don't methylate well. So that means in the chemical reaction, this methyl group can't get put on. So utilization of something like a B vitamin is not efficient and it leads to prolonged bouts of inflammation. And when I was younger and I'd get sick, I'd have this cough that would last forever and I'd feel fine, but I'd still have this cough. And when I was a med student, I had gotten whatever wicked cold was going around and I felt better, but I was on rounds with a infectious disease doctor of all things and I was coughing my head off outside of a patient's room and he just looked at me and goes, what is your problem? And I was like, you know, I'm not sick but I can't get rid of this cough. And so, you know, he listened to me. And as a kid growing up, I had childhood asthma, etc, you know, for a long time he's like, you have post viral pneumonitis. And I was like, oh, okay, what do I know? I'm a, you know, a third year medical student. I don't know anything, I'm just learning. And so, you know, if you now, knowing what I know now, if I think back to that, the way you kind of work around that is a supplementation protocol that has a methylated B vitamin supplement. And once you have, you know, it's like anything will call, like, you don't know how to take care of something if you don't know it is there. So if you don't know, you don't methylate well, why would you ever take a supplement that's methylated? So that you can avoid what I'm describing, which is post viral pneumonitis. So fast forward now one, I don't get sick because I don't, you know, I respect my sleep patterns and I don't like, eat poorly and, you know, just kind of basic things. But I recover much faster now, even though I'm 55 versus, you know, when I was, you know, 30, because I know now I don't methylate well. So every day I take a methylated liposomal B vitamin supplement, and that helps me. That's one common denominator in almost every single patient I have. They don't methylate well. And then other things that are common, that are aligned with my female population are things that lead to osteopenia and osteoporosis, which is poor vitamin D metabolism. So that's almost uniform in my patients. Other things that are variable will be their ability to manage chemical exposures, herbicides, pesticides, BPAs, things like that. That has to do with their glutathione pathway in their liver and then the antioxidant pathway. And for everybody listening, vitamin C is the antioxidant. Everybody knows that you rub some vitamin C, you know, on a fruit and it won't oxidize. Right. That's the whole point.

Or on our skin.

Yes. So that's the point of that. Right. So you want to have a reduced environment, not an oxidative environment. That's more healthy. So if people don't have good oxidation pathways, they'll have more problems with fatigue.

Yeah.

So if you looked at those and then sprinkled in people that have poor estrogen metabolism, that's pretty much your, your, you know, star right there.

Interesting. That's a lot of my patients too. I mean, it, it. There's definitely overlap in the thyroid population and your population for sure.

Well, they don't handle inflammation well, so.

Right, exactly.

It has people ask me all the time like, oh, is there one thing that, you know, you can test for? I'm like, no, this is a chronic inflammatory process of which an implant is part of. When you take the implant away, you didn't change the chronic inflammatory process completely because that's a genetic, environmental, diet, lifestyle situation.

Yeah. Yep. And it's just one less. It's less fuel on the fire of that poor inflammatory process. Tell me what you feel like. And I know your perspective might be skewed. I know even admittedly my, my perspective on thyroid is skewed because all I see is thyroid patients all day, every day. But what do you feel like the incidence of BII is like? How rare is it, how common is it in people with implants? I got the question on social. Is it possible to have implants, implants and not experience any form of bii?

Yeah, we just said, wow, you don't. Is you pick your parents.

Right, right.

So if you detoxify. Well, which I have a lot of, you know, relationships with people who have implants who don't have problems.

Yeah.

So we're both in the, you know, health profession. I'm in a lot of longevity groups. And so if you don't from a. Just like we said, if you prioritize sleep, have a healthy lifestyle and your genetics are allowing you to detoxify, I won't even say completely, but you're, you're maintaining balance, then you're not going to have. What we're describing is a lot of symptoms. You may have them, but they're not going to be like in the forefront. They're just going to be in the background.

Yeah. Yeah, I like that. Tell me about what you've seen. If you have seen a correlation between autoimmune disease, Hashimoto's, Graves, other autoimmune diseases, I would say due to, I don't want to say due to. Correlated with people with implants.

I, I think Hashimoto's and all these things with thyroid dysfunction predate implants. First implants were 1962. And chronic inflammation, inflammatory processes, autoimmune diseases, all predate implants. So once again, it just definitely adds fuel to the fire. I think the thyroid is by far the most sensitive endocrine system and thrown off very easily. I see that, you know, super common in all of our patients, regardless of if they have implant or not. Obviously, predominantly I see, you know, women 99% of the time for aesthetics, whatever we're, you know, looking at. And of course, I mean, many of them have problems with autoimmunity. Specifically Hashimoto. That would be by far the most dominant, you know, anecdotal experience we would have.

Yeah. Yeah, and it's interesting. I mean, it's. There's overlap too, in. In the symptoms of thyroid issues and bii. And, you know, I think it's so important to get your thyroid sorted on the front end too, so you can see what residually is left as far as symptoms go. But, gosh, I think about a patient that I sent over to you in the last year or so, and she had really done all the things. Her thyroid was great. She had an explant with you, and she's like, McCall. The next day I was a completely different person. I mean, it just absolutely changed her entire life. So I've seen like firsthand, even if your thyroid is perfect, your hormones are perfect. If you really. And she hadn't, like, she didn't fully understand or know if it was her implants, but, gosh, she got them out and she was a complete, completely different person. It's been close to a year now, I think, and she is just thriving. So. Thanks. Appreciate that.

Well, let's like, dive in that a little bit. So that is about a third of the patients. We recently published a paper. About a third of them will have a bacterial contaminant. And so if you follow the logic of if that leads to more immune system stimulation like an infection would, then when you remove that in some patients, like you're describing, when you take that away, then the. All the work that everybody's been putting in to helping get themselves better, then it's, you know, it's like this, you know, rainbow and unicorn type effect that. Where everything gets better.

Yeah.

And then, you know, I tell my clients not to do this. I tell them not to go on Instagram or a platform and. And put that out because, you know, in the.

Because that's not the norm. Right?

Yeah. And the other two thirds of the patients, they have to do all the extra work and it takes a lot more time, and they may have more bad days than good days initially. And it sets up a false narrative that I don't ever, you know, for every listening, I don't ever tell anybody they need an explant. Patients decide that before they come to see me because nobody wants to come see me.

Right.

McCall didn't want to come see me. Right. We can go have a coffee anytime. She didn't want to come to my office and see me and discuss what we discussed, because that's not what anybody wants. Nobody wants to come see me and have surgery. That's just silly. But you know what? I try to make sure. And everybody Understand, like, it's a process. And it's. You know, the cliche is, you know, this is a marathon, not a sprint. And this, in reality, is very much so that you can work tirelessly and not get anywhere.

Yeah.

You know, I have patients all over the world who. Who come or don't want to come see me. You know, they secretly stalk me on the Internet. You can look at all of my analytics and know this. So we've opened up our program so that people can take advantage of what I know. That only used to be restricted to patients who came to see me. So the book I wrote or the process we developed with our team is now open to everybody because you can lower inflammation now, and we have a very proven system to do that in this very specific patient population. So I'm not trying to take patients from anybody. I'm just going to let you know that it's a tough nut to crack if you haven't spent all the time we have learning how to take care of this specific problem in this group. Because, as you know, it's not an easy fit.

Right. Yeah. I want you. That's perfect segue, because I want you to share some with people about, hey, this is what you need to look for, because you can't just go to any Joe Schmo and get an explant. These are some very important pieces. And then I'd love for you and I, then I want to dig in deep on the things that your practice does differently. The sharp method, all of that. So kind of take me through those two lines of thinking.

Sure. If someone wants to have an explant, there's a lot of disinformation regarding capsulectomy, and, you know, people will argue there's not enough good data to support it. Well, I just published a paper of almost 700 consecutive patients, and so roughly 29% have bacterial contamination. So if you leave capsule in patients with that problem, you're not going to help them. Yeah, because you can't remove the biofilm by just taking out the implant. And the reason is, I didn't biopsy the implant. I biopsied the patient's scar capsule. I did that on purpose.

Right.

Because it's a tissue sample, it's not a prosthetic sample. So I showed that in almost 700 consecutive patients that roughly 29%, actually, 29% have bacterial contamination. Kidibacterium acnes and Staph epi are the predominant species. That's not important. What's important is if you just think about it, if you take out the implant alone and leave the capsule behind, you're not helping.

Right.

And when people say it's not safe, that's nonsense. Then just leave.

Right.

If that person's not comfortable, you can't talk. You should never talk a surgeon into doing anything they're not comfortable with. Just turn around and leave.

Absolutely.

Find somebody who's comfortable.

Right. I mean, I say the same thing about thyroid. It's like, don't try to convince someone to practice medicine differently more than any other specialty. I think that applies in surgery. Right. Like, you want the most experienced person, and at the end of the day, you don't want to go through all of that process surgery money, and not solve the core issue. So capsulectomy is a really big one. Anything else that you would say, people need to definitely be on the lookout for.

I mean, okay, so we'll just go logically, right? So one is capsulectomy. There'll be all sorts of terminology associated with this. So just ask for doing a complete capsulectomy. That'll be simple. And if there's pushback, then just leave. Two, I'm a firm believer of testing things because I don't like doing anything without a benchmark, a metric to then compare against.

Amen.

So I always look for cancer. My sister died this year from breast cancer recurrence. So I always look at every cancer patient with the same lens. I would want my sister taken care of was looking for a recurrence. So when you take things out, it's incumbent upon somebody who did oncology as a career to look for that. And that always should be looked at, because I found a handful of breast cancers that way. Lymphoma. And then, as I said, we test every single patient's scar capsule. So once again, it's not the implant. It's the patient's tissue that gets tested, because that's what's important. And that in 29% of the patients will reveal a bacterial contamination. And people ask me, well, do you trust that number? Do you believe that? Well, yes, I take the sample.

Right.

I sent it to the company. You collect the data, runs the sample. Yeah. I mean, that's. You just follow the evidence. I don't analyze the sample. A lab does that. So we can all choose to believe the earth is flat or round. And, you know, in reality, science is a thing. And PCR testing, remember, from the pandemic, PCR tests more sensitive than antigen testing. So I had been doing PCR testing on samples since 2019. I have the largest sample size in the world regarding this problem. So it's the wrong argument to pick with me.

Right?

So yes, those are my kind of non negotiable. Like you don't come to me and ask me to not do those things. You come to me and those things are going to happen. And then the other things that are going to happen is you're going to engage with testing. Look at your genetics, your gut health, your toxicity burden, your metabolism, your hormones, sensitivities to food. Because in reality, if you don't start, you know, dotting, I's crossing T's checking things off the list. We're going to do surgery. You're going to kind of, you know, either do good, do poorly or be average. And we're trying to move everybody into recovery as efficiently as possible. So we do things a certain way through a preparatory process. And then in my office, you've been in my office, I have all these my gadget persons. So I have hyperbaric in my office and I have lymphatic massage and red light therapy. And before the FDA was harsh, we, we had a lot of peptide therapy. Hopefully that will get resolved. I mean nano V, like whatever I think is going to help a patient, I have.

Yeah, why not take a holistic approach, right? Like if someone wants and they're on a quest for healing, ideally it's not just cut and go, you know, that they're fortunate enough to have a physician who wants to look at all these other supportive processes to help with recovery and really set them up for a long term success. And moving through the process that 2/3 of people move through slowly, right. That don't wake up and be like, wow, things are so much better. So many of these other people need all those supportive mechanisms. I love that. And tell me a little bit, I know so many of those things are in your book, in the sharp method. Tell me about the components that people can access outside of surgery to set them up for physiological success that you all offer now, which is really cool.

Yeah, I mean it was first of all, you know, writing a book and doing all the things is way more of a project than you you really want to get into. From a long time ago in academics when I would do book chapters for people, it wasn't that arduous because I just had to contribute a chapter or something or do an article and doing a book is such an endeavor. Now that we have it done and our detox program is in lockstep with everything, I cannot operate on that large number of Patients. So to find me and get here and do surgery and stay in Austin is a fraction of the people we can help. So I use the iceberg analogy. So the tip of the iceberg is who shows up and sits in front of me, either on the screen or in person and then stays and has surgery with us. I felt compelled that we share it because there's really no point in having a program that works as well as this one works without helping the larger group of people that are. And there are lots of limitations and self limiting beliefs. And you know, people will try everything because once again, nobody wants to come happen, you know, surgery. So they can take part in virtually every aspect of the program now. So the detoxification part is based on testing. So they can take the initial basic inflammation test to look and see if through their urine they're experiencing higher than normal amounts of inflammation. And then we have the next phase which looks at all the things, the genetics, the gut health, hormones, you know, things that will give a broad enough picture for our detox group to formulate a plan. Because, you know as well as I do there are many practitioners who say they look at hormones, but like they.

Don'T and they don't know what they're doing. So.

Yeah. And you know, for, you know, I deal with a lot of stressed out patients. High cortisol levels, high estrogen levels, low testosterone levels, adrenal fatigue. I mean, it's a very common patient that I see with all those problems that needs work beforehand to help get them in a optimized situation. So it does no good to show up in a situation where surgery is expected to be the solution to that problem. Because that's just a component. Because I, as you know, am the biggest stimulator of cortisol in the world. I operate for a living, so I'm going to cause a big cortisol surge. And then we have to get you in and out of that phase quickly to get you into a healing phase, more parasympathetic, you know, rest and recovery phase, if you want to think of it like that. And that's, you know, there's a lot of components that mindset is the most underappreciated. So don't come to see me if you're not ready for that because I can't make that happen for you.

Yeah, so true. Tell me. I want to ask you some questions that people posted online for you, but tell me a little bit too about one, how people can become a patient. I know you two brought in an Amazing surgeon as part of your team as well. So tell us a little bit about how people can become a patient and how people can engage in the Sharp method protocol who aren't patients.

Yeah. So Sharp is going to be open and you can just go to drrobertwitfield.com and you can book a call and talk to my team about engaging in Sharp. You can take advantage of the basic inflammation test. You can take advantage of our more elaborate testing or supplementation. We have a whole. We didn't mention this, but I adjusted all of our supplements that I could to make them liquid and liposomal so that absorption is in the mouth, not in the GI tract. So that based on what we're discussing earlier is we really want you to get the nutrients. And I'm someone who doesn't stop supplements for surgery because they're my protocol. So I don't ever stop them. I have you stop what you're doing because I don't know what you're doing and I don't care about what you're doing. I'm doing what I'm doing because I know it works and I'm the one who has the curated formulas and I'm comfortable operating on those. You'll. And you should, you know, when you go see somebody, they'll tell you to stop and that's rightfully so because they don't know what you're doing. So ours is more, you know, from a antioxidant. We've balanced out those. That's usually the problem. There are no extraneous, you know, types of supplements with a lot of herbal aspects because that can be, right, hard to manage. So you can start that. And I know that works to lower inflammation is it makes a lot of sense. It's based on the genetic results of our patients that have experienced so many symptoms. So we're augmenting their immunity and that lowers their inflammation. And then you clean up your environment, you know, you get better air filtration with something like a Jasper. And you know, we use echo for water. There are a lot of things you can do just to lower the burden. If you want to think of it like that, of what's going in your system. Because I was thinking about when you were saying that earlier, as you know, in a performance based industry. So, you know, it's. We just have the Olympics, the NFL is going world football all the time. We got the World cup coming here in 26, the United States, all of those are just performance based. And you know, whether it's you Take somebody like Cristiano Ronaldo, who's this physical specimen who's 38 now and looks like, you know, 20 better than someone in their 20s. It's like, why? Because she's super regiment about what he does for his body, right. He gets up after sleeping a full, you know, seven to nine hours. He does a cold shower, cold plunge, whatever. And he has this very strict regimen to care for himself. So it all starts with those, you know, what can we do to modify those simple behaviors? And I always start with sleep.

Yeah, you do.

Women are terrible at sleep. I mean, my wife's no exception. You're probably no exception. Like y' all are stressed and worried about kids and the family and all the things, and that leads to a sleep deficit. And every hour you don't sleep out of that seven, it compounds and it's not good compounding interest like in your ira. It's bad.

It's sleep debt. Interest.

Yeah, the more sleep debt. And there's lots of studies that show this. But so I, I, I work hard with patients. I was like, I'll have a patient go home after a week and they'll call me and they're like, oh, I don't feel well. Which is a, a big tell. I'll listen. I was like, okay. So first thing I'm going to ask, just for everybody listening, I'm going to ask you how long you're sleeping. If you try to lie to me, I'm going to find you out. So when you say you're sleeping enough, I'm like, oh, okay. From when to win, you're going to say, oh, nine or ten till, you know, seven or eight in the morning. I'm like, oh, okay. Do you have to take a nap in the afternoon? And if they say yes. So there's two problems. One, they're getting up or two, their protein content's too low. So we try to get everybody on a gram per pound of body weight. That's simple to remember. It seems like a lot. Most people don't take enough protein in their diet, especially women. And so I don't care what your diet's based on. It's not my, it's not my fight. Right. I don't care what your yeah thing is. My, my only thing is that you need enough protein and or amino acids in your diet to recover. So how you choose to get it, y' all make a lot of excuses too. So you know, I, I use a, a vegan plant based protein so that, that okay. Not, not an Excuse. We use pea protein. It's fine unless you have a pea. Pea protein allergy. So that's kind of basic. And then, you know, this, this particular patient said, I have to sleep at like 10 or 11 in the morning. I'm like, okay, that's not really normal.

So you just got up and now you're napping.

Only babies do that, right? So. And babies do that because of why they're growing, right? They're, they're their need or their sleep deficit has to be met. So they eat and they sleep and they poop and they pee and all the things and they grow. So when an adult does that, they have to actually, you know, you have to be introspective and say, why am I needing to take a nap at 10:00am that's your, your, their unmet need is sleep.

Right.

Number one and two is your dietary intake of protein. If you can't do those two things, it doesn't matter how good you are taking care of their thyroid or I am at doing their surgery, they're going.

To struggle back to the basics, right?

Yeah, it's very simple. And then people wonder why they stay swollen. Well, the simple thing is called oncotic pressure. You have to have enough dietary protein in your diet to increase the protein content in your bloodstream, which then creates oncotic pressure. And then things will come out of your soft tissues. The swelling, the fluid into your bloodstream, you'll filter it. Your kidneys will help eliminate it. Obviously, you'll hear people say, oh, I had to urinate a lot. Well, yes. So that's.

I, as a very puffy person, I'm going to use this tip.

Yeah, that'll work. As long as your gut is working, that's key. And your lymphatic system, you know, I don't use. We didn't discuss that. But I don't use drains in surgery anymore. So drains have been eliminated. In tummy tuck surgery that doesn't involve liposuction for a long time. It's called the drainless tummy tuck. It's not a new thing. In breast reductions, I didn't use them. And so in explants, I stopped using them. I just, I drain it through the subcutaneous tissues of the abdomen. And then we have all these fancy devices from New Zealand called filipresso. We have hyperbaric as well. So all these things are meant to, from a sleep diet, lymphatic drainage standpoint, improve and allow your body's natural filtration, natural elimination. You're trying to enhance that. There is no drug, no drain, no method that's better than your body already has. It's the most efficient machine that you could ever find. But you have to know what buttons to push, what switches to turn off and on in order to get a maximum effort out of your body. Like, if you look at someone like Cristiano, who can still run around at 38 with kids 20, there's a reason he's not on drugs, because he gets tested all the time. So what is it? He just takes care of the machine. So instead of not sleeping, not eating right, drinking out of a plastic water bottle, putting shitty products on your skin, start taking control of it and you'll do better, you'll feel better.

Totally. Right. And it is. It's about compensating too, even for poor genetics or, you know, fill up your environment, the air we breathe that we can't control. So, yeah, very, very important to go back to the basics. Okay, questions from social. I'm going to ask the ones I have so far, and then I might check and see if there's any new ones. But tell me about bii. Is it more common with silicone versus saline implants? What have you found on that?

Doesn't matter.

And so does it not matter because the saline implants have silicone in their shell anyway or. Cause you always hear that silicone's worse than saline. But is that kind of the reason?

Yeah, that study we did, the shell characteristics did not matter. I'm sorry, the filler did not matter. It's always the shell. Right. The shell has the same characteristics. And you know, the fancy thing that's put on Instagram all the time is saline implants have mold in them.

Yeah, I want. That was my next question. Talk about that.

Yes, we published the paper. One, because I knew that was not the truth.

Yeah.

And two, you know, I don't like fear mongering. I find it to be neither.

It is disgusting and it's pervasive, even. Especially in the world of functional and integrative medicine. And it makes me infuriated.

Yeah, it's super aggravating when I see people do it. So now if I see somebody do it, I invite them to be on my show or I invite myself to be on their show to discuss it. Because if you can prove your point, I'm happy. I'm happy to eat my opinion. But, you know, and I'll be perfectly honest, I've been wrong about a bunch of stuff in my life, but I'm not wrong about this. So it's not a thing. You know, I've had five patients out of a thousand have fungi, which. That's what mold is.

Right.

And once again, I tell you, if it's inside, it doesn't really matter. It matters what's on the patient's scar tissue capsule on the inside.

Finding it there.

No.

Okay, I knew that, but wanted to clarify.

Super annoying.

I know. And there's a lot. I mean, there's. And then people hear it and then they're afraid and they buy into it and then it just sort of self propagates on its own. One question. Thoughts on recalled textured implants? Should we seriously consider removing them if we have them?

Yeah. So I was. This is, this topic. I thought I would have a storm of patients rolling in to get their texture devices taken out because they're the most closely associated with breast implant. Implant associated lymphomas.

Right.

But I didn't. And I thought, well, did it not get to the patients? Do they not care? Are they just afraid? Like, what's the situation?

Right.

I don't know. I don't have the answer to that question. I think you definitely want to, for your own health and safety, personally and for your family, make sure that you're in contact with a surgeon and you can get, you know, exams and surveillance. It's not, It's a small percentage that will develop the problem. So of course it doesn't make sense for everybody to go explain. But you should be monitored, I think, you know, just like anything, you know, if you show up with a big swelling on one side, that's not good, that's too late, that could have been avoided. You know, so I just want everybody, you know, I don't like taking care of a huge problem. I want to help somebody get through the process in the most effective, safest way possible. And, you know, it's always about making things smaller and easier to manage. That's a, that's a big issue. If you go back to my testimony that I gave in March of 2019 at the end.