Breast Explant Options: Lift vs Fat Transfer After Implants

Once again, share this with a friend, family member, loved one, acquaintance, anybody who could learn about potential problems, uh, with or after implants who are, um, you know, concerned about appearance changes, problems with volume lifts, all the different things. So everybody, I'm Dr. Robert Whitfield, and tonight we're talking about the decision, uh, obviously many of you face after deciding to remove implants. So the explant alone is always an option for every single person. It's absolutely everybody's prerogative to do exactly what fits them. Then there are other options. Stella from Switzerland was asking me about an explant with a lift. What happens to nipple sensation? That's a big question, and we'll address that. Explant with a fat transfer. I do that frequently. How about explant with a lift and a fat transfer? This is the one that I think should be done the most frequently in this country, in the world. That should be the go-to, and I'll explain why. So this conversation once again is educational only. This does not serve any consultative purpose, okay? It cannot be used to dictate any procedures or what's right for you. That decision is obviously one that goes through a consultative process, in-person examination, review of history, imaging, all of the goals that need to be discussed. So once again, this is for educational purposes only. Now we're live streaming on TikTok, Instagram, Facebook Live, YouTube Live, Substack Live, Rumble Live, X Live, LinkedIn Live. I want you all to share this around so that you can help as many people as possible. Be kind and help people who are looking for information, and you're just providing an opportunity for them to learn. Also, because I have problems being censored on all sorts of platforms when I discuss this, we created a private community, drrobscircle.com. If you want to go there and watch the livestream, it's drrobscircle.com/live. Now, um, we did launch a brand new website. It's got over 4,500 videos, 180 podcasts, 200 blogs, over 500 pages of content. It's all directly related to all the work I've done regarding implants, implant-related problems, capture contracture, implant infections, implant illness, BIAALCL. All those things are on my website, the brand new one. It's launched, it's up, it's live. You can go check it out. And then I have both books, the one written about the Sharp Method and the one written about BII. Okay, all right. So once again, we're talking about after explant. What are we doing? Are we doing a lift, fat transfer? Are we doing it delayed? Are we going to do it all at one time? So the most useful way to think about this is to separate the 3 different problems. The first question is what needs to be removed. The second is what the skin and nipple position may need. The third is whether you want to restore Some volume at the same time of the procedure. These are related questions, but they are not the same question. Confusion usually happens when we ask one procedure to do it, and that's not going to be solved by just the one type of procedure. So let's start with an explant alone. Implant removal addresses the presence of the device and the scar tissue around the device. I do a capsulectomy every single time. I think we've talked about that ad nauseam on live streams. Debris from the shell can rest in the capsule material, which is your scar tissue, as well as bacterial biofilm. And recently there was a case reported here that we did a stream about as well as some other videos of a case of food poisoning from salmonella resulting in an abscess around an implant. So depending on the individual, the surgery may also involve Obviously, as we discussed, the surrounding scar tissue, that plan obviously is going to be patient-specific depending on certain criteria that we've discussed in the past. Are we worried about someone with BIA-ALCL from a textured device? Do they have a history of seroma? Do they have a history of changes, rupture on exam or rupture on— I'm sorry, not exam, but a study? Something else to be concerned about? Are we going to run into old gel in the pocket? How are we going to take care of that? So an implant removal incision may be placed in the fold under the breast. We don't place them around the areola because typically it's very hard to access and get all the scar tissue out except for in very, very small devices. You may remember Danica Patrick had breast implant illness and had an explant. That was done through an areolar incision. She has a very small device. So after an implant is removed, the breast can look flatter, it can look looser, lower, or less regular than it did with the implant. How much change you see, it really depends on many variables, including the size of the implant, how long it was present, the quality and elasticity of the skin, the amount of breast tissue, the position of the nipple areolar complex. Has there been pregnancies, breastfeeding? Associated weight changes with or without those events, and then just aging and the condition of the scar tissue around the device. Today I took out devices that had grade 4 capsular contracture bilaterally. That is why 2 women with similar implant sizes obviously can have very different needs after removal. Pretty much that's the case in every case, including from side to side. Okay. I lost my spot here. Okay. So explant alone can be a reasonable option for someone who wants just to have the implant removed, accepts that the change in volume, especially in the upper pole and the shape, and does not want anything additional at that time. I get that request. I don't get it as frequently as I used to, but that's absolutely fine. It can also provide a a period of time that allows for decision-making later once they've had an opportunity for healing. They can see how their tissues settle, see how much breast volume they actually have, and then see are they comfortable with the nipple position, remaining skin, and remaining volume. So choosing the explant alone is not doing, um, them any kind of disservice. It's allowing them actually time to choose what they want to do. They could later on have a lift or just a fat transfer or both. So now we can separate that from a lift. So a lift for me, or mastopexy is the the term in plastic surgery, is designed to reshape the breast. The way I like to think about it is instead of reshaping breast tissue, which we would do if we were reducing a large breast, because everybody's concerned about how it's going to look after, right? So what I want to do and what many of my clients ask me to do is give them the highest possible, most youthful nipple position that I can do, and that is with a vertical lift. Now, vertical lifts leave a scar down the front. That's the lollipop scar, but that allows you to reposition the nipple areolar complex higher. You do not take it off and on. We'll go over that. And then use the skin envelope to To help reshape, tighten, and lift the breast. Anytime you take out a round skin excision and close in a straight line, you vertically lift the breast. Very simple. So the— that's the scar pattern I use for access to take out the device, remove the scar tissue, perform the skin lift. Now, an incision just in the breast fold would not allow us to move the nipple complex up. But can help with bottoming out caused by an implant pistoning down. And once again, we talked about the incision around an areola. We only use that if we're trying to reduce the size of an areola as an isolated procedure. I don't otherwise use that for an isolated lift because it doesn't really do anything to vertically change the position of the areola. Marketly. So that's how we think about lifts. And a lift may be considered, like I said, when the nipple position is lower, when there is a lot of excess skin, when the breast envelope has stretched, or when the desired shape cannot be created by just volume alone, like putting back fat. So a lift does not necessarily add volume because obviously it can't, but it reshapes and makes it look redistributed and looks like we added volume, especially in the upper pole if we have enough tissue. It improves, like I said, position and shape, but has a vertical scar in the front. In my practice, you know, the nipple areolar complex remains, you know, of utmost importance. Stella asked about sensation. So we're careful around it. And the skin is excised very gently on the top only, kind of like when you peel the top of a vegetable, very thin layer comes off that preserves the blood supply in the dermis as well as the sensation. So that's the best way to do that. The operation that I plan is with particular attention to this every single time when we do not have nipple sensation or blood loss— I'm sorry, or blood flow problems. Obviously, there's no guarantees when we do this, but the way we do it, the care with which we do it, and the technique really matters. You want to avoid problems with bleeding. Or fluid accumulation or any kind of infection there or wound healing issues. So everybody who's watched me and knows how I think about this, we're very careful with this. And we obviously discuss all the risks and benefits of this, but we've not had this be a problem. Explant and lift is the most common operation we do. And if we could, I would like to put volume back at the same Time. I think that's probably the best way to resolve all the elements at the same time, and we'll talk about that. So next, let's talk about a fat transfer. A breast fat transfer uses fat harvest. We have special tools for this to remove fat from donor site areas, typically posterior inner thigh, posterior outer thigh, love handle area, bra fat area, back fat. All these are good, and we do those in the prone position. We line your tummy. Kind of in the Superman position. So the job of getting this fat is to be able to restore volume and help with these contour changes. It may help soften these transitions from especially the upper pole. Now remember, from the clavicle, collarbone, down to where the nipple complex would sit, that is the most space to put fat, and it goes beneath the skin, above the breast tissue, in the fatty plane. It cannot recreate the profile of an implant. The density of fat is not strong enough to create the pressure that an implant can provide, whether it's saline or silicone. The most dense is a saline implant because the filler. The next most dense is silicone, and the least dense is fat always. So here's the rule: fat transfer cannot do what a lift does. It just is adding volume back. It cannot remove or redistribute skin somehow. So adding volume to a loose skin envelope is not the same as reshaping and lifting that envelope vertically. If the main problem is a low-set nipple, then adding volume is not going to change. So that would be incorrect methodology in that setting. And then, you know, candidacy for fat transfers is bantered a lot about all over these platforms. And we evaluate donor site fat availability through DEXA scans, physical exams, photography, of course. And the breast skin is really the dictator of all this. If it's really, really loose, Um, you can actually put a lot more volume in if that's what you want to try to do. If it's really tense, like someone who's super young, it's very hard to do a fat transfer on somebody who has a tense skin envelope. So once again, with those thin patients, it's not like they're automatically excluded because we do a lot of low body weight, low BMI patients. Just follow along with the thought process, right? If you need more fat and you don't have a lot in a particular area, you have to go to different areas and cumulatively create enough volume for that patient to have a fat transfer. Now, fat transfers, I think, have been ridiculed for uncertainty, but I think that's unfair. Oh, shout out to Kylie from Australia. Are you in Sydney or Perth or Uh, Melbourne. I just threw out the biggest 3 cities I could remember. Um, so I gotta get back on track here. I went off, uh, for a moment there. So, okay, I'm thinking about where I gotta go get my areas. I gotta go get fat, posterior inner thighs, posterior outer thighs, love handle area, bra fat area, back in general. Lots of volume there. So typically you can get what you need in that position. All right, Kylie's on the Gold Coast. Lovely beaches there. Um, we get all those areas, we flip over, and now this becomes, um, you know, can you get more around and shape the breast contour? Can you take some from the abdomen? So I've listed all these different sites, and cumulatively you can create quite a bit of volume even for a low body weight patient. So that means the amount placed Um, can be significant for that particular patient, right? Everybody's got individual bio— uh, biologic characteristics, and it's not that no volume— or I'm sorry, it's not that a low volume doesn't make a difference, because it does, especially in a low body weight patient. So some people may consider doing another session as well, which is absolutely fine. Um, I don't ever promise You know, we'll do a specific, you know, amount. I like ranging it based on our exam, based on DEXA scans. And then, you know, we want to really improve as much as we can at one time, knowing that fat transfers can be added to in the future. The risks are pretty much the same. We've talked about them before. You know, maintaining your diet, keeping your BMI the same. That helps preclude some of the loss. We don't have substantial problems with fat necrosis. I think overgrafting creates a lot of this. We do a lot of preparation with our patients to decrease toxicity burden, so we don't really see as much problem with resorption, necrosis, cyst formation, calcifications, or irregularities. They can all happen, of course. So the actual fat harvest obviously creates a certain amount of donor site risk, including swelling and bruising, discomfort in those areas. Now, when we do this, the most sensitive area is always the lateral thigh, but we have a very specific anesthetic nerve block performed by my team for that, which really helps with that. We use long-acting local anesthetic for all the areas, of course. And then, the big thing I always offer at the same time as skin tightening, I think everybody's just got to realize if you haven't already, as we get older, our skin gets looser. So that's just going to happen. So I offer skin tightening at the same time. We do it 2 ways: do a deeper tightening procedure with BodyTite, and do a superficial tightening procedure on the skin for texture, for collagen production. We do that with Morpheus8 microneedling. And so, you know, in general, fat transfers, skin tightening, breast lifts. I think they're all very safe and effective ways to get to the outcome. As it relates to fat transfers, in terms of— I get asked questions about screening for breast cancer. Of course, fat transfers have been done in cancer patients routinely over the last 20 years. They don't increase the risk for cancer and they don't affect screening for cancer. So that's not a discussion point. Anything that looks like fat necrosis, obviously is visualized and either can be seen on ultrasound or mammogram or in combination. Oil cysts are very easy to deal with. Obviously, the imaging team who does the screening needs to understand that you had fat transfer if there's ever a question. So who might consider an explant with a fat transfer but no lift? You know, in my head I'm always thinking of like, ah, this is an easy one if they don't actually have low-set nipple position. So nipples just at or above the fold, that's a good position. If it's substantially lower than that, then you got to consider a lift. And the fat is always used for volume. It's not used for lifting. Who might consider an explant with a lift but no fat transfer? Once again, a lot of people do this. It's just kind of undoing or doing a think of a reductive procedure. And so, if the main concern is stretched out skin. Low nipple position, maybe some shape concerns after having implants a long time. Then removal and revision using a lift-type incision, probably vertical, will give the most volume reshaping at one time I can do with the skin acting as a brassiere, basically. And then the bottom is what you have to control. Every patient's different depending on how much implant has contributed to something called bottoming out or stretching of the skin of the lower pole of the breast, even onto the abdomen at some points. So who might consider an explant with a lift and a fat transfer? Once again, I think this is the thing that, you know, if you can do this conceptually, I think this provides the most answers to the variables of volume discrepancies. Skin laxity. What what do we do after we're you know basically this is my holistic mommy makeover, right? I'm undoing a previous augmentation, taking fat from areas where it's hard to lose, redistributing it to the breast, doing skin tightening. That's like the best of all scenarios in this case. So the lift reshapes the envelope, of course, reposition nipple complex. Fat transfer adds volume back. Combining them, we get a lot of rejuvenation of the breast, and that brings it all together as a simultaneous procedure instead of staged. So some patients are great for this. They pre-op have a workup. We look at their tox test. Maybe there's nothing on it. Great patient of mine, Alexi Panos. Look her up. I did a show with her. Had nothing on her tox test. Did her explant and fat transfer, no issues, no problems. Uh, Jessica Brassington, uh, did the same for her. You know, all the things. Madison Miranda. I have tons of patients. Just go through my website, drrobertwhitfield.com, or go to my YouTube channel, Dr. Robert Whitfield MD. Listen to the patient stories, watch the podcasts, learn about all this stuff. They don't show me in feed anymore because it's upset too many people, but all of it's there for you to learn from. You know, as a surgeon, I've done them simultaneously, probably more so than anybody around the world at this point. But if your surgeon recommends staging, it's totally fine if you're comfortable with them and their process. And you understand what you're doing, you make your best informed decision. But if you want to come to us, go to drrobertwhitfield.com, book a free discovery call with my team, and they'll explain to you the process. Everybody can do that. Um, you know, for me, I get asked all the time, is it safe to do? Yes, it's safe to do. You just have to help get the patients prepared properly. You got to teach them all the things. That's why For everybody listening, I wrote a book about my methodology. It's not a secret. It's called The Sharpe Method. And we look and prepare you properly to undergo a procedure, any type of procedure. In this case, my practice is devoted to taking care of patients with breast problems. So we do explant surgery, we do breast lift surgery, we do breast augmentation with fat, we do explant lift and fat transfers, we do skin tightening, body contouring. All these things happen. Mm-hmm. And we feel like it's the best way to take care of patients. I want everybody around the world to be able to take advantage of this. We had Stella on earlier from Switzerland. I had a patient on from Zurich today. So I had 2 patients from Switzerland just wanting to learn about my program, engage in how we approach the care. And that's what we really want for everybody. We want to change the standard of care for surgical preparation and recovery in the United States and around the world. It's It's easy. It started here in Austin, you know, the way I do it, and we're going to get this program out and grow it as much as possible. Okay, we talked about using skin tightening. I think that's critical in patients. You want to offer that to them all the time. It really helps these donor site areas where we remove fat. Um, what else? Yeah, I mean, obviously people try to compare plans that I create for them Probably with others, and we understand all the limitations with travel. If you come spend time with us in Austin, my team is phenomenal. In the office, we have a full-time certified lymphatic massage therapist. We have a full-time esthetician, full-time MA. We have our nurse practitioners at Xplant. Two of my detox practitioners have had Xplants with us, so I have a full. Functional team that works with my patients for a whole year. I have a full medical team that works with my patients for a whole year. And when you come to the office in Austin, we have the Human Regenerator from Germany. If you don't know what the Human Regenerator is, go look it up. Lovely wellness device, gets you in a nice parasympathetic state. Um, I love lymphatic massage as an adjunct for postoperative care, so I think it's one of the best things for that. We don't use drains. So once again, No drains in my practice. Haven't used drains in multiple years in an elective case. So why do we do that? We concentrate on preparation. We want to diminish the cortisol surge. We want to diminish fluid retention. We want to upregulate your nutritional habits, if you will, so that you work harder on getting protein in, filling in gaps with supplementation, coming to the office, use the Human Regenerator, use the lymphatic massage from New Zealand called Flopresso. Use our vertical hyperbaric chamber, use our 6-foot-tall G of red light, use our NanoVi therapy. You got to do all these things and take care of yourself. The exercise every day is walking. It's very simple. It's the only reason I tell you to go to a mall because it's climate controlled. For all you people who don't know what a mall is, Austin could be pretty hot. So, that is the plan. If you stay here a week or 2 weeks or a month, we'll get you taken care of. I feel like You know, my long-haul patients from Asia, Australia, Europe, I like them here for a 2-week stay minimum. And then if you're local to us in Austin, you can come back and forth as much as you want. We know how to take care of you. The patients who are flying in from all parts of the United States are here for about a week. We encourage them to stay as long as they want. And, um, love.aesthetics.co is asking me, all that before surgery? So that's my stack after surgery when you're here in Austin, not before. That's my clinic in Austin has all that. So, all right, what else do we got? Well, I think that's probably, you know, it— I'll wrap up by saying there's no single answer for every person having an explant. Explant alone may be absolutely The right thing for them at that time. Often a lift is considered, but it's really dependent on the patient, where they are, what they want to do. And then fat transfer, of course, can be considered, but I gate that hard. I gatekeep it hard because I want the best possible outcomes. So you can stage them as well. All right, if you want to talk to us through Hearing this conversation, then go to DrRobertWhitfield.com. You can set up a discovery call with my team. You can join us in my private community. Tons of teaching there. I go live typically multiple times a week across platforms. I have a podcast that drops every Thursday. I've written two books. And I'll take some questions now. All right, I think I've rambled enough. Let me just put, uh, this down. Let me get some questions. How soon can I explant after a lift and new implants? Having issues pretty significantly. You can do that anytime, uh, Mrs. Geisel. I'm sorry to hear that. Feel free to reach out my team, uh, and we can get you set up to help you with Um, hold on just a second. I'm gonna help somebody here. Uh, all right, I gotta do a better job with this, so I'm gonna put this back in the chat. All right, so for everybody who wants to hit my team up— okay, I just, I just sent you the link. Yeah, Elizabeth, I don't do a traditional tummy tuck anymore. I can't stand that scar, and it's hard on the patients in terms of recovery. So Tina, I don't see complications with nipples. They should heal well all the time. If you're concerned about that, please contact my team because that should not be an issue. All right, I'm gonna put in the chat on everywhere how to get in touch with my team because it's important that y'all have that opportunity to do that. All right, so I'm gonna put this in the comments everywhere so you can have it. I always have trouble on TikTok. I don't know why. Okay, here we go. I'm gonna comment to somebody. I just posted a comment and hold on a second. I gotta find a question on TikTok. I'm gonna reply to Stella who's in Switzerland tonight. Stella, are you in Zurich? All right, I gotta see where we are on the live here. Do I have any comments? Oh great, I have Lori on Facebook. She's one of our fabulous patients. Thank you, Lori. I was giving a talk, so I couldn't see all the different people on Facebook or YouTube. And so I'm going to put a link here if you need to get in touch with my team. Lori's in my chat on, um, the live on Facebook. Why don't you reach out to Lori and ask her about my team? I have no problem with, um, anybody discussing anything about my team. My team is phenomenal. I would consider them top-notch, both at my clinic and at my surgery center. We have a brand new surgery surgery center opened in Austin here in June. I'm going to put the link to our discovery call in the chat here in just a minute. I'm happy to take some more questions if anybody wants to pop them in the chat on Instagram, TikTok, Facebook before we go into. The circle, which is my private community. All right. All right, man. I don't know why I put all that action in that comment. Well, Elizabeth, we definitely could do a holistic mommy makeover, but I don't excise that tummy tissue anymore. I think that's such a difficult recovery for patients, even in our hands, that that incision is such a large one. It's really difficult for patients to handle. Okay, okay. So we're gonna have some instructions here that everybody's gonna follow along with, and we're gonna continue our overall discussion in my private community. So, oh, Circle is lagging behind Instagram. That's not uncommon. Let me just do something here. It might be secondary to Wi-Fi. Turn off the Wi-Fi. It might buffer for a second, but just let it hang in there. All right. I need y'all to wave at me or give me a show of hands. Who can join us in Dr. Rob's circle? Who wants to go to the circle and carry the conversation longer in the circle? I have so many people that keep joining the stream. That's awesome. All right. Love.aesthetics.co said, could you explain an under the muscle versus over the muscle? Over the muscle is super simple in terms of recovery. You're going to do a complete capsulectomy. Usually can do in-block almost every single time without difficulty. Behind the muscle, the muscle is layered out over it, so you have to reflect the muscle off of it like a fan lifting up and then take out the capsular tissue that's stuck up against the posterior surface of the muscle, anterior surface of the rib cage, and pectoralis minor. And then, we repair the muscle. We wanna repair that as much as possible to help control especially the lower inner quadrant or cleavage area. All right, so we answered Tina's question. I just wanna make sure I've got as many of these questions answered as possible. And Mrs. Grissel, I answered her question. Be Healthy with Stacy B said she's coming to see me in 2 years. I hope I'm not retired by then. You better hurry up. Cami, you have to set up a call with my team. I don't know what all you need, okay? Okay. Who else do we have here? All right, still got people going. Are y'all heading over to the circle? I feel like nobody listens to me. Is that a problem? Is that Tina Alvarado, my patient who I did a deep flap reconstruction on? If it is, thank you for joining, Tina. I hope you're doing well. Tina is a deep flap patient of mine. Okay, let's go. You got to share this around to everybody so they have an opportunity to learn. Um, you know, uh, Karina, if, um, if you can keep your BMI level, go up a point or two, you'll keep as much as 80% of the fat. Thanks, Danielle. Is it, uh, I hope it's better in there now. Ah, I did Tina's reconstruction 16 years ago with a deep flap. Bilateral D flap, I believe. It's awesome. Thank you for joining, Tina. I'm very, very happy to see you here. Thank you. All right. Any other questions for me? Are you guys ready to go over to the circle? Can you head there now? Lori's there. Danielle's there. If y'all want to head over there, if you take the following link and you just tap it. Oh, golly. Trying to answer this question. Hold on a second. Okay, I was trying to— I'm gonna type a comment in here. So drrobscircle.com/live. All right, everybody, if I'm thumb typing this, you can just hit this and put it in and go there. You'll be directly linked into my private community. All right, I'm gonna do it on TikTok. Sorry about how slow this is. All right, there you go. Mitri, um, the lift is based on your desire for position, not mine. If they're asymmetric, I can make them more symmetric. Um, so that's basically up to you. A lot of, of clients ask me to get it in the most youthful position possible. So happy to go over that with you. And, um, Oh my gosh. I tell you, I'm the worst thumb typer. I need one of my kids to do this for me. Set up a time. Everything's— you can talk to my team about getting in to see me. What else? Facebook blocked my comment. Oh my gosh. Oh my gosh. All right. You can see it in the chat. So silly. I don't know why Facebook does that. It's crazy. Yeah, I mean, Eliquis is a thinner— you're on it for a reason. Typically you have factor V Leiden, antiphospholipid syndrome, something of that nature. So you got to come off of it, and then we resume it after surgery. Um, yeah, I mean, we, we do do that. We do all of our patient, uh, care as an outpatient. Nobody stays overnight in the hospital. We don't work in hospitals at all. So we have to make sure that everything is safe. Of course, can't have blood pressure problems, cardiac problems. If you're on a thinner, then we have to address it and make sure that we're doing absolutely the safest, most, uh, appropriate thing, you know, for you and your history. Okay. All right, who else do we have in the circle now? We have Lori still, Danielle. Is that Going to be it. Is anybody else going over? Can you head over now? I don't know. We'll see. All right, y'all, I'm going to shut down the other feeds and just go to my private community. It's been a long day. Okay. All right, y'all, thank you for joining. I really appreciate it. I had fun. All right, give me just a moment. I'm going to shut all these other feeds down. Sorry about all the confusion on Rumble. I put in the wrong title. It's my fault. I just duplicated my talk from last week. I just selected the wrong one, so I'm sorry about that. Everybody give me a minute as I end all these feeds and I just go into the circle. Almost there. Okay, cool. I'm in the circle only now. Oh boy. Okay. All right. This question is, if you're low BMI, can fat grafting possibly fill in the volume of a 255 low profile implant after explant? I don't have wide tissue naturally, which is why I got low profile to begin with. I feel like they project too much still. I'm very uncomfortable with the under-the-muscle placement but don't have enough tissue for over the muscle. Um, I mean, that's a great question. Once again, I don't go by BMI. I use a DEXA scan. I think that's super helpful in lower body weight patients. So I would get a DEXA scan. It's a GE device, not InBody, a DEXA, a formal DEXA scan. That just helps me clarify actually how much tissue you have. And then that in combination with physical exam, if you're super low BMI, I just have people fly into Austin if I can't get comfortable with what I see on DEXA and photography and any other, uh, materials we have. So pretty routine for us. We've done several thousand explants. I don't know how many explant fat transfers I've done. I've, I've done over 1,000 fat transfers in general. I just don't know how many I've done specifically just for, um, explant-related cases. So can everybody hear me okay? I'm still streaming according to all of my analytics here. Okay, thank you, Danielle. I thought I was losing my mind. It's okay. All right, so for all of you left here listening to me drone on, I definitely went off script tonight. I did not follow my talk at all. That's what I get for creating a talk. I just got doing my own thing and Hopefully it was good. I just kind of went— I got going there and just was riffing. So hopefully it was good. All right. What other questions do we have here? And the thing sometimes when you join live, I can't see, it just says member. So I hope I answered your questions. If I didn't, please follow up with another question. This is totally your time. Yeah, thanks, Laurie. I think I've given these talks a few times, so It's definitely not hard for me to give a talk. Any other questions for me? You're going to make it this easy for me tonight? All right. Okay, y'all, it's almost 7 o'clock. I am tired, so I will shut it down. Thank you so much for joining me. I look forward to doing this again soon. If you want, I have been streaming on TikTok in the morning answering questions regarding Posts I make on my subreddit thread, so look for those. My subreddit thread is Surgery Prep and Recovery. My Reddit profile is Dr. Rob Whitfield. We've not been banned or blocked on there yet, so seems like a good opportunity. Oh, hi, Kiko! So great to see you. Hear you. Thank you very much for joining us from Japan. Everybody, thank you so much. All right, have a great night.