Breast Implant Illness Live

All right, we're live. Hopefully everybody was able to hop on. Tonight we're gonna do live Q and A. The subject matter is going to be breast implant illness. I'm having a little trouble with one of my streams here, so we're gonna go ahead and reboot my Facebook stream. IG seems to be working. Chime in if y' all have some questions on IG and also on YouTube. So the chat's live right now. Go ahead. All right, I see there's a request here. No, I'm not doing additional videos. Hi, Kristen, how are you? Great to see you. Thanks for joining. I am going to get up and running in just a moment here. I got to change something on Facebook and then I will start it. All right, just had a little glitch there. I don't think Facebook's going to work. Okay, so are there stats for how many people actually feel better after implants are removed? I think that's a fair question. So we published a paper last year that everybody can find online, and it really shows the rate of bacterial contamination found on X plant specimens. In our series, those are all PCR tested. The analysis is done by a third party lab called MicroGenDX. And so in that series, 29% of the patients had a bacterial contaminant. So in that setting, we're removing what is a potential underlying infection. Now, also, when you take that data and combine it with a paper published by Dr. Muthoon Suna, who I had on my podcast, and I did a video about his paper, Oxylipin 10 Home. So if you have bacterial contamination and you actually know the interaction between the breast tissue, which is specific, between the oleic acid, which is a fatty acid in the breast tissue, that interaction can create oxylipin tenhome and other oxylipins. So when that happens, immune system activation happens. And that's what we had always thought was the case with where your immune system gets turned on and you have trouble actually getting it to calm down or not turn off. But that heightened state of the immune system, the activation, if you will, is caused by Oxylipin 10 home and subsequently it activates macrophages downstream. And that has been shown. And in patients with more symptoms, that Oxylipin 10 home has been measured at higher levels in their bloodstream compared to controls. Oh, Su22wat says is it normal to drain patients before surgery? So I offer that to patients who have saline implants for a simple reason. First of all, if you go throughout the course of time In a career like mine, you'll have patients come that had a ruptured saline implant that deflated. When they deflate, the patient doesn't know, you know, right away. It may take three, four days, maybe a week before they notice completely. And if you don't exchange them quickly, that pocket just contracts down. So the reason we offer sterile saline deflation in the office setting under local anesthesia is, is so that we can get those tissues to contract back down, make the space smaller. So it's a much smaller area to remove. It should be overall an easier procedure for the patient to tolerate because you're removing a lot less space, if you will, because the tissue that used to be expanded is now contracted. So I always say it's more like taking out a Frisbee than a Beach. Hi, on YouTube, it's underscorelaki47. Do you have a question? Let me just check on YouTube if there is a question. All right, back to ig. It said, is there a test to see if you have a rupture silicone? So traditionally, if you were concerned about a rupture, there is the standard exams, usually a high definition ultrasound is how we would start. If, in fact it was difficult to characterize, you can move to a devoted breast mri. Usually what happens in a regular MRI of the chest is that the patient's laying on their back and getting that MRI done. So it'd be easy to miss a leak on the backside of the implant because no gravity is involved. J. Bean, 79. I went to a console and was told to leave the capsule, that my body would eventually break it down. It would dissolve the whole capsule. That's not true. That's not true. So depending on the thickness of any capsule, that dictates more of, you know, will that statement that you wrote, that's how we were all taught in plastic surgery. And if you've ever had to reoperate on a patient with an implant, you know all too well that all of that capsule does not dissolve and go away. Oh, my mic is not up high enough on YouTube. I apologize. Can you hear me now better on YouTube? Let me just check and see if my mic is better now. Okay, back to IG. Is there another question? All right, let's see on YouTube. Can we do a detox without a date for explant? That's a great question. That's from Rose, Natalie Budd. I hope I'm saying that correct. So our Sharp program is now actually available. So people can run Sharp, they can do it remotely, they can use our supplementation to lower inflammation starting now. And they can access our testing and work with our detox practitioners. Obviously not everybody can get to me very quickly. It takes a lot of planning and you know, I want to help as many people as possible. We've worked on this problem for over nine years now and we're very comfortable with our experience with the problem and overall the supplementation pathway, the testing pathway we have and the detox plan we have. Alyssa Seaman. I had a single side mastectomy and I'm ready to explant though want to confirm fat transfer is not possible to match the other side, the fat will essentially dissolve. Is that correct? No. I mean, if you follow my career, the first 19 years really of my plastic surgery career was spent just taking care of breast cancer patients. Did 100 to 150 fat transfers a year on patients with whether it was a implant based reconstruction or a dip free flat based reconstruction. So no, the closer that we can get your body in balance, the better. Fat has the opportunity to heal. Fat is the original filler and still is the king of fillers. I like that said king of beers. Fat is the king of fillers are most contractures. You find ruptured implants Also any way to convince my surgeon not to do drains and let my body handle seroma? There was a paper published last year out of Australia that shows you don't need to place drains during explants. It was in 140 consecutive cases. They had no trouble with seroma zmatomas. Similarly in our series we haven't used drains for the past several years. I have a very high volume practice. I do three to five explants or actually I did four explants today. The last one I used drains because there was an infection. So that would be the time I use a drain. Linda is asking is fat transfer the only option after explant to fill the upper pole? That is the natural option. Of course with reshaping and a lift procedure that helps as well. You're welcome, Bianca. All right. Are there any other questions here? I explained I was told my body would break down the capsule. Would you recommend another surgery to move them or just detox? That's difficult. Amanda Brook, if your symptoms get better with detox, then I would just sit tight. Obviously reoperations are another matter altogether. I've done those for patients who've remained symptomatic. Tawny, what do you recommend patients test for before? Small town doctors that only do routine blood work and multiple ER trips and misery for six months. Then you should actually contact us and look into Sharp. That would be my best guidance. We've developed a series of tests that we favor for that, and we can help you. Brooke, Hi. I've had gummy bear implants 14 years. I'm trying to get them out next month. They hurt. And I've been noticing tingling radiating down my arms, sometimes into my fingers. Have you heard of this? Yes, Brooke, there are lots of reasons to have that. But if you have bilateral arm pain, then you always want to make sure your neck's okay, first and foremost. All right, Michelle, thank you for responding. You can hear me well on YouTube. I appreciate that. I don't think we announced this carefully on YouTube. So please, if you have a question on YouTube, please put it in the chat and I'll answer it. We're still getting some more questions in on Instagram. Michelle's asking on YouTube, is detox done post explant? So, Michelle, we have a program that runs the entire year that we take care of patients. Sometimes patients can't get to me for several months, so they start supplementation from the time they meet us. They get their testing completed. And then there are certain things that we do in detox 4 explant. It depends on the patient and their testing. That's a great question. Everybody's waving. Hi. Susan's asking, do I take insurance for explant part of the surgery? Susan, I got out of insurance actually at the end of 2019. So no, Ma' am. Question on YouTube is how dangerous is it to have kept the ruptured implants in years after rupture was diagnosed via ultrasound or etc. So it depends on the device. A ruptured saline device, not as big of a deal. Ruptured silicone device depends on the device and the shell integrity and whether or not it's contained. I still recommend all devices that erupt should be explanted. Goes on to say, especially with textured ones that were recalled due to the associated lymphoma. Yeah, textured devices. I took out a textured device earlier today, actually. It was a saline device. So texturing in particular, bio cell texturing is most closely associated with anaplastic large cell lymphoma. It's still very rare, but I always worry about when we're taking out texture devices. We send all of our capsules to re evaluate it for breast cancer and any breast implant associated cancers, including squamous cell cancer, breast implant associated anaplastic large cell lymphoma. We want to not Leave any of those questions unanswered. All right, Y' all are doing a great job. These are good questions. Anybody else on Instagram Here, let me see. All right, what did I have here? I'm going to make sure I answer these into skin explanted three months ago, including capsule feeling heaps better. That's also into skin. Please make sure that you at least are careful in terms of getting evaluated for any other things that could be bothering your GI tract or other toxins. Michelle, in Canada, it's so difficult for me to get to you. Do you treat virtually? I have mentor textured implants with flu collection around the right implant explant is scheduled for March 26th. Michelle, we do meet with folks virtually. The problem with Canada and Mexico is customs. Even before this New Year, I had trouble getting testing and supplementation to folks in Canada would not pass through customs. So that's been a problem. Tawny asks, wondering what could mimic bii? Oh, my gosh, Tawny. Anything that causes chronic inflammation, like Lyme mold. I have a lot of people with a lot of gut dysbiosis and inflammation. There are a lot of chronic inflammatory processes that look very, very similar. But if, if those things have been treated and otherwise negative on a medical workup, then you have to consider looking at carefully the implant or any other foreign bodies. I have a group of patients who've separately gone and had all their amalgams taken care of. IUDs, some of the other kind of smaller implants as well. Is there. There's a question over here on YouTube. Is there a higher likelihood of development of fungus or mold and other bacteria once ruptured over a longer period of time? You know, in my experience, actually, I haven't been able to demonstrate that, so the data doesn't reflect that. What I don't like is the interaction of the tissues with any kind of ruptured device. I'd be more worried about immune system activation. All right, I'm going to go back and make sure I answered all of these. Oh, there's something I missed here. I'm sorry. No questions yet. Ask something. Okay, Let me see what else. I want to make sure I answer all these. Oh, I missed this from Tawny. What do you recommend a patient rule out before multiple debilitating symptoms and no answers. Small town and doctors don't do much other than basic blood work. Yeah, I mean, the things that we always look carefully for. Obviously you want to make sure that on routine labs or autoimmune workup, those things are vetted. So if someone has already an established autoimmune and then has breast implant illness or another problem developed from that, there's potentially going to be obviously some overlap. What typically comes to me is a patient who's already went through a pretty large workup and everything's really been negative. And they've been working already hard on their diets, lifestyle changes, and still are feeling brain fog, anxiety. They may have chest pain, chest pressure pain in their muscles and joints, fatigue, a lot of gut symptoms, bloating, swelling, cramping, diarrhea, constipation. They may have problems with UTIs, bacterial vaginosis, neuropathic pain, tremors, muscle and joint pain. I mentioned really just a host of symptoms if you want to. It's hard to narrow down, honestly. Question on YouTube is, have you experienced a connection to autoimmune diseases such as Hashimoto's? Hashimoto's happens without implants being in place. So that's a really common problem. So I don't draw any correlation with that. I missed this on, I believe earlier on Instagram. Is there a test to trace silicone if you've had a rupture? So typically all that is going to go to the lymph nodes initially in the axilla, and that's the most common thing you would see. Other tests I haven't really had that demonstrated on toxicity testing. Another question on YouTube, in addition to autoimmune diseases, trigeminal neuralgia, I have seen a lot of interesting neuropathic symptoms, including trigeminal neuralgia. It's really infrequent, but I have seen that. Yeah, if the fluid is negative for CD 30. Yes. You would consider that negative. You still would want to address that. I don't consider any. Any fluid around an implant is concerned for infection and. Or if it's a textured device. Alcl. So I wouldn't leave any devices in. I don't feel comfortable with that. So I would always recommend getting that device out. Actually when the recall happened for the doctors. So the recall was to the doctors, it wasn't to the patients. Patients got letters, but then the recall was to the plastic surgeon. So I thought I would see a lot more patients who had textured devices and then, you know, want a discussion regarding, you know, what's the next best steps? That didn't happen, to be honest. That was odd. Oh, I missed this question. This is from hers, underscore. JLT would love to know how long it can take generally to heal from BI symptoms in the body post explant. So it really depends on where you start. And then what you're testing reveals how your genes allow you to detox. Some people will do well within the first several weeks shortly after surgery. Others will take longer. It's a function of what is going on at that time. Remember what I said. About a third will have a problem with an underlying or subclinical bacterial contaminant contributing to immune system stimulation. Sometimes when that is taken out, they feel better right away. Other example is my client, Lauren Bostick hosts the Skinny Confidential podcast and she had a lot of heavy metals in her system. As soon as we did her explant, she felt better right away. Michelle, you're welcome on YouTube. I'm glad that answered your question. Any more questions on YouTube? No. Okay. I want to make sure I have everything on here. Shan, I don't know what the question was. It says do most surgeons test for that or is that preferred testing? I can't. I don't know what the other question was. Shay Magnuson, how do we know the whole capsule is removed? Well, we take pictures of all of our specimens and I do a video for every patient so they know what we found and that helps everybody know. This is all put in everybody's chart. So there's no question. A well known. Oh, there's a question on YouTube. A well known plastic surgeon mentioned. Usually the cultured cultures come back negative in terms of biofilm, even if it can be assumed that they are present. Don't recall the exact specific he was referring to. Sure. So all we can do is actually go back to the literature and to actually assess biofilm. The most appropriate technique is using PCR analysis. Everybody remember from the pandemic you could get an antigen test or PCR test. The PCR test was always going to be more sensitive and specific. Ours looks for 150 different types of bacteria, fungus and mycobacterium. They are not cultures. Cultures are like Q tip swabs that then have to be put on an agar plate and put into an incubator. And that's how you grow bacteria on a medium. And then they place antibiotic disc next to it to see what it's sensitive to. That's an entirely different type of culture technique. And that may be what they're referring to, but that does not help you establish whether or not a bacterial contaminant or biofilm is on a device. Typically you can't culture those out very easily. So the PCR test allows you to amplify the DNA of the organisms that could be there. Michelle's asking what was the percentage of implants that have the bacterial contamination? In the paper I published, it's 29% and almost 600 specimens. Yamile, is there any way to know if someone had the capsules inside after explant? No. I mean, the reason we do pictures and show everything all the time is so there's no confusion about that. Question on YouTube, is the PCR test the standard for all plastic surgeons? No, that is not the standard. It's my recommendation that it be used for this particular problem. I'm trying and hopeful that that will become the standard of care. PCR testing is not actually, as I think, useful in ruptures when you're trying to look for bacteria. It's Amanda Brook, do you feel each explant patient should have capsule removed? In my experience, I've had a handful of breast cancers, I've had one lymphoma, and I've had, on our experience, 29% have bacterial contamination. So if we had not taken those out, high likelihood those patients wouldn't recover. So, yeah, my recommendation is for capsulectomy. Oh, I missed this one from Bianca. Hi. Are most contractors you explant rupture? No, ma'. Am, Most contractures are not ruptures. A question on YouTube. How do we test to look for a rupture? MRI. Devoted breast MRI is the gold standard. You can use high definition ultrasound, but if you're really concerned. Breast mri. All right, I'm going to see if I have any more questions here. Did I get everybody's questions answered? All right, let me see. That's a great question. Hersjlt, Are your kids at higher risk of us passing things on during pregnancy with implants in our body? Yeah, I mean, that's a great question. Whether it's a hip, knee, breast, dental implant, they can all become contaminated because they're foreign bodies and there's not a study to show transmission that. So no one has the answer to that. Oh, question on YouTube, the best test for biofilm is PCR testing on X plants in terms of ruptures. Like I said, devoted breast mri. All right, question or I'm having pain under my left breast, which is getting worse. How long would the wait be to get an explant surgery? This is Lori. Lori, you should just reach out, message us on this handle or go to my website, drrobertwitfield.com and fill out a contact form. My team will contact you. What else here. Trying to make sure I Get all these answers answered. Sorry, Rose, I do want to get scheduled this year. Fiona's asking are wrist much higher if implants are under the muscle? Well, since there was a moratorium in this country and we switched over to saline products in the 90s, most implants got placed behind the muscle. That continues and today I did three sets behind the muscle and one set above the muscle. When you explant a specimen that's above the muscle, there's obviously less disturbance of the muscular tissue. Muscle repair is not necessarily indicated in those cases. You just have to assess each patient. And we're doing retropectoral or sub pectoral implant cases. We're going to explant all the capsular material. We're going to try to repair the muscle and provide better continuity for the breast and the muscle in the cases that are retropectoral. JDOT being 79, my gummy bears are above the muscle. What is normal downtime after explant? That's usually a one to two week recovery in my practice. Hi stuff. Question on YouTube. How many sizes do you go down in cup size when you explant? Well, typically the average implants about 300 cc's that I take out normally. And so you're at least going down a cup and a half. Average cup size is about 200 grams of tissue. So think of it like that. Thank you very much, Rose. I always appreciate being called young. Not very young anymore. Thank you so much. Love that comment. All right, did I get all these answered? Is anybody. How soon after explant can you inject fat into breasts from another area? Depends on your timing. But if you're going to do it secondarily, we wait about six months. Don't worry, I'm hanging out answering questions. So Kels, I have under the muscle and want to explain but still want more kids. Should I do a lift after or is it worth to wait? It depends. Kels, my nurse practitioner had explant and she wanted to live. She hadn't had children yet, but she said under no circumstances would she not have a lift. So it's a personal decision. After explanting the previous implants, can you exchange it for a new one? I don't do exchanges anymore. I just do explant surgery now. Hold on just one moment. It's. It's late in my office and people are in here making a little noise getting the place cleaned up. I have a question about my bundle and I guess it's about lupus, which is the best. Which of my Bundles is better if you have lupus. Well, something that lowers inflammation is better if you have an autoimmune disorder or lupus. So I would definitely do the inflammation support Bundle question on YouTube. How can you have explant if you're allergic to medications? Basically allergic reactions to most things. Mast cell activation syndrome. Yeah, boy. I've done a couple patients with mast cell activation syndrome lately and one of them was a nurse and she was triggered by a lot of things. Sorry, everybody keeps making noise around me. So mast cell activation has a lot of triggers and obviously if you're allergic to a lot of medications. Fortunately we don't actually use a lot of medications and our anesthesia group is great. They're sensitive to mast cell activation syndrome. So just probably go to this site, fill out a contact form. We can discuss that further with you. Got a question about is X plant covered by insurance? We haven't used insurance in our clinic since 2019. Bianca? Yes, it's Dr. Campbell Lloyd's study. Yes, it's the only one in the literature. I have yet to publish mine. I'm a little tardy. Sorry about that, Michelle. I would not order the bundle from Canada. It has been blocked at customs. It's probably best to do a virtual with us and I can give you some guidance there. I hope at some point to have somebody in Canada. I just feel like I spoke to somebody in Toronto this week and there's just a lot of different issues with supplements. I don't know why that's the problem in Canada, but that's become the case. It was that case last year, so it's not a new problem. Izzy, I'm sorry, you can't come see us. The. The explanting surgeon. If they take their time, they'll be able to get the capsule out. It's not dangerous. Thicker capsule is easier to take out. And then I have people detox with us who can't have surgery with us. So that's still an option for you. Question on YouTube is from my talks. Is it best to prepare for surgery with diet supplements to help with surgery and medications too. So the diet that I have patients go on is a gluten free, dairy free diet, higher in protein. I prefer that you get higher amounts of protein just so that your body gets used to that. So say for instance, somebody's taking Ozempic or Wongovy or Mongoro. I have those patients stop that for three to six months because those change your behavior around eating. And I need people to develop an appetite and Eat. The key to recovery is how you sleep, what you eat, what the quality of the food and the fluid and the air that goes into your body. Question on YouTube. Would it be okay to put new implants in at the same time as the old ones are removed? I understand you don't do that anymore. Yeah, that's your decision. I mean, I don't tell anybody to explant. People choose to come and have an explant because having implants probably to them at that stage in their life doesn't align with them anymore. So that's the. That's the key there. Like, I'm not the person that's going to tell you you have to explant, just like I'm not the person that, you know, 10 or 15 or 20 years ago told somebody they had to get a breast dog. That's a decision that each person makes. I try to help people make the best informed decision they can about explant. Am I seeing this with patients that have saline as well? Yes, ma'. Am. Yeah. I've explanted every kind of implant from around the world. Basically saline and silicone, textured and smooth, round and shaped. Danny? Yes. You can detox with us now. We've opened up Sharp, which is the book above my left shoulder for everybody to participate in. You can get the book online or you can purchase it. And then my detox team works with people remote now for the first time ever. Question is from Kells. Do you have a recovery center if coming in from out of town? So most people who are coming from out of the United States stay here for two to three weeks in Austin, and they'll typically rent a home or stay in a hotel. If you're going to be here a lot longer than a week, typically people are getting the renting a home. And then you come to my office. I have a hyperbaric chamber, lymphatic massage devices, red light therapy, nanov. Yeah. All my staffs here who are wonderful, like, the best part of coming to Austin is to be able to spend time at the clinic with the staff. I have a great team. Great team. Jesus cannot sleep. All right, Jesus, I want you to do the three, two, one rule. This is easy. Stop eating three hours before bed. Stop drinking two hours before bed. And then try to get off of screen devices about an hour. Get your room cooler, about 65 degrees Fahrenheit. And if you need a mask that will help you. If you need earplugs, something to block out noise, and then try to get to Bed the same time each and every night. All right, what else do we got here? Rose says, I also think if you are a smoker, nicotine or cannabis should completely stop because it hinders your recovery. I don't operate on smokers. Nicotine is very problematic in terms of healing, so it's a very powerful vasoconstrictor. My MRI came back normal. I have lots of pain on my breasts. Would capsule show on mri? No, the capsule is typically not thick enough because the resolution of MRI is not that good. So that would be more of a examination or a discussion that we could have regarding that. I'm sorry. Adrid. Jesus. Doctor, There's a doctor in Adelaide. I want to say it's Dr. Campbell Lloyd. He did the drain study I was talking about. So he can do the explants and then people can run recovery us remotely. So that's an option. Oh, thank you very much. Hers? Yeah, we like people to stop nursing for at least 90 days. We recently had somebody who had been still nursing relatively close to explant. It was a little problematic, so I'd Recommend at least 90 days. Brandy wants to know, do I use drains? Brandy, you got to listen to my show if you're going to ask that question. So, no. I tried to get rid of drains many, many years ago. So the only indications I have to use a drain and unfortunately today somebody had an infection, so I used one today. It was an obvious infection. So that would be one of the main things. If there was a really difficult rupture of an old device that was more like syrup, that would be a potential option for a drain as well. But my standard is not to use drains. Is there a similar physician in Ontario? Not that I'm aware of. Do I recommend certain detox supplements? Really? I recommend getting testing done and that helps clarify what is the best course of action. I am not one to start protocols without a baseline of testing, especially toxicity testing. Yes, you can Explant Love bucket 512. Yes, ma'. Am. That, that. That kind of weight issue may just represent fluid and that's probably, you know, what you're experiencing. So, yes, you could still explain. Yes. Fat transfers down the road are great, Kim. Absolutely. At any time. Don't worry about it. Very familiar with Von Willebrand's disease, Brandy. My sister is one of the first people diagnosed with it from Scripps in La Jolla. Good luck. Yes. Fat helps with any dimpling, rippling as well as volume expansion. Fat transfers can definitely be done down the road. Yeah. Brandy, Basically, if you have von Willebrand's disease, basically you have DDAVP nasal spray or DDAVP IV on hand and it's not difficult to do. I did somebody with von Willebrand's. Oh, this is February. Must have been in January. Good luck, riley. Kmao Kmay. Go to my website and fill out contact form and my team will reach out to you about that. What type of testing do I recommend? I always start with, you know, in my book, sorry, books over here on this on YouTube. So the book is right there and next to it is the company we use currently for genetic testing and vision labs. So you got to know how you detox in order to figure out the best plan. And then what are the toxicity problems that you have? What's the healing time if you do a fat transfer of the explant? Actually, it's not as bad because I have patients do I recommend thoroughly doing additional lymphatic massage to help reduce fluid accumulation in the tissues after whether it's explant or explant lift fat transfer. So that's number one. Number two, my patients swear by doing more hyperbaric oxygen they convinced me to get the chamber and that really helps them as well. As well as red light therapy, nanov therapy. So those are my go to's. Hello from Miami. I have a lot of people that come to me from Miami. I don't know which the best person, I don't know who the best person in Miami would be to go to. You'd have to go do some consults there. I don't have a specific recommendation. Everybody on YouTube is asking about the link to my book. It's in the bio. Go to the homepage after this and click on the links. It'll take you to everything that we offer. Yeah, we have additional fat transfer surgeons actually now as well. So in addition to me doing them, I have another surgeon, Dr. Chung, who does fat transfers as well. So we're trying to accommodate as many fat transfers as possible. That's the main initiative in 2025, is to offer augmentations with your own fat instead of implants and then to care for those patients who need fat transfers. DeLorenzo69. How long does the fat transfer last? Well, I think we'll all kind of appreciate when we're younger, things work a lot better. So what we try to do with the Sharp method is really optimize. You get everything on point. Diet, hormones, supplementation, any toxicities, try to lower that. And then whether you're explanting or doing explant lift or explant and fat transfer. Whatever the procedure is, work with you to maintain and keep that number of changes that helped you get better and will help you continue to get better. But you really got to concentrate on a lot of things all the time, including sleep, diet, fluid, so your hydration levels, supplementation. I'm a big fan of air quality. I live in Austin and the air here is difficult. A lot of mold. So there's a lot of things to always keep in mind. It's not just, you know, aging that affects potentially a fat transfer. It's all the other things hers underscore. Jlt do you recommend water cleanses? No, I don't. I don't recommend water cleanses. Question on YouTube, can oxygen water help? I think you mean hydrogen water. Yeah, I did a video with the CEO of Echo and yes, they have some good data on hydrogen water. Mo underscore. Yeah, you would prefer to have fat available. That makes it easier for the fat transfer surgeon. I know that's a difficult thing if you're low BMI and you just are lean. So we do a lot of cases of low BMI patients, so that still is an option. On YouTube. Do we use alternative substances for volumes such as hyaluronic acid? No, I don't inject HA for volume and I don't inject Sculptra for volume either. I do not do a lot of explants on patients after mastectomy. I think many of the time, many times the patients I'm seeing with cancer, I provide a lot of second opinions for patients with a history of cancer and reconstruction with the implants. Because my, you know, first, you know, from really 04 until 2019, all I did was really concentrate on cancer care and really a small amount of cosmetics. Of course I got very good at doing implant based reconstructive care and problems from that with radiation capture, contractures, need for reoperation, infections, all the things that come along with that. So I got very adept at that and had a pretty busy practice with taking care of complicated breast problems. But then in 2016, I explanted somebody who had an infection that we found afterwards and it kind of just opened up the floodgates and people started coming to me for explant surgery. And now we are, you know, in 2025, I do, you know, sometimes 10 in a week. Of course, everybody can request me for their fat transfer. I'm booked out obviously more than Dr. Chung. So it's just a matter of Waiting. How many days is the detox program after explant? If I were to travel to you for the procedure. That's a great question. I like to have people here about a week. It makes it easier for the team to take care of everybody and we make sure that everything is in order. Before you go back. Oh, it's a great question on YouTube. Could fat injection increase the risk of breast cancer? That is a hard. No. Fat is not an epithelial cell and it does not increase the risk of breast cancer. Fat comes from basically a mesenchymal origin. The only tumor it could cause would be more like a sarcophag. Dilorenzo69. Yes. Neck and shoulder pain can be from implants. Just like if you had large breasts and got a reduction, that would reduce your need. I'm sorry, the strain on your neck and back. So that was published many, many years ago showing that breast reductions actually improve lung capacity and they help with neck and back pain. Best thing for adhesions after explant. Fat transfer in ways. Anything we can do to avoid them. I'm sorry, I don't have anybody in Orlando. Oh, this is an interesting. Do you have a list of questions to ask this? I guess it's their surgeon before explant. So the things that I would ask is, are they comfortable with doing a capsulectomy? That's kind of first and foremost. If they're not comfortable with that, then it's a pretty short discussion. If they say they can't do it or it's unsafe or all these things, then just find somebody else. Basically, Yeah. I don't like. I always worry about textured implants. So I agree with you. You got to monitor those and make sure that everything is okay. Either in person examination. If you have pain or something's changing, you got to get that checked out. Do I recommend a fat transfer over a lift? Well, I do like volumizing whenever possible. So my favorite overlift. Oh, I favor getting the best shape. So if the person really doesn't need a lift and they just need volume, then I would obviously take a fat transfer over lift. If they have a really wide breast that needs to be narrowed and lifted for better aesthetics, then I would pick the lift and then augment with fat. Hi, miss ashley. No, we haven't taken insurance since 2019. That's a great question on YouTube. How much excess fat do you need for a minimum? I would say you want to get a DEXA scan if you have a really, really low BMI. If you're like, we'll say below 24, get a DEXA scan, try to see kind of what is going on so that the surgeon who's going to do the fat transfer has some data. I find that helpful. Days with Amber asks if you're going through some chronic conditions, would you wait till cleared for explant or before would be fine. Well, a lot of people show up Amber, and they have those chronic conditions and chronic inflammation. And it's very difficult sometimes for their protocols or programs they're trying to run with different providers to work. So I used to have a lot of functional providers. A lot of people doing integrative care send their patients to me because they couldn't get them better on certain protocols that had worked for them. So we would do their explant and then let them return back to their programming and protocols they were trying to do so they could hopefully get the response that those providers were expecting. Yeah, the question is about adexa. Yeah. ADEXA allows you to see fat all over the body. It. All right, y', all, we're coming up to the top of the hour, so I'm gonna end the live. It's been great. This is the first I've done in 2025, so thanks for hopping on. Look forward to seeing you all again in the future.