Breast Implant Removal, Genetics & Recovery: What the Research Actually Shows

Welcome back to another episode. I'm here with a very special guest, Dr. Robert Whitfield MD, here in Austin, Texas, where he is a board-certified plastic surgeon. And we're really happy to have you on the show. You're, you're kind of a different perspective in terms of most plastic surgeons, where you've done over 2,000+ explant surgeries and counting. Well, welcome, and I'd love to hear just the background, how kind of you got to this point where you're really focused on the explant side of things.

Yeah, thanks for having me. I, you know, I get asked pretty frequently how I kind of departed into that. And so I trained in traditional general surgery. So for 6 years from '96 to '02, you know, I, I trained in taking out your gallbladder, doing colon surgery and doing vascular surgery, trauma, all the things. And then I got really interested in microsurgery during my lab year. So I spent a whole year just in a vascular biology lab doing microsurgery and And that became a very big driving force or passion of mine to do reconstructive surgery because I was really interested in and always liked problem solving. And I was always— most people, unfortunately, if they have to face cancer, don't know all the things and elements that go into doing a a case, right? So usually you have to meet with a, a series of providers. Like you may have your oncologist, your surgeon, uh, radiation therapist. There'll be all these different disciplines involved. And that was always the most interesting, uh, to me because you had all these people involved trying to coordinate a care plan. And, um, to be honest, like I never knew what I was getting into. Especially when I was younger in surgery. And, uh, when you show up, you kind of have an idea maybe of what the surgical oncologist is going to do. Like in, in breast cancer reconstruction, it's a little bit more straightforward. They'll do a mastectomy and you're responsible for doing the whole breast reconstruction. But if I came into a head and neck cancer case, I kind of knew what was gonna happen. I may have to reconstruct somebody's tongue or their jaw or both. Or their esophagus. So those are a little bit more straightforward. I would also do sarcoma reconstruction, and I honestly never knew what I was getting into with those cases because they would take out part of someone's hip, um, they would take out their femur, they would take out their tibia, their knee joint. I mean, all these things. And I, I would show up and I'm like, okay, and you just have to figure it out. And, and that was super, uh, exciting and fun for me and challenging.

How long are those surgeries, especially if you're going in there kind of having to figure out what was taken out and resected and what you got to work?

I mean, if it's microsurgery, they can be several hours, you know. Um, but that was always really challenging and rewarding, and taking care of those patients is still the best experiences I've ever had. Um, so I did that till 2019, and just problems with insurance reimbursement and difficulty with solo practice doing that. Um, I turned my attention to doing more cosmetic surgery, and I had already been doing these explants. And, um, I guess it became more of a not so much trying to figure out what to do surgically, but it became how to figure out how to prepare patients better and solve the problems, you know, that way. Because a lot of what you face surgically. You know, in my career, it was hard to parse out like why some people would do well versus other people. And you could have the same exact, uh, procedure done by the same surgeon to people and have really different outcomes. And in training, they don't really explain why that's even possible. And for that matter, I don't know that they really understand why it's possible. I think now, you know, many, many years into this, if you— and I'm old now, right? So the Genome Project, the Genome Project came after I finished medical school and training. Like for most people like who are listening, I still read books when I was in school. I didn't have an iPad and I went to the card catalog and I would go look up journal articles and read them. And the thing that you call PubMed used to be on disk.— if anybody remembers what a disc is. So you would load those discs, you would get through a certain amount of the literature, and then you'd have to, you know, load another set. And that just goes to, you know, the thing we discussed earlier, like the global literature is certainly— and still to this point— is not really understood by AI. So when people like tell, you know, Google to do a search on something, Google can't access the scientific literature. And many of the journals, especially, that's how they made money, right? They blocked access to it. It was behind a paywall until they developed something called open access journals. And Open Evidence now is an AI tool that doctors can use and look at the scientific literature. And that's— you want to have access to that. That being said, like, understanding genetic better has been a big curiosity of mine since I took a good genetics course in college. I was like, oh my gosh, the professor who taught it was brilliant and I just felt like the stupidest person on earth because it just didn't make any sense to me. And now if you look at it, we have all these commercially available tests. They can do whole genome analyses. And moving forward, you're going to go at some point to the lab. And when you have a cold or an infection or something that's hard for the practitioner to figure out, they're going to go there, going to draw your blood. They're going to run a whole genome analysis real time and know what's yours or human versus what's bacterial or viral or fungal. And then they'll be able to have a more targeted therapeutic for it. And that's, that's the way it should be, right? They should be able to do that.

How far away do you think that is?

It exists now. It's just not commercially available everywhere because our country, as I— we're sitting in Austin, Texas. Just for everybody listening, Spain fits inside of Texas, given the World Cup right now. Um, we're— it's an enormous place. And people often ask, you know, why are implants still used for breast reconstruction, right? So my specialty was not using breast implants for breast reconstruction. Mine was doing microsurgical breast reconstruction. I taught something called the deep flap. And I started a fellowship in microsurgery for it because I thought it was very important for people to learn and be able to execute at a high level when they went out into their communities. But it was not something that was easy to get the plastic surgeons to learn. It still demanded a lot of repetition and effort by them. And then wherever they went to work, they needed an operating room microscope. They needed all this extra instrumentation for microsurgery. And those are all costs that are capital costs the hospitals would have to take on, and then they needed nursing care and specialized monitoring equipment. And that's— most people, it's hard for them to understand that. If you look at an implant-based reconstruction, that is always going to be the most common thing done in a country of this size because it can be done anywhere in a community-based, you know, hospital setting, a smaller hospital, of course. They should discuss all the options. And if you needed to be referred out to someone like me when I was doing that, that's absolutely fine. But that's why that happens. So in 2016, I had a patient who retired in Austin and didn't want to have a breast reconstruction anymore. It'd been done with an implant. There was nothing quote unquote wrong. She just didn't want it anymore. She wanted to go flat. And so, um, we did her workup., and I do all those consultations and workups and look at all the labs and any studies. And, um, we did her surgery and, uh, it had to be done at a hospital because she needed, per her, um, cardiologist, they want her monitored overnight. That's fine. I did in the hospital. And so for everybody listening, since the 1950s, uh, looking for an infection has been done by basically taking a Q-tip swab and swabbing it around inside of the space we're operating here. It was inside the pocket before I'd taken all the scar tissue out. We sent it off, took the remaining scar tissue out with the implant, and then, um, did the flat closure. And about a week later, we got all the information back from the hospital, and the pathology showed there was no recurrent cancer, which is first and foremost you know, for the patient's long-term health. And on the cultures we sent, it showed that she had an E. coli infection. And so for everybody listening, that's a really disturbing thing to have enough bacteria to register on a hospital that you had an actual infection. You have to have greater than 10 to the 6, so greater than 100,000 colony-forming units per high-power field when you look at it under a microscope. That's a significant number, and I don't know how long she had this. I went back through all the notes. There was no indication on her blood labs or anything physical exam-wise. She had no redness, swelling, pain, nothing. And so I missed this, and, uh, my sister passed away from breast cancer. So I'd been, you know, obviously very upset if somebody had missed an infection on her. But nonetheless, She did have one symptom that when you go back through all the notes, it's a very common symptom if you've had chemotherapy, you get bone marrow suppression, so they'll have fatigue. And so that's what she had. And, you know, we treated her with an oral antibiotic based on the culture results and sensitivities. And what do you know, all of her fatigue went away. So it was quite enlightening and embarrassing, humbling, all the things. And so I just all of a sudden had all these patients I presume because she put me on Facebook that I did this, come to us and start wanting their implants out. And so that led to a lot of different, um, you know, cases and learning from the cases. Of course, I had done implant removals and capsulectomies and reconstructions for cancer patients, so none of that was really new to me. Doing it for cosmetic patients at a, you know, more High volume was obviously very new. Um, and then in 2018, we had a patient who was a nurse who came from Louisiana. She had family here, wants to see other family and have me do her surgery. So I did her surgery. I took out her implants, and she had some silicone gel implants, and I took them out. And, um, I would say, um, when you have something kind of sticky or slimy That was the feel of the implant. Now it can be ruptured and leaking, you can have that feeling. You can have something called gel bleed, which is kind of, it's on its way to rupturing. It's kind of just leaching out gel, if you want to think of it like that. Or you can have an infection. And I was really suspicious it was infected because after I cleaned everything off, the grossly, the implant was intact. There was no problem. So I said, you know, confidently to the family, I was like, You know, we'll give it about a week. We sent these cultures off. We'll have some information, and then we'll be able to, to help her. Uh, I will make a side note here. Anybody who's a healthcare provider is uniquely susceptible to multidrug-resistant organisms because of their line of work. And, um, she was an ICU nurse, so she had been exposed to all sorts of things. And so I had a, you know, even higher level of concern for her because of that. And ultimately The culture results came back and it said, um, the, the junk term is normal flora. That means skin bacteria, quote unquote. But in reality, that is not an answer, right? I don't think any of us who do work like that, um, should accept that as an answer anymore because that is an antiquated method of evaluation I mean, putting a culture swab in a pocket, now when I think about it, just seems really rudimentary. And then growing it and wiping on an agar plate, giving it to the lab to incubate. I mean, okay, that's not changed since the '50s.

Yeah.

So that, you know, really forced me to get engaged with a lab about PCR analysis of all the specimens. And finally, in 2019, we transitioned to just doing PCR analysis. And, um, it's more sensitive and specific. And so we published a big paper in 2024 of 694 samples, and 29% had bacterial contamination. Now, in the literature, like, there's upwards of like 48% on PCR, and most of those studies, I really love sample size, so I think there's just too much bias in small samples. So I believe, you know, over 600 is more than adequate.

1 in 3 though, like that's, that's common enough to not be uncommon.

Yeah, and I think the sample size takes the bias out of it. So, um, I think that's a real number. And then people ask like, how does that even happen? So in reality, 3, you know, there are really 3 ways you get an infection on a device: hip, knee, breast, dental, cardiac, whatever. Um, when something is given to an operating surgeon by the staff, the staff can, through, you know, unpackaging it, if you will, contaminate. That's super low. That's almost never going to happen.

You're saying, I think, in another— either double package, so there's like already reducing that risk.

Yeah, always double packaged. And then when the surgeon engages with a device, especially a breast implant, there's all sorts of no-touch techniques involved— changing of gloves, protecting the skin. So once again, it's a really low incidents in that. And then the third and the final, which is the most common, is what I like to call life. Like, people are going to get sick, they're going to get urinary tract infections, skin infections, all the things. And the classic example is heart valves. Mechanical heart valves used to get infected and they would cause emboli from the vegetations on the valve that would go out and cause a lot of awful outcomes. So they knew that if somebody had a mechanical valve, they needed to get antibiotics for colonoscopy or teeth cleaning or all the things. So similarly, like, you have to think about that if you have a device in place. So, I mean, all those things, I think, have rounded out the experience. And then the most interesting thing to me is like, why do people— and this goes to bio-individuality— experience things so differently? So we know that genetically in our patients, about 83% have single nucleotide polymorphisms in multiple detox pathways. So the— most people don't understand vitamin D is super important for a lot of metabolic reactions, and it doesn't matter what your blood level is. It matters genetically whether or not you can convert, transport, and uptake the product. If you can't do any of those three things properly, it doesn't matter what your vitamin D level is. So that's not a meaningful level. So when I have somebody come in, they're like, oh, my vitamin D level is great. I'm like, doesn't really mean much. Genetically, can you, can you do those 3 steps? And then everybody's heard of MTHFR, and, and we've made this big deal about methylation. Methylation is very important for nerve and wound healing and all these metabolic processes. Probably the one that gets, uh, more attention in my practice is glucuronidation. If, if you ever really difficult time in your, uh, glucuronidation pathway or utilization of glutathione, you cannot handle biotoxin loads. So if you have a big mold exposure, if you have a— you live in a place that's got a lot of herbicide or pesticide exposure, or you just got inundated with things from plastics for whatever reason through products or whatever, whatever the thing is.

Yeah.

You're going to have a tough time with NACE and other things. Like, you, you just do that, plus you have a bad antioxidant pathway, or you are in a— you know, my clients are female, so if you have poor estrogen metabolism, that is the sine qua non of the patient coming to me.

Yeah, I think that's a lot of times traditional healthcare is— that's not even on the glossary of terms to even worry about, right? Like No, it's not even like you said, it's like genetics.

You go into genetic class and it's like, this is like opening a whole new world. I'm just going to close the door on that and just kind of like look the other way.

It's a very difficult discipline to understand.

Yeah.

So I mean, it's dumbed down now because there's all these, you know, snippets of tests really. And that's, you know, I just had this patient tell me that, you know, had a— I don't want to get sued by any vendors, but Somebody was making about $1,000 for 8 genes. Yeah, I think you know what I'm talking about. I was like, ah, that's such a money grab.

So yeah, because you can run—

you're just talking about one pathway and you're not even doing a complete analysis of the pathway, but you're going to charge somebody $1,000 for it. Like, that is the biggest money grab I've seen lately.

Yeah, I mean, for the last 2 or 3 years or so, you've seen those tests coming. You're like, man, we could have run so much more for a few hundred bucks.

Another patient's bereaved or begrieved or pissed at you because you tell them like, it's not really good, or you want more information.

You're like, hey, we do want to look at Genex, but like, that's not covering it. We're going to go and ask you to spend more money again on actually a panel that looks at it. Yeah, like you feel bad, you're like, but it's the same.

That was all marketing. I mean, that's, that's what they did. There's countless examples of this over time.

Um, in terms of like the— so the study you did on the capsule. That was the largest to date on—

yeah.

Did you look at— was it just bacteria?

I know, like, so they look at 150 types of bacteria, fungus, and mycobacteria. And so mold is reported a lot in the, in the social media world about being a component of implants. So for silicone implants, obviously there can't be mold inside the implant, right? So it has to be external. And so really early on, I stopped sending samples of the actual device shell.

Mm-hmm.

I just transitioned quickly to the scar tissue cuz that's really the money. That's where the immune response is. So for us, if we just exclude, we'll just take saline out of it and say, okay, in these devices, is mold really a problem? And the answer is no.

Okay.

Now if you go to the saline devices where quote unquote it could be the problem, It's still in, in the first 1,000 I did, I think we have 5 examples, and one was a triathlete, and I presume theirs was from micropunctures of their feet running in, uh, getting out of the lake or whatever. Because, uh, everybody listening, lakes, streams, pools, jacuzzis are terrible.

They're gross, especially in Texas. Like, there's no one natural lake in East Texas, and all the rest is man-made.

It's not a safe environment. You're going to get fungi, parasites, all the things are going to come from that. And then we had Acinetobacter, from us, that's a soil contaminant in the, in the larger sense of the world. And then people who are really living in areas where there's been bad devastating floods, like Houston, New Orleans, pretty much anywhere in Florida, they have it, but they're exposed to things in a much different concentration probably than anybody.

Yeah, yeah.

I feel like, yeah, I mean, it's— you see it a lot, and I see people like, are you having a bad response because you've been exposed to something but your immune system's already dealing with a bacterial issue and another toxin?

Sure.

And gets— again, you can only handle so many things coming at your, your defense system at once, and it does a really good job.

It's just— so I, I think, you know, this is a, a way to think about this is If you've ever heard of transplantation and experienced or had a family member had a transplant, like that person is alive because their entire immune system is being shut down and, and it's, it's being allowed to do enough so they don't get super sick most of the time, but it's blocking a response. And so a big paper came out that was fascinating to me. I was, I was doing research for a talk I was giving on capsulectomies because I promote and endorse doing capsulectomy for this reason. So the paper showed that at the tissue level, there is a T-cell, B-cell, and plasma cell response. So in organ rejection, there is a T-cell, B-cell, and plasma cell response. So the traditional teaching in an implant case is it gives you a foreign body reaction, which is mediated basically by T cells alone. And you get on pathology histocytes and giant cells, which are the standard teaching. That's what the pathologist report shows all the time. Chronic inflammation, histocytes, giant cells. They may make a remark on silicone foreign body or something, but that's about it. And Joseph Murray did the first kidney transplant on Siamese twins in the '50s because he didn't need any drugs, same genetic code. Then he did non-identical twins and they used ionizing radiation. Then cadaver transplant was launched because they had azathioprine and they have steroids at that point. So If you go back to it, like, I used to do reconstruction with your own breast tissue, and I'd hook it up using blood vessels under microscopes and microsurgery. It's really an autologous transplant because if it was from a Siamese twin, I could do the same operation. And it's been shown in the literature you can do that. So auto means your, your thymus, no self, is not going to reject it. It can't. So that always works. Everything else is going to get some level of reaction and/or rejection. Now, patients have a lot more symptoms. You know, I always say you can't pick your parents and you can't outrun a bad diet. So the bio-individuality of that patient, whether it's their HLA, whether it's their specific tissue response at the level of the device, they're having more of a rejection episode. And that's why you get these really wild systemic symptoms. And people go to the GP and say, I have all these symptoms, and the GP is like, I don't know what you're talking about. This is too much. You got to go see the gastro, you got to go see the endocrine, or you got to go see the room, or derm, or whatever, whatever the thing is, whatever the system is. We're going to go parse it out that way. But To me personally, if at some point along the lines, say they go see a rheumatologist or a derm, if they have a really aggressive one, they'll get steroids. And it's a perfect tell because I'll say, "Hey, they gave you steroids?" And they're like, "Yes." I go, "Can you tell me how you felt after you got steroids?" I like, "Did all the symptoms go away?" And they're like, "Yeah." I said, okay, so quote unquote, that's your rejection response, right? Because if you weren't having a rejection response, that wouldn't have made a difference. But because you're basically having a rejection episode, that makes a difference. Now it's a tiny amount of steroid. Like, you could basically make everybody symptom-free if you gave them enough, but nobody's really equating the two things, right? They're not really seeing that that's really what's going on. They don't believe that scenario is happening. Now, this paper out of Denmark, awesome.

And when was that published?

It was in, um, July of last— August of last year, '25, August '25. So it's, it's about the transcriptome. So they showed that through RNA analysis, which gives you a protein, there's upregulated T-cell, B-cell, plasma cell activity. And when people say, am I going to get an autoimmune reaction, which is, you know, you make an antibody to your tissue, like this is actually that happening and it's trying to reject at the tissue level. So when people say like, I say like the system is on, you can't turn it off. There's the signals there. They also showed that biofilm is obviously going to contribute to it, which is what we showed. I think the science is catching up with finally how to look at and understand the problem. But I go back to like what we were taught in the '50s by Dr. Murray. He's like, okay, if you just take it from the genetically identical and put it in, it'll work. And everything else needs a drug or a form to something to suppress it. That's really the game.

Well, I mean, so would you, do you still do actively do reconstructions?

No, basically we stopped in 2019.

Okay.

And, um, I departed. I would do some, uh, implant-based cosmetic, if you would call it reconstructive work. It was all fee-for-service, but it was just using the techniques I learned taking care of cancer patients with radiation injuries. And although I could fix the quote-unquote aesthetic problem, all those patients ultimately have more problems. And so I just departed from using, you know, devices or doing any work like that about 6 years ago now.

Okay.

There's something you said earlier. There's the, uh, uh, the capsule, the explant of the capsule itself. There's doctors who don't get rid of that. They just take the—

the—

yeah, there was a series of papers. So I testified at the FDA hearing that 2019, March of '19, and I became president of the research foundation in May of '19. And so we funded some projects, and one of them was to look at this problem. And they did a series of analyses and wrote several papers about heavy metals, about biofilm, about symptoms. The problem was the sample size is really small. So the samples were 50, 50, 50. And the thing when you have a small sample size like that, that's how they got this really high incidence of biofilm, almost 48%. I was like, look, I've done hundreds of these things and it's not that high. So I published our paper just to try to give some, I think, better context around that. Now, the, the issue that I feel was partly not well understood, probably because technically we didn't like think of what testing should be done. It's like they digested the scar tissue samples to look for heavy metals and things like that, when in reality, like the way we look at it now, we do a glutathione challenge and look at a toxicity test that's a urine test, and we get a lot more information. I don't do hair analysis and I don't do blood analysis for heavy metals. I've been, you know, I think looking at the environmental toxins, I've seen enough of the environmental toxins and mycotoxins using that test. It's been limited for heavy metals. I think the thing that stimulates heavy metals a lot is heat. So one of my patients who is an avid barrel sauna user, had the most heavy metals I've ever seen in a human, but they were just basically giving themselves a Herxheimer-type reaction every time they, they did it. So they were just over— you know, it's like they exceeded the balance of their system to handle it, and they weren't doing any binders, or they didn't know what was going on.

So we had a patient last, about a year ago, February, It'll be a year this past February. She had implants in and she's reaching out to us from Florida, like, just like, hey, I heard about you through a family member. Like, I don't feel good. Oh, and it was like 6 weeks, maybe it was April. It's probably so 2 months ago. Yeah, just upload everything that you've had done prior. So she went into the surgery already like borderline anemic. So like, well, your phase 1 is going to take a beating, but then we start running like tox panels and it's like 70% of the test comes back an issue. Before I could even tell her, she already scheduled the explant side of things. So she had them, I mean, probably by early June they were out from going in at the start of February.

Oh, that's a quick one. Yeah.

I mean, she was just like, and it wasn't even like, I was like, well, let's just talk about this. You know, I've sent— I think 2 or 3 of our patients have come down. I think I've seen you over the past 2 or 3 years because of the capsule mechanism, because not everybody is really diligent about the capsule. So it's kind of— we try to steer them in certain directions with recommendations.

Sure.

Um, but I wanted her to, again, like, hey, find the right explant surgeon if you're going to do this. Um, but again, it— you know, 2 months, 3 months after, she started to see improvement. But it was just, it was crazy. So I'm like, you got them in, it wasn't cheap, and then you had to get them out and that cost actually more.

Yeah, that's the problem. Like, you guys are helping, you know, identify some of the issues. Um, and we talked about a little bit earlier, like, we run a program that's really a functional medicine program for surgery, right?

Yeah, but it's needed.

Yeah, it's just kind of like, it's evolved and people are like, oh, you do all this stuff. I'm like, well, okay, well, genetics is not really functional medicine. Just, just so we're all super clear, like genetics came along later. It's not really, you know, when I think of it, I'm thinking like nutrition and toxicity burden and, you know, gut issues and things. That's all kind of standardized things to me.

Nutrigenomics a little bit.

Yeah. I mean, that all is like pretty like, and just so everybody knows, like, a surgeon who goes through traditional surgical training understands nutrition. It just, it's a choice if you say you don't do it anymore. Um, the way I was taught, both in general surgery training, and it was a big part of training and your certifications, your boards, your testing, all the things that came along. And then when I went into plastics, I didn't maintain my regular surgical boards anymore because it wasn't germane to what I did. I was really focused on oncologic reconstruction, like I said, for head and neck cancer and sarcomas and breast cancer. And I did all this other stuff. But I knew very well how to take care of someone who's ill and how much protein they needed. I mean, there's only 3 macros. This is not groundbreaking stuff and we all understand that You know, you need certain trace minerals and things, but like there's, there's just basic things. And when I hear people, you know, talk about, or they like our program, fine, that's, that's great. I think it just should be like the standard of surgical care that you discuss nutrition and you have some expanded testing, especially as it relates to, you know, toxins. Toxicity, probably that's the— maybe understanding genetics and toxicity would make it easier for them. I don't think either of those are so complex that we can't, like, understand them.

If you're going in for knee surgery, you usually go and do prehab and stuff to prep you to have a better, like, response after. Like, why wouldn't you do that for other surgeries, right? Right. They just— um, so when you talk about kind of the prepping for surgery and your programs and stuff like that. Is that the SMART program?

So SHARP is what we named it. SHARP, sorry, I was like, "SHARP program." No, it is SMART if you do it sharp.

It is SMART if you do it sharp.

Yeah, so basically I talked to somebody today who's coming from Wisconsin and they said, "When do we need to start this?" And it's the same conversation. You're talking about getting ready for a joint surgery. Like the most famous orthopedic surgeons in the country operate on the athletes and they, if they tear the knee on Monday Night Football, they don't operate on 'em on Tuesday morning. You're going to swell up, swell ass go down, and then you're going to operate on the joint. And, you need to— many people talk about doing ACL prehab like you're talking about to strengthen around the joint before they ever do anything. And, it's really no different. Today, she's asked me, "Well, when do I need to do all these tests?" And, well, you need to do that now because the goal is to— we have a curated set of supplements and I focus on the genetic pathways I mentioned previously and then supplement them with liposomal liquids is most of my patients have really bad absorption. So having caps and tabs doesn't make a ton of sense for them. And we just transitioned to liquids, you know, over about 4 years ago now. So, you know, compliance is better. You know, it's obvious that you should get better absorption. And I try to get them aggressively on this 2-week challenge and then do testing. And obviously, you know, that genetics is not going to change and gut health, those shotgun PCR tests that we all have access to aren't going to probably change much. The talks test, though, after a challenge can. So that's really what we're trying to figure out and try to get as much context about so we can help them. I used to be a little bit wary of, of mold because it was a little confusing. But we have a nice program pre and post for that. If we're doing, say, a fat transfer, which I try to do a lot of simultaneously to help offset volumetric changes, I will do a lot of pre-op hyperbaric and post-op hyperbaric. And then we do a lot of medical therapy if the burden is high, or if we're really concerned, we'll do itraconazole and we'll do cholestyramine therapy pre-op. And I mean, some people try to take the piss out of me about that too online, which is funny. But in general, like, to get a fat transfer to work, taking a tissue from one place, putting it to another, and, you know, fat itself stores toxins. You want to try to decrease that burden and make it easier for the patient. And then, you know, in our office we have these devices from New Zealand called Flowpresso, and we combine that with Nano V Therapies post-op to really get fluid out of tissues. And then we do hyperbaric therapy here in the office in a vertical chamber. It just goes to 1.4. It's not a hard chamber. People don't get claustrophobic. They can sit up. It's easier. And then, we have the Human Regenerator from Germany, which it helps, I think, in terms of thinking of getting you out of fight or flight quicker if you want to think of that. And then, all the things are meant to just try to get inflammation down, lower the cortisol response, and then boom, put them into positive nitrogen balance more quickly and more efficiently. And that's the trick, right? As soon as you do that, the body's, you know, faucet, if you will, will turn off and they'll, they'll recover faster, feel better quicker, they'll mobilize better. Our patients don't have as much problems with swelling as we have them on really aggressive protein diets, much to their dismay. But that's the way that you can help them. Help themselves heal quicker, basically.

Go ahead.

In our, in our office, a lot of our patients are coming from a toxic environment, not something being, yeah, you know, permanently, or not permanently, but in there. And, you know, we can do a lot of the pre-work, you know, start helping the detox pathways. Almost everything you're saying is like, yeah, yeah, like that. Yeah, we talk about the same things, but until we remove them the environment, right? Until we do like that first step of like, hey, you're living in mold, or you, you have this chronic sinus infection, or you have this chronic UTI, or whatever, whatever it is, um, we're not going to see, yeah, you know, the miraculous change that the person's looking for. Is that similar to what—

yeah, and we can start prepping, like you said, getting like some foundation, some strength in the system. So when when you're out of the environment, it's an easier momentum build.

Well, that becomes the biggest problem, right? So if you start talking about mold in someone's home or their workplace, they get very sensitive. And so I've tried to like let them know it's not a personal attack. And, you know, we, we talk a lot about air filtration and, you know, we have Swiss IQ Air and we have Jasper's. Jasper's a local company. You have to like make them aware as best you can that that's a real problem. And if you're sleeping in a master that has a water leak or a roof leak, then you're just basically every night respiring mold spores. And I've had a mold exposure from a place we lived that was older. It was nice, but it was older and had a leak. So It's hard to like separate, you know, folks, but if you can get the emotion out of it and just let them know like, hey, you can live 4 minutes without air. So if you have OSA, obstructive sleep apnea, which a lot of my patients are female who they don't snore, they have central sleep apnea. So that's a really underappreciated problem. And you have something that's really affecting you from a respiratory standpoint, giving you problems like sinusitis or headache and all these things, like you have to work hard to let them know, like, these are the cheapest things to do, or try to sleep better, eat better, you know, taking better fluid quality, and then clean up your air. Like, if you did those 4 things, you would have a much better opportunity to feel better quicker. And you went out and, you know, you got some sunlight, you didn't, you know, eat late or drink alcohol late or drink fluids late before you go to bed, then you have better rest period, and your lymphatic drainage will happen. Your lymphatic drainage will happen. And because the only time you recover is when you're sleeping. So we make a huge deal about— the thing I prioritize over anything else is sleep.

I think a lot of people too, like, for, for years, people like think it's a point of pride. Like, God, yeah, I feel like I just— I get 5 hours a night. I'm like, that's not stupid. And it's just— and they think it's— and someone's like, well, I'm not going to change that, that's just how I function. I'm like, Yeah, but you want things to change, right? And that's probably one of the most pivotal things. That's where, like you said, recover beta cells, insulin, like kind of resets, like all these things like pivot off of that.

Every time someone says that, I just say it's utter nonsense. Like, very rarely would I encounter anybody who slept less than me from the time I was 22 until the time I was like 34. Mm-hmm. Training and work and everything was just so demanding. Not great in terms of your body, but for training, you know, that's the way it was. And it's— you have to give your body enough time, length, uh, so duration and depth and quality of sleep is super important.

Yeah, again, I was probably a decade ago, I'd pride myself like I felt fine on 5 hours, but it's like, hey, like little things would be other elsewhere, it'd be stubborn or frustrating even though you ate well, slept well, like moved well, exercised. I was like, oh, hey, this makes sense. Yeah, it's like finding that needle or that fine line between like what's optimal, what's, what's actually going to like take you down or not make you as efficient.

Yeah.

You know, in terms of like breast— yeah, we're trying to come on our way down to, to do this podcast, just a conversation like how many— like what's the prevalence of like how many women in the US have breast implants? Because I worked— going back to your study in '24, about 29% of the capsules have a bacterial issue, infection, and try to extrapolate that data over the population base. Like, holy crap, if I think it was like 4 to 5% I saw of like American women have implants.

Yeah, about 300,000 get placed annually in the United States per reporting, and about 2.2 million annually worldwide. Okay, so you just take a third of those roughly. Um, and I've operated on patients I think from over 40 of the states and 15 countries, I think. Yeah. Um, so it's not like a unique problem to us. So, and that's not really going to change. The, the kind of broader discussion is, I get asked, is there a test, a specific test that you can do? And Dr. Mathun Sina has the best biomarker test. It's an oxylipin profiling test he does on oxylipin tin home and others, but it's a research-based test. It's a blood test, and it's been shown to be elevated in patients with breast implant illness, symptoms of chronic inflammation. So, you know, if that became commercially available where you could do it, that would be helpful, but only for those with biofilm that, that would be elevated in. So it would not absolve the others. But in our study, Staph epidermidis and Cutibacterium acnes were the two main bacterial contaminants. And that study found that that was elevated in those with Staph epidermidis contamination. So it's not like a perfect situation, but when people are really like stuck and their providers are stuck and they're trying to be like, I don't know what to do, that could maybe, you know, help. I don't know that the— most people don't ever want to come see me. I think the joke is nobody really wants to come see Rob and Austin, right? So they would like to talk to y'all or somebody else to just solve the chronic inflammatory symptoms so they can just go about their life and everything be cool. So, you know, many people just run the the, the program with my team because I have a team now that just runs our detox remotely because a lot of people can't come here but they still want to take advantage of the program. So we have different levels of programming ran by actually former patients of mine who are FDNs or nurses. And so they can run the program, and we know the program works to lower inflammation. After the pandemic, we had people approach me all the time for like different inflammatory tests because during the pandemic there were all these restrictions on research removed, and people were just doing, you know, more work that was good work. And they came up with some, I would say, some pretty good studies. And we had a test that looked at thromboxane A2 metabolites in the urine, and it was good if you had a person naive to diet, drugs, so no NSAIDs, uh, no like turmeric or ginger in the diet, just like a regular standard diet, you would get these crazy high numbers. And then you put them on proper supplementation, take gluten and dairy out of their diet, and take seed oils out of their diet, and you would just watch it go down. Problem is you could mess up the number easily by introducing supplementation or anti-inflammatory type dietary recommendations. So if they were naive to it, like, you had your, your marker. Yeah. Problem is that company, like a lot, go under.

Yeah. And, uh, no one's picking it up, or the idea?

No.

All I— I mean, I had the data, or I have the data. I didn't have it, I have it. And it's like a lot of things. Like, I think we have the largest EEG study in the world on people with breast implants, and they have decreased electrical activity because I didn't understand brain fog. So we just bought Wavi EKG, you know, EEGs and did them. And it's not like a super sophisticated EEG, right? But it had showed decreased electrical activity, which is like bad for you, right? How much?

Like how much?

It was not like a statistically significant amount, but improved after explant when you looked at 3-month intervals. And we have the largest genetic audit by far. I mean, gosh.

Yeah, how many— like, again, you've been in research for a minute. How many articles have you been either authored on or co-authored on?

We have 15 on PubMed that we were looking at for this. We just— the biggest one we have in this space is really the biofilm article. And then the fat graft space, we have the safety of fat transfers. We want to have an IRB for the genetics article, but it's really hard to get it and compare it to something because all my patients have, quote unquote, the problem. And then the same with the toxicity data. Like, in our audit of toxicity data, 500 consecutive tests, the number one environmental toxin is BPA. Number two is glyphosate. Number three is aflatoxin.

That makes sense.

So that's not really like super exciting, but if you combine it in somebody's patient population that 83% of them don't detox well, that would be the significant difference. But nobody has anything to really compare that to. Like, we don't have like a— the argument is like, who's the control? I mean, we don't have a control. You can't.

No, ethically it's not.

Yeah, we're not.

So we, we can't. I guess we could just publish it, um, as like a, a series.

In terms of like publishing that article about the capsule and the bacteria, like, did you get pushback from colleagues or other, you know, people in the field?

No, I mean, we don't really care. So basically, um, ethically You should just do what's right, you know, for patients. I don't really concern myself with what the position of the body of plastic surgery is like. I don't really think like that. It, you know, patient care should be first and foremost patient care, patient-centric. So everything we do is just focused on that and helping the patients. I'm not interested in the other part.

Yeah. On that study, you're testing people who are getting them out.

Yeah.

And of them, 29% have the bacterial infections. Um, do you think that— do you think that extrapolates out to, um, like, what— they're getting it out for a reason, right? Were they all getting it out because they felt ill? Were they all getting them out because—

yeah, there's a lot of bias in the sample, right? Because the people are coming to here, coming to me specifically for explants. So they've chosen to do it and they self-identified as having the problem.

Yeah.

So then it becomes like, you know, the symptom inventory, quote unquote, study. Did your symptoms change? I think, and y'all can correct me, I think symptoms as a variable in a study are just really odd. In that, how can you—

It can never be objective. Yeah.

To me, it just makes no sense. If you give me a number, like the number of bacteria, or if you give me Dr. Sinha's oxylipin 10-hm number and you can measure it and then measure it again after and compare it, okay, those are objective things. I just can't like get into the— I ask about symptoms, a lot of them improve. Improve, but not all of them are going to go away because there's other factors involved with why they're having some of them. They have mold problems. They may actually have arthritis, who knows. They may have, uh, you know, um, a huge glyphosate exposure, or they don't methylate well. So they're never going to heal at the same rate. They're going to have neuropathic symptoms, and people are like, I don't understand why you have neuropathic symptoms. Well, if you don't methylate well and you have a high glyphosate load, you're going to have neuropathic symptoms.

Like, and that's the beauty of a program like yours where you do the program and how many of them feel better, you know?

Yeah, it would be rare now that we have somebody at— the gut healing takes longer, so depending on what the gut is, like, those people will extend beyond a year and you can do our program as long as you need to. There's nothing that stops, you know, people from re-engaging and staying in our programs. The, the 3, 6, 9, 12 thing, you know, I just look at 90-day intervals. I don't ever try to like concern myself with day over day, week over week stuff. That's not practical in surgery, um, especially when, you know, somebody's— always say if you had a problem for multiple years, I'm not going to solve it in a day. And, you know, although I have people here for, you know, I have this kind of rule of thumb: I want you here for about a week. Because if you go back to your life, the stress of it, or the activities you have to participate in, or whatever is going on, you're not going to focus on yourself, and that's going to be harder for you to heal. So everybody's so rush, rush, you know, I got to get here, I got to get there. And, you know, it's, it's still surgery. Uh, just because I know how to do it, I've done thousands of them. It's still surgery, still a big deal. And I have a great group here in the office that get a lot of— and should get a lot of the credit because they really put a lot of effort in caring for the patients afterwards.

Yeah, we— like, for us, like, there's always like the, the idea, like, the most ideal situation is to take the, the individual out of the boiling pot of water, right? Like, to get them out of their environment, get them to a place where, again, the other influences to why they maybe are stuck or not feeling as great are just off their plate for a week. And like, they also then get to see maybe, oh shoot, like there, there is an impact to that. And then prioritize when they do go back, like something needs to be different as well as not just the explant surgery or the—

yeah, yeah. Most of people can't really— we talked about like air quality, food quality, food quality, you know, people don't understand how to eat eat. So we have a restaurant here called The Well, and it's gluten-free, dairy-free, no seed oils. So I used to buy people gift cards there, and what do you think they would do with them? Well, they wouldn't actually use them. And so finally I said, well, we can't do that anymore. You can have— we have a discount code, right? But once you go there and eat there, you're like, oh wow, everything's really good, and you don't feel bad after you eat. You don't feel bloated. Um, anything on the menu is good. You have to be careful, like if you go to those restaurants, they're gonna incorporate a lot of like cashews. So if you have nut allergies and stuff, you gotta be careful. But otherwise it's like a great opportunity for somebody to get educated all about how you can eat. Then most of them come back and say, "God, I wish I had a place like this in my neighborhood or my village or my city or my state or whatever." Because it's just not easy. Like we're in Texas. Like for us, like I can get any kind of like animal protein. All day long, but some people can't.

No, it's weird. Every time I leave Texas and then come back, I'm like, man, I'm always so glad to be home. Especially I feel like Dallas, Austin, like you can get good food. Yeah, great, relatively easy. Whereas we went up to a neurology conference up in Chelsea, Michigan.

Oh wow.

And I remember we just, we went into Detroit for a hockey game, like, hey, let's go find something to eat. And it was like 2 hours of just trying to find stuff that we would deem as edible. Like, the food is like, you gotta go find a chop house. Well, and that's it. And even like this, like, you know, like, you know, once you have a Texas steakhouse that's decent, like, you know, we went to— yeah, we met my— like, my family is just across the border in Windsor, Canada. So they're like, oh, we'll just drive over and we'll like grab steak the one night. And they're like, oh, this is like supposed to be the best, you know, steakhouse in Ann Arbor. And I was like, this— I'm not— I wouldn't pay for that again. So it's just, we're spoiled, I feel like. In—

well, yeah, Texas is very, very much so. Don't have fish here, but yeah, yeah, you gotta fly in the fish.

No, none of that. Um, so in terms of like the SHARP, like, what is it? Is it an acronym like S-H-A-R-P?

Oh my gosh, uh, we, we made it a long one, but I've of, you know, basically the strategy, or the S, is to be holistic in how we approach the patients, right? And we want to accelerate the recovery process using, you know, whatever programs, options we have available. And that's really the acronym, like Strategic Holistic Accelerated Recovery Program. So it's very long, and afterwards I'm like, well, that's really long. But any— nonetheless, it's, it's what you know, we were striving to do, right? We surgically are doing things and we're not using, quote unquote, a lot of my traditional allopathic training in medicine, which is fine. We don't use a lot of— we don't use any post-op antibiotic therapy, which is the way it should be. And we, we try to be as, you know, upfront with supplementation and nutrition and support and counseling and the testing we talked about from a functional standpoint, genetic standpoint, to, I think, just elevate and understand better what every patient's dealing with.

So they say, a female, a lady listening, is like, hey, look, you know what, um, this is on my radar. Um, they get into your program from, you know, what's the time frame? Is this like 6 months from kind of getting through the program to explant, or again, if they're, if they're going that route?

Yeah, I think it varies. I think the quickest turnaround is just a few weeks depending on what we're doing. Um, if somebody wants a more complicated surgery, something outside of an explant or an explant and a lift, if we're gonna revolumize the area with a fat transfer, we're going to get all that testing back and we're going to see like what are the levels of If they have any PFAS or forever chemicals or organophosphates, they're going to have to do some work pre-op. And if they have a high mold or mycotoxin level for whatever reason, we're going to be aggressive with them pre-op. And really, one of my patients out of Miami was very focused on having an explant and a fat transfer simultaneously, which is what I try to do is often as possible to really absolve what everybody's worried about, which is how this is going to look when it's done, right? They got implants for a reason. And so if you're just trying to trade out volume, um, I can only do like a cup, cup and a half size change at one time anyway, because fat layers out. It doesn't expand, right? Think of density. So if you have a column of, uh, fluid or a glass of water, we have a glass of filtered water and we pour pour olive oil on top. Olive oil is going to be on the top, and then on top of that, you just dump some popcorn. That's kind of how the column of the fat looks after we get it out. So you have all the salt water that we put in to take it out, and then you have some other, you know, oil-ish layer, and then you have the fat. And so when we're putting it back, we put it beneath the skin, above the breast tissue, and that's where it belongs. And you can only put a certain volume Like, and then it can, you know, it can't really expand beyond that. This, the skin holds it in place. Now when you put an implant in, it stretches out because you can't compress it. So it doesn't really matter, right? Um, this patient wanted to have this, you know, holistic transformation with fat after I did the explant. And I said, okay. And then her testing came back. She already was a known Lyme patient. And had been treated for that. And she had went on vacation and got a mold exposure. And like a lot of things happen with spouses or caregivers, they were on the trip and they didn't get the same problem. And they came back. And now these people already did a lot of testing because they knew about her Lyme and they checked her when she got back. She didn't feel well. And they showed she had a, a pretty good mold exposure while she was gone. And so they're like, hey, you know, what do we need to do? And I was like, well, you need to get all this mycotoxin level out. Like, this is all in the 95th percentile on a Vibrant Wellness test. And I was like, I'm not operating on you because this is not going to work. He's like, what do I have to do? So, um, they had a lot of access functional because of her Lyme. And so they took care of it. They had a bunch of pre-op hyperbaric. They did, you know, colchicine and itraconazole for a couple months. And then they showed up, did her surgery, and she did really, really well post-op. You know, we do about a week of hyperbaric here and lymphatic massage, and then she went and spent time at the Sintner Center in It's in Miami. It's around Miami. And they have the same types of things I have. And so that's really the best practice is to continue hyperbaric. Certainly like the month after surgery, I think is really important. And then keep your nutrition up. So people always ask me like, you know, doesn't the fat go away? You know, how much of it dies? And I'm like, okay, what, what's the, the main issue here? If you look at why things work well is like you reduce the toxic burden. So you take the mycotoxin level down, or the PFAS level, or whatever we're dealing with, down. And so the toxin stored in the fat, that goes down. So the overall health of the wellness of the patient should go up if we're just thinking that way. So we're just using that logic, and we're increasing the oxygen tension and further reducing, uh, what should be an infectious element, because fungus and bacteria do not like oxygen. Oxygen. They can't tolerate high hyperoxic environments. That's why wound healing is improved with hyperbaric oxygen. It kills all the surrounding shit and allows you to heal. So the thing that can be the rub though is you got GLP-1s now, which burn fat. You got people who start feeling better after explant surgery because they've had all this inflammation, joint pain, muscle pain, fatigue, all this stuff. So the thing then becomes an issue of balance. So if I'm doing a fat transfer, I get an old test called the DEXA scan, and I see what your actual body fat, lean muscle mass, bone density is, especially if you've decided to partake in the GLP-1 epidemic. And, um, basically at that point I can at least guide people and say, okay, the way to keep the most of this transfer, the fat transfer, is the following. Like, here's your BMI. Now you want to stay at that, but to improve your chances of fat graft survival, you want to bump it up in a healthy way. So you want to eat enough protein and healthy fats, but not overtrain. So if you get out of balance and overtrain and create a caloric deficit, then you'll burn. Or if you take a drug like tirzepatide, you're gonna burn. You know, there's just lots of ways to undo what should be a very, very, to me, smooth and natural way to take care of the problem. And I just want everybody, I don't think anything I said is illogical or—

No, not at all.

Out of, out of like, Most people, you should be understanding, this is layperson, like, if you eat enough, get enough rest, and don't do HIIT, HIROX, CrossFit, cycle, uh, run, run, uh, ultras, or stupid— all that stuff, so dumb. Do not ask me to do your case if you do any of that stuff because those things don't align with maintaining a result. If you're getting a surgery to maintain a specific aesthetic, then by all means listen to what I'm saying, because you have to have a BMI and you have to maintain the BMI. And I do a lot of low BMI fat transfers because I don't have fear of doing something because I think about it. I think it's very pragmatic. Everybody has fat, even the thinnest person. So if you look at it objectively and help them understand, okay, this is what we can do. These are the areas that, you know, inner outer thighs, abdomens, love handle areas still, you know, we store fat there, but you have to eat enough, rest enough, and not exercise in a really impractical way for the fat to survive. And then you have your opportunity. And a fat transfer is different than an augmentation with an implant. You can always add to—

I was just gonna say, can you add to it down the road?

So the, the thing is like, um, people get fearmongering like, oh, it doesn't work. It works half the time. You're gonna get cancer. You're gonna get necrosis. You're gonna get cyst formation, all these things. I'm like, okay. So I used to do exclusively cancer reconstruction, predominantly on breast cancer patients cuz it's such a prevalent cancer in this, in our society. And I would do 100 to 150 fat transfers for those patients annually because I did 100 to 150 breast reconstructions using that technique, the DIEP flap, annually. Now, for a second, you think I would have a problem in a cancer patient doing a fat transfer if I didn't know what I was doing, or if I did too much, or if the radiologist or the oncologist thought it was a bad idea. Well, the short answer is no, we wouldn't do that. Now, for everybody listening, breast cancer is an epithelial cancer that forms in the ducts of the breast. That's what breast cancer is. Fat transfers are mesenchymal cells that can't form an epithelial cancer, so they can form what's called a sarcoma, or it's a phyllodes tumor in the breast, but that's super rare. So of course I was never ever worried about doing fat transfers in breast cancer patients, but I never did them in my sarcoma patients. Because that's the cell type that can give you the cancer. So I was the guy because I did all the sarcomas. And if you look at my, my bibliography, a lot of it has to do with sarcoma. I would be the guy that got up at the meetings and gave the talk about don't fat transfer our sarcoma cancer patient because that's the cell type that can transform and give you a cancer. So it's not going to cause cancer. So let's just stop talking about that because it's not a thing. 2, anything you put anywhere in the wrong amount at the right time in the patient who is not healthy or otherwise ready can form fat necrosis or can die. It can be a technical error, it can be too much in the wrong space— I'm sorry, too much in the space— or I think of it as a timing thing. Like, I'm trying to get the patients prepared so the timing, the space, the amount all are correct. That's the balance, basically.

Yeah.

You said you reconnect the vasculature to the fat, like, kind of, that's part of the—

No, when we did those breast reconstructions, that was microsurgery. So the fat is, you remove it in the similar way you do liposuction, but it's special instrumentation. It's all in a closed system. And when it's put back, we put it back in a way to evenly distribute the fat. That. So technically, like, we're all very experienced at it in my, in my practice. My tech, my anesthesia team that we use, they're all very experienced. The thing that keeps changing is, like, you know, the— you know, if you're talking about art, it's always the canvas, right? So the person keeps changing. Now, how can we help the person get really as prepared as possible so that that's less the variable, right? So if, you know, I was liking it, like, if we're all a little bit younger, a little bit healthier, things a little bit easier. So if I just did liposuction on 20-somethings, job would be pretty easy, right? Skin's going to tighten up, they're going to heal well, haven't really experienced a lot of hopefully difficult times yet, don't have a high toxic burden, but That's not who I operate on. I'm operating on perimenopausal, postmenopausal patients, a lot of chronic inflammation problems in high toxic burden situations at times. So we're trying to always help the patients understand that and get that to a level where it's more acceptable for them. And I tell patients, though, and that some patients get pissed at me and they go on and are keyboard warriors and, you know, write crazy things about me. It's fine, whatever.

Hey, but for, for all those, there's a thousand that are praising you for, for the work you do and you helping them, right? I just say it's easy to have opinion behind the keyboard and hide anonymous, you know.

It's all good.

And it's always the ones a lot of times that like, yeah, like you went above and beyond to help them, but then again, like, they're just— those are the ones that I feel like we've, you know, again, we don't have many negative reviews, but it's always the ones we're like, oh, we actually gave service because they're financially hardship, or—

yeah, it's like, oh cool, those are 100%. You're just like, it's 100% right. You just like took the most time, try to give you extra. Now what we do nowadays, um, to be very, very clear, is every single one of my appointments is always recorded and transcribed. So there's absolutely no confusion about, you know, what I said or why I said it. And all you have to do is go engage with one of the 4,000 videos I've done if you want to know what I think. So I don't really deviate from it very much.

So, um, go ahead.

Well, I was going to say, with, you know, with those patients, um, the, the toxic burden, like, do you find there's any, like, increases, like the Herx reactions, right? So when you do the fat transfer, do you notice people have— obviously you're doing things post-op, the hyperbarics, to make sure that they're not, you know, binders and the functional med side of things to make sure that that's not happening, but, or that that burden's as low as possible.

That's what we're trying to do. Anybody who's got that, you know, yeah. On the Vibrant test, you know, there, you've got the red bar above 95th. So we're trying not to do, uh, those cases without a lot of aggressive upfront treatment. And I feel like that's kind of the best thing we have at the moment. There's probably nothing that's perfect in terms of systems, but one, we've identified what we feel is like a driver of potential problems of, you know, more inflammation because I cause inflammation with surgery. So they're already in a chronic state and I'm going to give them a big acute bump of cortisol. So we're trying to do our best to really once again, prepare, not react to a problem. Because if you're just always in reaction mode, it's just going to be more difficult.

Yeah, anytime, like, we'll have a patient go and do surgery, we'll check in on them. They're like, man, like, and they'll talk like, I didn't realize it's gonna be the source. Like, I thought it was just a small surgery. Like, it's still disruptive. Like, you're cutting through tissue layers, blood vessels.

Like, it's—

there's no magic. Well, that's, that's probably something that I'm glad you brought that up. So that is a big problem with surgery in general. Um, and I spend a lot more time talking about anesthesia and somebody's had 9 times outta 10 a bad anesthesia experience and it was from the '90s or, or whatever, '80s, '90s, 2000s, whatever it was. And so if you think about anesthesia from this perspective. I can do a facelift under local. I can do all sorts of things under just straight local. Like if you get a cut and go to the ER, they're going to just going to— they're not going to put you to sleep. They're going to numb it and close it. Okay. So why does that work? Because it blocks the signal back to your brain. So we do a bunch of preoperative nerve blocks. For local regional pain control for the chest. My, my, um, anesthesia group doing the ultrasound guided in the pre-op area, or before we go to sleep, and they're prepping drape. So before we ever start, there's a bunch of local on board from a regional perspective. And then when we clear an area, think of like a pie chart, I'll inject a mixture of short and long-acting anesthetic. So our patients don't wake up in recovery having all this pain. Now, I will tell you, when someone wakes up and they're a little off, I think it's more to do with, like, they should have had EDMR, or they should have done some self-work beforehand. Because when you're disinhibited and you wake up, and you wake up crying or carrying on, That's a different problem in my practice because we know all too well how to take care of local regional control of pain. Now those other things, you know, somebody has a sexual assault history or somebody has really untreated emotional trauma or physical trauma, those things are wildly out of control when they wake up from anesthesia.

You throw the limbic system in and you're going for a ride, potentially.

Yeah, it, it makes everybody uncomfortable in the recovery area because they think something's really wrong with the patient. And there's something wrong with the patient, but it has nothing to do with the surgery that was just done. And it's, it's, you know, they're all very sensitive to want to help the patient, but they don't understand the problem. So I always tell patients Like, I'm not a psychologist, I'm not a psychiatrist. You have to work a lot on yourself because, you know, we've to date not been able to get someone on the team who can handle that. It would be great, but that's something that everybody should do more of.

Oh, for sure. I mean, they got them initially with all good intent and coming out, I'm sure there's some, yeah, all the things, some psychological things that need to be 100%.

Some identity shift too. Like, again, like you got them to maybe feel better about certain aspects and then are you undoing that too?

Yeah, I, I've, I mean, interviewed a bunch of patients on my show. They've been bullied, you know, goaded into it by their modeling agents, saw peers, their mom said it was a good idea, sisters, saw somebody, uh, one patient from Germany told me it was Pam Anderson and Baywatch influence. Another gal, Barbie. I mean, whatever. I mean, there's just like, it just goes on and on and on.

Yeah, real.

Yeah, we know why it happens sometimes. And again, I guess I get it. Like, it's— I'm not there to judge. It's just, I remember, you know, we have 8 months of cadaver lab, and so we flipped our cadaver over. She was an 82-year-old lady And she had implants, like, and again, like, call the professor over. He's like, oh, okay. Like, and so he's helping us get them out. And then, like, from that moment on, like, I, you know, I was like, was indifferent at that point. And obviously, as you start to learn, there's more and more things that compound and give me a better perspective. But at that point, I'm like, I would never want, like, somebody I'd love to get these because it was just getting just the pec to be able to like be a good like specimen, just to, to learn from. There's a lot like it just was leaking. It was everywhere. It was up into the axilla and, and it was just like, holy smokes. Now I asked him, like, how often does this happen? He's like, more often than you think. Yeah. So and again, it was not like a knock on it. Just like, okay, like this isn't just you're enhancing something that you want. Like you have— is there really informed consent on some of these these things.

Yes, there's a lot, there's a lot of trouble with that.

So I guess that's a question, like, I know we've been going for a minute, but like, do you think there's, you know, when women go and get the implant, like, does there need to be more of an informed consent change, like, to— or is it discussed about the, the negative, like breast implant illness, implant-associated lymphoma, like all the maybe things that could happen?

Yeah, I, you know, everybody Certainly will mention infection because that's part of the process. The lymphoma, which is associated with textured devices, will certainly be and is part of all the consent process. I think when you say like, is somebody going to discuss breast implant illness? One, you have to like acknowledge that you believe that's a problem. And then two, there's not really an international classification code of it. It's not recognized. So you're trying to have somebody who's trained a specific way talk about something that, quote unquote, is not recognized in the literature. Now, I testified at the FDA hearings, and, um, we acknowledge that it's a problem, and we wanted to do research about it. We tried to go about it in a pragmatic way. We don't have all the answers. I think the things that we've highlighted with establishing a rate of contamination at 29%, looking for biomarkers like Dr. Sene showed with oxylipentinum, and there's others. And then really this transcriptome paper out of Denmark probably gives the most like logical credence to aspects of it. But I don't know what you call it. I don't know what you name it. And so to sit down and discuss it as part of the consent process, obviously Like, I always tell everybody, like, hey, a percentage of these can get infected. Now, this is somewhere along the lines, you know, in, in the becoming infection. The problem is, like, it doesn't necessarily look like an infection, and that's the problem.

And then I guess my question earlier too, and I had it, is like, how long does that— like, if somebody's going to have an issue with it, like implant illness, whether it be infection or just kind of like the that almost like organ rejection mechanism, is it, hey, years down the road, or do they— do you tend to see a pattern that it tends to be sooner than, than, than not? Or is it just random?

I would say if we had— in the genetics of it, I would say you have to have 3 of the 4 problems I mentioned previously and then X. Like some other exposure, and then you're the avatar. So can you have devices and do really, really well? Yeah, if you detox well, if you have all the other things in your favor, then yeah. I actually have examples of this in my practice. And then You know, you would say like, well, can they just do this test? And you know, I get asked about this all the time, like, should I just do this, you know, genetic test? Well, not everybody wants to do that because they don't want to know that. And then you're going to get somebody who says, well, that's not a thing, genetics aren't important, right? So you have that attitude. And you know Do I think that is gonna work all the time? Well, it won't work all the time. There'll be something, but that's your framework for like somebody who doesn't detox well and they get too many exposures, right? Then you're out of balance and then you're gonna get the problem. If you're like a supremely good detoxer, like the people, you know, we thought we could compare our population to Eric Topol's Wellderly study. The people who live to 6th, 7th, 8th decades with no chronic diseases, well, they have to detox well, right? That's by definition. But it didn't really fall out the way, you know, we, we thought it would. But we weren't doing whole genome analysis. They're looking for longevity genes, which don't exist. It just sounds stupid when you say it, right?

Yeah.

Especially if you don't detox well and you just build up oxidative stress, then your genetics are going to get beat up anyways. Like, mitochondrially, you're going to accelerate aging at a faster rate, right?

So, I mean, it makes— when you talk about it, we can talk about it, it makes sense. But so, like, implement that as a screening tool, I mean, so something like—

in the handful of conversations that I've had with women that are either considering this, like getting them done, getting them out, or getting them done. Um, one of the, I guess, maybe common misconceptions, maybe you could clear it up, is you're not— the female is not having an actual reaction to the implant itself. It's more of an infection of some sort.

They're not necessarily having like a reaction against the outer portion of the So I think at the scar tissue level, the paper out of Denmark shows they are reacting to the device.

They're reacting to it as if, as if it's an implant, like, like a hip or a—

no, this— they're having more of an organ rejection.

Organ rejection.

So the traditional implant reaction would be, as I was classically taught, would be a foreign body. So you get like a splinter caught in your finger, and that has this kind of T-cell-mediated reaction that gives you a giant cell histiocyte formation at the tissue level. But the paper published out of Denmark talks about increased T-cell and then increased B-cell and plasma cell. And that's what you would get in organ rejection. So if you put, quote unquote, a kidney from one of y'all in me, my body would immediately be like, whoa, that is not your tissue. And you would start making antibodies, your B cells would respond like it would just be a full-on organ rejection picture. So in those patients who— and they didn't have whole genome sequencing of those patients, which would have been so interesting how they had that. You don't know how many of them are like my group, which don't methylate well, which don't— we can assume that 36% of them don't methylate well, but it would have to be a higher group.

Yeah, to take that question a bit further, like, taking it out, taking the capsule out, cleaning up as best as possible, turns that process off?

Well, you don't have, um, the classic biomarker to measure that just dropping, um, but in our clinical experience, the ones who I told you had a steroid run and they get improved. If you explant them with that history, all of them do great.

Because I think there's— I mean, what are your most common things that come into the office? Like, let me clear that up for you a little bit. Like, what are the things that— common misconceptions of it?

Oh, the— The misconception is that it's fundamentally not the source of inflammation. Yeah. It's been said it can't cause that problem.

Yeah. Because research on the implant itself is saying it's safe.

Well, yeah, I guess we should talk about that.

I kind of want to, that's where I was kind of taking it.

Yeah.

I get asked about, are implants safe? So first of all, I'm not a regulatory agency, so regulatory agencies allow things to be placed in people. And we talked about the informed consent process. So nobody, you know, gets drugged and kidnapped and put in an operating room to get anything. So what they want is to understand what are the ramifications. And then we just want everybody to make a better informed decision. So in terms of like the things I get told, you know, oh, It's bigger than I wanted. That's a common one. I never felt right, never felt good. And now I've been off and it's usually fatigue is the kind of number one thing. And because that's so vague and, you know, in the perimenopausal group, that's a real common problem. Weight gain. Like all the kind of like symptoms that are common amongst like a lot of different chronic inflammatory conditions coupled with, we'll say, being perimenopausal.

Oftentimes that's just when breast implants or not, that's just when kind of shit hits the fan at some point.

Yeah.

And that's, you know, they'll go through this whole laundry list of stuff and I'll be like, yes, Yes. And the difference between that person and the other person who's in another office, they don't have implants. So, you know, that's your control basically, right? They can— I always tell everybody, you have all these same symptoms and not have implants.

Yep, for sure. It's just a straw on the camel's back.

Yeah. So like, if, if, uh, maybe it'll help Um, so a textured implant versus a smooth implant. There's like these— you have to do a visual in your head, okay? You have a smooth implant, which is like a lake that's perfectly smooth in the morning. Nobody's on it. A textured implant is like the mountains around that lake. It's like the Rocky Mountains, all these peaks and valleys and different— because it's textured, so the surface area is much greater to interact with your tissue. So those people will have a lot more potential symptomology that tracks, right? Because they get a T-cell lymphoma in a certain group.

Is that the proposed mechanism? It's just more surface area to have—

it's rough, it's a roughness, it causes this reaction at the tissue level, like a—

you stand there for friction—

more of a T-cell reaction, right? It's more irritating to the tissues. So You haven't seen it in smooth per se. And I've seen a B-cell lymphoma. The predominant one's a T-cell lymphoma. So, you know, for all intents and purposes, smooth shouldn't cause the cancer problem. So that's an option. Round, smaller, doesn't cause as much, you know, positional problems like The bigger the implant, the more stuff you're going to have go wrong typically. And then, um, capture contracture is the firmness thickening around the device. The transition from above the muscle, which that's how it was started in the '60s, to behind the muscle in the '70s was to reduce capture contracture, which I think it just made it harder to figure out. I don't think it reduced it per se. And, um, in that Denmark uh, study. Like, that's fascinating because the capture contracture is all subjective. There's no objective measurement of a capture contracture. It's me or the patient in combination saying, oh, this is different, this hurts, it's malpositioned. So that's a really terrible system. It's what they've had and used for a long time. No offense to Dr. Baker, who invented it in the '70s, but Like, from 1975, we probably should do a bit better with, you know, our understanding of that. And that, that paper, I know many grants have already been written about that paper to try to explore, like, what that paper showed and then enhance it, because that's really where you're going to figure out— like, our paper is based on DNA fragments and PCR analysis of the DNA. That paper is based on RNA analysis and the protein formation. From the RNA. And if you had a commercially RNA available, you know, testing way for us to utilize it, then we'd have a lot more answers.

So if only, if only it was that easy, just get that information and start gathering it.

Yeah, I mean, I was very excited when I read the fact that they could do it, but that's, you know, commercial, commercially available RNA analysis is not around the corner for me. Yeah.

And it's a— if this was something that was like 50% of the American population, but we're talking about such a small percentage that it's like, even if we knew how, like, the cost of it would be prohibitive.

I would assume, like, is the US the leading country in the world for breast implants?

Uh, size-wise, uh, maybe. Yeah, I don't know that.

I'd have to say, you see, like, maybe South American.

No, I mean, South America is, is not— as, uh, it's more buttock than breast, but there's a lot of breast. It's just not as— our society is more generated or geared more towards breast enhancement. Um, I don't know who outranks us. 2.2 million annually. Oh, I should know that.

What about explants? Is there a number annually of explants?

They don't report that number.

I'd be curious. I was just— when you mentioned like how many annual, I'm like, what's the plan amount.

Yeah, they don't want to report that.

No, I can see them not go searching for it.

It's bad for marketing.

Well, everybody's like added it as a, you know, not everybody, a lot of practices are adding it and double dipping, right? They're putting them in, they're taking them out, and that's not necessarily fair to patients because if your, your thought process is Well, if they have these symptoms, I'll just take them out. Okay. Like, for the layperson—

system.

Yeah. So if you just think about what I said earlier, like, a third of them basically have a bacterial contaminant. And if you have any shell degradation, the shell is made of a silicone elastomer which contains heavy metals— tin, cadmium, cesium, tellurium. All these things will degrade over time and be leeched or come off into the capsule. And if it's a ruptured silicone gel capsule, I personally had a patient come to me who had ruptured silicone gel taken out under local in the office. So yeah, just replay that in your mind. Somebody made an incision underneath the breast, under local, patient's awake. Reached in, lifted up to see, and then, oh, it's ruptured. Okay, so now we're taking out something that's like jelly. I'm not going to use any brand names, but we'll just say jelly or jam, and trying to get it out. Now, everybody who's ever had grease or stuff stuck on their hands knows how hard it is to get off. So you can never get that off the inside of the scar tissue, which is what I'm talking about. So that on a whole, to me, is an unethical practice.

That sounds terrifying.

And if you had the gel plus biofilm combo, then the signaling that we're talking about happening at the scar tissue level from the T cells, B cells, and plasma cells is not going to stop because it can't stop. Now that person came to me to do their capsulectomy. So I had to take, go back in and take all that scar tissue out. And then their symptoms got better, but then they still, like a lot of people don't get told they need to do anything else because they've either read on Reddit or some phenomenal Facebook thread that you don't really need to do anything but do the implant removal or do a capsulectomy. Many people criticize, you know, what we're talking about and think that I'm somehow taking advantage of patients by looking at, you know, toxicity burden or gut health or food sensitivities or hormone imbalances or whatever. And I'm like, God, that sounds so ignorant. If you just think about it, You have to have enough information or context to explain why somebody's experiencing something a certain way. And if you can't, then you're really not doing your best to help them.

You need to start trying to figure out why might this be happening. It's the same thing, like, I mean, for years, a patient goes to a GI doc and they'd be like, "Oh, your diet has nothing to do with your gut problem." like, and just like a certain superficial level, like, you don't have to go that far to think that that would be a pretty easy way to understand, like, your gut would be beat up by things you put in it.

We had a patient come to us recently who clearly had a history of Giardia, lives on a lake, diarrhea for like a year. And I was like, did anybody ever think to check you for Giardia? She's like, "No, I went and got a colonoscopy and they said I was fine." I was like, "I mean, you sound like you have Giardia." And so we treated her for Giardia and operated on her and, you know, she got better and everything. I was just like, "What are y'all doing?" Slow down and ask questions.

Think a bit.

Mm-hmm.

I mean, she lived on a lake and I mean, it's not that hard to figure out.

No, but that's it. It's just, I feel like a lot of times it's just like a very superficial interaction. A lot of times I just—

I think colonoscopies are for plumbing purposes. Yeah, I mean, there's a real lot of obstruct— not obstructions, they're looking for constriction or polyp or cancer, right?

That's anatomical versus structural.

Just look at the pipes.

Yeah, I just told that to a patient. Yesterday I was like, got all this anatomical workup, but no one's talking about function whatsoever. No one's talking about what's living in there.

You know, things you can't see, what's living in there, what's interacting in there, what's creating maybe an inflammatory environment on the surface, and that can maybe become something or down the road.

But yeah, and that's what takes this to another level, is like these chronic inflammatory responses. It's the immune response that's perpetuating that gives them a lot of the symptom. It's not solely just the breast implant. You take that thing out, like in that office, you take that thing out, you're leaving residues, you're leaving scar tissues, you're leaving— this kind of goes back to my first question, is a lot of places that do explant don't actually take the—

yeah, I know, I see all the conversation threads and they get, they get sent to me and stuff.

If you have poop on your hand, you don't just like wipe it You wash it, you clean it, you do everything you can.

I would hope so. I know we've been going at this for—

I just had a baby, so I get poop on my hands all the time.

I was wondering why that was fresh in your head. So like, for women listening who are considering going down the, you know, one, the, hey, I'm considering breast implants, is, you know, is there any advice? Is there any safe implant that's even worth considering? Or is it, hey, is it fat reconstruction to build the tissue up.

Yeah, I mean, we don't use implants anymore, and I don't talk down or bad about implants. Like, everybody can decide to do their own thing. It's their decision, so they just need to make the best informed decision. So we wrote a book about, you know, just implants and explant surgery and like the things to maybe consider. And there's stories in there about experiences our patients have that. And, you know, if that resonates and changes someone's mind, then that was the thing they needed to help them make a better decision. Um, in terms of safety, like, there's a bunch of implants out have been used for a number of years. And they're used by and for cancer reconstruction and for cosmetics. So from the regulatory side, they've been deemed safe. Like we've already described, like, lots of people are gonna have reactions. Some are gonna have more vigorous reactions.. And, um, if you're one of those people, then I would caution you about not doing that and maybe exploring a natural augmentation with fat, which to me is like, although I don't wanna write another book, if I do write one, it would be about fat transfer.

Mm-hmm.

So the book here, uh, available on Amazon, like how do they find it?

Yeah, both of these are on Amazon. Um, both of these are on all the Audible platforms and both of them are, uh, available on our, our store, our Shopify store.

We'll make sure to, we'll, you know, drop a link in our, in the comment section.

Yeah. And we have a private live stream for patients who are interested in learning more and want to ask questions. We're going to do those. Typically we've done them on Thursday nights. So then go to drrobcircle.com and that's just a private thing because I've been censored on so many platforms for talking about this. Because it's not, doesn't align with certain people.

I mean, I can see it. I mean, it's just you're going against the grain in a lot of colleagues' view. And so there's always gonna be some friction. But in this book too, is there stories in here about women going through the explant, like their testimonials?

Yeah. Okay.

Yeah, 'cause that was my next question. So then if there's a female or a lady listening that is like, hey, I think I might need explant, like again, the resource for them, would that be the book or is there other—

So in the book, if you want to listen or read the book, there's, I believe, 8 different stories in the book. And then we have over 20 patient stories just on our YouTube channel and in podcasts. On the YouTube channel, it's simple because you can just listen to the patient story list. You can go to our domain and see it as well. It's all embedded now at Dr. Robert Whitfield MD MD. Whitfieldmd.com. We went to a lot of effort to make sure that it's simple to, to watch or listen to, depending on if you want to— some people like Apple, Spotify. We try to make it simple.

Well, I appreciate like all the, the great information for, for our listeners, whether you're a husband listening, you have a wife that needs to hear some of this, or again, just a female listening. Again, just, I think it's a great conversation, or provider listening, and I think it's just if it opens up a different thought process that can lead to a different avenue in how you approach any procedure, but especially in the breast augmentation world, I think it's, you know, a really big gift that you've been doing and spearheading, and I really appreciate it. And then if you had a, you know, a vision for the next 20 years in terms of like goals or kind of calling that you see that you still have to execute, or like you haven't written that chapter yet, do you, Do you have a—

Yeah, we opened a new surgery center and I'm 56. I never thought I'd open a surgery center at 56. But the point was that medicine has been commoditized and doctors have been employed and systems have taken advantage of the patients and the providers in a way to make more money. And left out the experience of both the patient, their caregivers, their families, and the staff of the, the, the place where they're being cared for. So I tried to take what, you know, we've developed at our clinic, apply it to the surgery center so that we improve the patient experience and the caregiver experience, and really You know, I hate to say it, like, surgeons are kind of treated like fungus. They're kept in the dark and fed shit, and they just kind of deal with it over time because they're a different type of provider. If you know any surgeons, they work really, really hard typically, and they're a different breed, and they'll tolerate a lot, and they'll just keep putting up with stuff because they're focused on taking care of patients, which is the goal. So I really wanted to make a better environment for them to take care of their patients and kind of give them a tip of the hat.

Yeah, it's, uh, we have a couple of surgeons we play hockey with, and yeah, it's the way you, you summated it, it's like they put up with a lot of crap, and, uh, you could just tell it. And to the point where it's like, you know, he's probably gonna get out of it 5 or 10 years faster than he would if he actually she like didn't have to deal with the, the back end, the politics, the kind of the system behind it. Yeah.

If y'all are looking to move to Austin, which a lot of people wanna come here from places like Dallas and Houston, um, we're gonna make a center for not just like regenerative therapy, which is something that we should be doing more of anyway, especially in our country. Um, we're gonna make a really excellent opportunity for some of the orthopedic surgeons who want to do outpatient joints. We want to make a great place for patients experiencing or wanting to experience a different level of care for cosmetic surgery or facial plastic surgery or breast surgery. So we want all those things, and we have the facility now. It took over— oh my gosh, so long to build out and so many more millions than we anticipated, but it is done and it is open and functional.

Just another zero. Yeah, but well, that's awesome. I really appreciate it. And then again, we can't wait to follow up and just any conversation or service we can be for you, we'd be happy to help.

Yeah, thank you. Absolutely.