Breast Implants, Explant Surgery: Robert Whitfield is live!

I have something wrong with this. Let's see. Working on a capsule episode. Oh, there we go. All right. There we go. All right. So we're just gonna go over some prep work for the episode I'm doing on capsules. A lot of times it's probably not super clear. All the different things are going on with the capsule that develops around an implant. We end up in the run up to an episode I'm doing. We've looked at multiple papers throughout different decades because the first implants were placed basically in 1962 in this country in the United States by Cronin and Giroux. But in the literature, when you look things up, which I have to look something up now, so I'm just going to open up my computer. I like to go back and read some of the older papers and. Review the literature when I can about capsules, capsule formation. What was the thought process when they were trying to review their experiences with device placement? And there ends up being a lot of discussions certainly on social media about in block capsulectomy, complete capsulectomies and cat capsulectomies. Do you need to perform capsulectomy? So if you have questions, just put them in the chat and I'll answer them as they come in. It's probably not all that busy here on a Saturday morning, but this is when work gets done. A lot of times. It. A lot of glare off one of my lights. So we're going to look up some articles and go through them. I really enjoy of the articles from the 80s. I'll pull it up and go through it. I have so many articles saved. If you haven't. I did a whole series of. Episodes about biomaterials. So what was injected for augmentation? It's crazy. What was injected for augmentation. So I did a whole series of those. You can go back and find them on my YouTube channels, put them both, put out the videos on both. So it's very. It's wild. They started with paraffin, which is not liquid, at room temperature, has to be heated to become liquid and then it can be drawn up and injected. But it really causes tons of problems with long term granuloma formation. One of my favorite papers is written. It's published. It's written by Mary McGrath and published in. October of 1984. I just really, I enjoy the paper. It's a good summary of the literature and it cites a bunch of papers written by Brownstein and Owsley Baker, Cronin, Hupps, Kay, Pickering, Trutman, Wharton. Just a. It's a really well written paper too. One of the topics in the paper is concerns about breast implants. Concerns about breast implants include the physical, biochemical and immunologic responses to a silicon formed body which may be expressed as a contracting capsule or potential for the induction of neoplasia. Is interesting goes on to say the surrounding tissue generally reacts with a mild transitory inflammatory response without evidence of chronic inflammation associated with toxicity or the antibody formation and plasma cell infiltration associated with an immune response. Well that was October of 1994 and I can assure you we now have evidence to the contrary and that's probably a good jumping off point. That's one of the main things that I'm interested in highlighting, explaining. So when we're developing this episode, which I'm going to film another piece of here after I get done with this prep is the capsule that forms around the breast implant starts, you know, developing, you know, right away. And the response is, is really what's different. And in this paper it says it's an inert foreign body, which it's not Obviously anything that's stuck in your body is not recognized itself because you don't. We have genetically from each parent we get what's called a haplotype. So you get part of your genetics from one parent, part from the other parent. And the mixture, especially in what's called the HLA human liquid site antigens that creates the polymorphism that allows you to recognize different antigens. And it's that recognition that helps your immune system tell for and from self. And of course a device is foreign. So. Also goes on in this paper to talk about the response that you have to different types of biomaterials like liquid silicone, the silicone elastomer shell. Once again this is in the 80s and. There were some limitations certainly there. But once we're, we're talking about capsules and capsular contractures and. Our body normally basically tries to wall all that off to protect us. It's, that's the response. And I just had a call yesterday from a patient who's developing more of a capture contracture. And they were concerned about that and should they have surgery that was already scheduled, moved up earlier and like all devices have, you know, a capsule formed around them. And then since we're talking about a breast implant, like there's this to me like era where they were behind the breast predominantly when they were first placed in the 60s and 70s. And then because there were so many problems with capture contracture, they ended up putting those behind the muscle. And the thought was that actually reduced the rate of capture contracture. I just think it made it harder for the examiners and the patient. So I don't know that it actually changed the rate of anything. I think it's pretty subjective, meaning like the patient has to tell you. You have to examine the patient. And many times it's very hard to gauge the severity of something even, you know, on the multiple thousands that I've examined. It. And also in this paper, it talks about two leading causes of problems with gaps or contracture, which are infection and hematoma. So those obviously are still to this day. The case problem is like, how do we define infection? When is it infected? I published a big paper last year looking at just biofilm in general. Biofilm is. Think of it like a small amount of contamination. Frank. Infections are usually graded at 100,000 colonies per high power field. Looking through a microscope. That was all done in the. In the 50s with urinary tract infection as the. The infection model. I don't even know that I have this paper in my other notes, but I'm going to put it in there. It's such a good paper. So. Too early for everybody. Nobody's asking any questions here. Sorry. That's all right. Not a shock. Not a shock. Gotta import this into my Remarkable. So I can keep track of this. It's. There we go. Yes, go ahead. How do you. I don't know how to pronounce. Your name is Izzy. Liz. Yeah, go ahead, ask question. So it's fine. I'm just preparing to talk. Yeah, I mean, I'm preparing a whole podcast just about capsulectomy to hope just help raise awareness to why a capsulectomy should be discussed and why it's important. So for many, many years, capsulectomy was done from an oncologic standpoint because cancers can develop in those. So. And there's literature, actually you can go to either. I guess we should post all these on my website. But I wrote a paper last year and published it that 29 have bacterial contamination when we explant them and do full capsulectomies, which I do on every case. And so if you don't explant somebody and they have that underlying contamination, then they can still have symptoms. If you were to do. And I'm saying, you know, do I do a complete capsulectomy on everyone? It's not dangerous. Which is it said, you know, routinely. That's not a problem. You're not going to injure people or cause problems with the lung or, you know, in many times, because I take out so many that have problems with inflammation and infection and swelling. They come out actually some of them very easily. And so the harder ones certainly are ones that are more like a toilet paper. We're like, really thin. So I don't advocate for partial cap selectomy, so I would not recommend that. That's not something I would. Oh, yeah, that would be good. It. Gotta see if I can wake up my patients from other places around the world. Since you seem to be the only person paying attention this morning, We'll see. We'll see who else can come on board here. It's. It's all right. So go to my website or if you want to go to my YouTube channel, and in the links you'll find the paper about biofilm. You can share it with the doctor. There's plenty of of work that should make that obvious. All right, let me see this on the paper here. Yeah, I like that paper. I gotta include more of that in there. Oh, my goodness. Gotta answer patient question here on my patient Porter really quick, See if I can get it to load. It. It's. Oh, we get to welcome Lisa. Another person awake this morning. That's good. Welcome, Lisa. I said I would start doing this more frequently, but I think I work too much and too early for most people, so it's not probably as beneficial as I thought it would be for everybody. Hello. Just to answer in a patient question here on medical record, we identified a bunch of mold toxins on a toxicity test and created treatment plan. They said question about it. So we'll. We'll resume our discussion here in a minute. Ouch. Smash my elbow. All right, Lisa, do you have a question? All right, now. All. All right, I'm going to end the stream here.