Breast Lift vs. Fat Transfer: Which Do You Need After Explant?

Okay, explant, fat transfer, skin tightening, and rejuvenation. I'm Dr. Whitfield. Tonight, those are the points we're going to discuss, and we'll get right to it. When women come to see me about removing breast implants, the question is really just, can you take my implants out? There are typically deeper questions. What are my breasts going to look like afterward? What will happen to the skin? Can I restore shape without putting another implant in? Do I need a lift? I often get, you know, told I think I need a lift, and then can I help them better understand that? For revolumization, many people have come to know that I prefer fat transfer. It's an autologous product. It is not a product that is from cadaver fat, and they want to know if they already have any procedure, is there another way to address any kind of facial concerns or another area at that time? whether it be an area of loose skin or extra fat, textural problems, indentations, anything really. And those are all important questions and they deserve more than just a quick answer or a simple, you know, menu of what we offer. Tonight I want to talk about skin tightening and breast shaping, how we reshape Around the time of explant surgery, breast lifts. When we're doing breast lifts and fat transfers and/or other operations like natural augmentation with fat transfer, we always want to explain how other areas can be treated at the same time if that is the patient's area of concern, or can we coordinate it with them? Because many of my patients come in from out of state and spend about a week in Austin, Texas, where I practice. And we want to coordinate things. More treatments are not necessarily obviously better. We just want to make everybody aware of what we can offer and how we can help. Every combination should follow a full, obviously in-person, individualized examination and detailed discussion of, you know, what can we do? What can we offer? What are the risks and benefits? Are there alternatives to it? I mean, what are the patient's specific anatomy issues they want to take care of? What are their goals? Most important for me, obviously, due to what we wrote about in the Short Method and what we put forth in all of our care plans, is the patient's health and wellness, their ability to heal, tolerance for other procedures if needed or if wanted. And after implants are removed, The breast does not simply return to the way it looked before augmentation. It can't. Many times patients have had weight loss, weight gain, pregnancies. They have had previous breast revision surgeries or other issues. Breast tissue may have changed, obviously, with age, like I mentioned, nursing, weight change, hormones, and just aging. Many times the implant pocket affects the shape. There's concepts, think of like bottoming out or stretching or Displacement into the armpit area. The nipple position will change. One breast may behave entirely different from the other. That's very disconcerting to patients, but that is very common. Implant size, placement, the duration of implants, scar tissue, and the quality of the tissues all matter. That is why 2 women who both want explant surgery may need obviously very different plans. One may have Good skin elasticity or recoil and enough natural breast tissue to accept a smaller size without a lift. Another may benefit from a lift because the skin is just too loose and the nipple position will be too low if not raised. Another may want a lift plus carefully planned fat transfer to restore upper pole volume. Someone else may prefer explant alone, allow the tissues to heal, and decide later whether or not another procedure is worthwhile. As you can tell, like, there are no right answers. There's a series of options that we try to explain, and then patients have to make their best informed decision. I don't ever make that decision for patients. It's one of those things too, it also helps to separate, if you will, all those different ideas we mentioned. Obviously, removing an implant removes the volume of that implant. A lift reshapes the breast, and the more breast volume or breast tissue there is, easier it is for the surgeon to reshape. And we need to do something with the excess skin. You know, fat transfers add a selected amount of volume using the patient's own fat. Other skin tightening treatments may support contraction or improve selected areas of laxity or textural problems with the skin. Stretch Think of like stretch marks as they're just tears in the skin, and they're very frustrating to deal with because they compromise how skin will tighten. So we do a lot of microneedling for those, and we'll talk about that a little bit later. And I don't use tightening devices on the breast itself. That does not substitute for what we need to do with the skin laxity facing most patients. It would be too inconsistent. A breast lift can help reposition the nipple and reshape the skin envelope around the patient's existing breast tissue. So the wider the breast, the more tissue there is. And the— think of like the best-case scenario is somebody who really didn't necessarily need an implant but got an implant because they were told or the impression was given to them that would help give them a lift. Those patients are the The more simple patient to help achieve good shape with especially a simple vertical lift because they're wide and you can make them narrow and higher. And then as you get bigger implants or smaller amounts of breast tissues to work with, that's harder on the surgical side. There is always going to be scarring with any of these procedures. Obviously, if we do everything underneath, we can hide that relatively well. And we just want to choose the best series of, of Executable steps to help patients achieve their goals. You know, some patients ask me a lot whether energy-based tightening can help reduce the need for a skin lift on the breast area. And I said, you know, previously, with these cases that I'm doing, we don't do that for the breast. We do it in other areas, especially where we take fat from. So if we need to change nipple position, we always do that with a skin Excision pattern and giving a vertical lift, and that is the best way in our opinion to do that. Whenever you know we're going to do a transfer, we're trying to be very thoughtful of how we do this. But everywhere we take fat from, we offer skin tightening and skin treatments externally to help with those areas because we don't want them to get looser. We are not getting younger. Obviously, we lose collagen and elasticity over time. We prefer to use BodyTite and Morpheus8 for these. BodyTite is a minimally invasive radiofrequency-assisted option used in the same areas where I take the fat out of. Through the same opening, I can treat those areas with BodyTite, which is bipolar radiofrequency. It's a very safe, very effective treatment. And then we use for textural treatment over the top on the skin surface Morpheus8. And that helps as well. And I mentioned previously stretch marks, but skin laxity in general is— that's a great 1-2 combination therapy. So anatomy, skin quality, donor sites, treatment overlap, the procedure length, of course, risks, recovery, patient preference, and obviously whatever they choose after giving consent. is really how we develop our plans. Technology themselves don't substitute for skin excision. Don't ever think that. If the patient is better served that way, we'll always let them know, especially in any of the areas we work on. Morpheus8 obviously works differently. It combines microneedling with radiofrequency energy delivered at different depths. We're always using superficial depths when we're on the skin. It may be used to address these textural changes, like I said, and my laxity, but it's not going to be a big visual changer. That's not it. And we do it all over the body. And if patients want their face treated, we'll do that for them as well while they're under anesthesia. It's very simple, efficient treatment, doesn't take long. And once again, it's obviously going to be better tolerated when you're under anesthesia. There can be— Quite a bit of discomfort with energy delivery from radiofrequency treatment. So we still have to consider obviously what we're doing, the condition of the patient, the tissues, blood supply, swelling. What what are we doing in the areas? And we don't want to ever compromise wound healing, so we won't do things that would do that. We did touch on stretch marks previously, but we'll go back to it. Morpheusate may be really helpful in those textural areas. The texture of skin can be really difficult to manage. All right, Morpheus8 may also be discussed for texture concerns after pregnancy or weight change, including the appearance of some stretch marks. The language obviously here needs to be careful. Stretch marks are changes within the skin. They're tears in the dermis. Their appearance may soften or improve in selected patients, but they are not going to be erased. So it should never be interpreted that way. These are to help shrink them. They will not erase. Another technology we have, which is office-based technology we have, is Softwave. It's one of the additional treatments that are available in the office. It's a non-invasive ultrasound option for skin tightening. It does not remove fat, add volume, or perform a specific lifting-type procedure. We have Evolve or Evolve X and Evoke. Those are all office-based in our practice. These treatments obviously may be planned separately. The surgery, depending on the timing of it, we can work out before or after. Because people are staying in the office the week after, it's a little simpler, obviously, after a few days of recuperation and coming back to the office. Once again, these treatments are for remodeling, and those treatments obviously take time for that to occur, but they can be started while you're here. And so that actually brings us to an important part of the conversation. A woman may come in focused on obviously the explant surgery, the breast surgery, and, you know, just entertain or want other options. Sometimes that answer is we can do that in the office, or sometimes obviously we will do that in the center. We try not to get into very lengthy treatments in terms of facial procedures in the OR plus the breast procedures because they become too lengthy. But once again, we make that decision after discussing Everything with the patient for facial planning. Obviously, we start with our basic same principles. What are the main issues? Is it skin laxity? Is it deeper tissue descent? Fat loss? Is there other volume issues, skin texture, wrinkles, or true excess skin? How healthy are the tissues? What prior procedures has she had? How much swelling and recovery can she reasonably manage while also healing from breast surgery. FaceTite is a minimally invasive radiofrequency-assisted option that we use quite frequently for the lower face and neck. We've coupled that in my no-cut facelift as well. It may help contour and support contraction when there is appropriate anatomy, such as in early jowling or mild to moderate laxity, or selected fullness beneath the chin in combination with liposuction. But it is not and cannot be— Parsed out the same way as a facelift would. It is not powerful enough to do that. If there is substantial skin excess or deeper descent, FaceTite is not a good option. We also have Ellacor, which gives us an office-based or surgery center-based microcoring option for specific facial or body concerns. It removes small amounts of skin without leaving a scar. It is FDA-cleared. We've used it extensively in our practice and are happy with it. And because it addresses the skin differently from FaceTite, there are carefully selected plans for patients in which the approaches may complement each other. We do that as part of my no-cut facelift, but that does not mean the combination belongs obviously in every plan. Evoke is a non-invasive radiofrequency platform for selective facial remodeling. Definitely works. I have to be careful with patient selection always. And you could do a series of these depending on the patient's age relatively easily while they're here. Evolve or Evolve X extends, and think of like where the body contouring ends in the hip-thigh area, the abdominal area, the left handle area. These systems allow the applicators, once planned, to work on the skin and localized fat in those areas. Those targets obviously must be distinct and planned out, but this localized fat treatment is not a weight loss treatment. Skin treatment in this case obviously is not excisional. This is all non-invasive. Evolve or Evolve X may be useful for a patient who prefers a non-invasive treatment program. And so we're not like parsing out or doing a checklist here, and that's intentional. Technologies obviously are tools. I have a lot of them in my practice in addition to all of our treatment modalities like the Human Regenerator, the hyperbaric chamber, the Juve Red Light, the Flowpressor from New Zealand, and NanoVi. We have all these other tools to help with skin treatments or fat treatments. So the question is, what tissue is causing our patients concerned, how much change is realistically possible with these modalities we have, and what combination offers the most benefit. Sometimes the best answer is just obviously do the procedure we're set up to do, no add-ons. Sometimes obviously it's better to stage some things out depending on their ability to come back and forth. And, you know, one of my favorite things to talk about is fat transfer. So let's approach that now. I think it's a really underutilized way to augment the breast. I know there's all of this talk now about cadaver fat, but it really is not going to become part of my practice. This is a natural autologous treatment, so I prefer it. Fat transfer begins with obviously removal of fat from the donor areas, and these are kind of standardized for us, but they include The abdomen, the love handle area, the mid-back, the bra fat area, the inner outer thighs. You can do arms; you just have to be very careful with them. It is not placed after you acquire the fat back into the old pocket. It's placed beneath the skin above the fat. Think of breast augmentation and buttock augmentation. Subtract the breast tissue out. And they're fatty layers over muscles. Here in the breast area, we have to be above the breast, not in it, and we don't want to be in the muscle in either of those operations. We should never inject anything into the breast gland. You know, we use this fat to really augment the fatty layer, the donor fat available, the breast skin capacity, its circulation, existing breast tissue, imaging history. and other operations all play into how much I can place safely. And a fat transfer can help restore selected fullness, obviously, after explant, soften contour transitions, address some asymmetry, or create a modest natural breast augmentation in the right patient. It does not tighten loose breast skin. It does not lift a low nipple. Adding too much volume to loose envelope may make heaviness or descent worse rather than better. That is why a patient may need a lift with a fat transfer, a lift potentially first and a fat transfer later, or none at all. Not every transferred fat cell obviously can survive, and the final retained volume can vary. We concentrate on preparation with the Sharp Method, doing DEXA scans, working on toxicity burden in preparation for our patients to have fat transfer. The breast changes as swelling resolves and the transferred fat in the tissues will settle. Sometimes you will have oil cysts, you'll have necrosis, that can happen in any case. It should be limited if you follow some basic tenets. Future screening should not be impaired by this at all though. When we combine explant lift and fat transfer, that's one of the preferred things I offer, the operation is designed around this patient's tissues, their blood supply, their toxicity burden, gut health, food sensitivities, how they detox, you know, what is on their tox test, trying to get them ready. Any additional things like prior scarring, previous procedures, implant malpositions, current positions, I mentioned thickness of tissues, all those things play into how we do it. In some patients, a single stent plan is Great. And others, they need to be staged given their state of health or their tissues. And that's fine. We allow, you know, totally staging of those when necessary. And this is where other procedures like my Smart Tummy or Smart Arms can be done because then the patient's already had a larger procedure, typically at 6, 9, 12, 16 months, they're doing better. And And it means just being strategic. Maybe they wanted their arms done at the same time as the other procedure, but I couldn't do it, and now I can. Maybe they want another fat transfer, or maybe it's their first fat transfer. It doesn't really matter. We can sequence and stage these things however we want. And that leads us to, you know, one of my favorite things I came up with and felt very comfortable with doing for many, many patients is a holistic mommy makeover. Where you just take all of the excess fat that is created through pregnancy and nursing and aging and weight change and all the things from those stubborn areas and use that to augment the patient's breast. And it's using their fat, so it is very holistic. It means we're looking at all the parameters, you know, that are highlighted in the Sharp Method. Their overall health and wellness, nutrition, sleep, stress, inflammation, toxicity burden, gut health, food sensitivities, all those things, giving them counseling about obviously nutrition and how we want them to exercise, looking at a DEXA scan pre and post and keeping that top of mind for them. And, you know, a patient may need an explant with a lift or skin excision and other treatments. Those are typically going to be spaced out because the recovery from those can be much longer. Another may choose obviously just have breast surgery and then consider all the other options later, whether it be Morpheus8, Softwave, Evoke, Evolve X after healing. And another may want to add additional facial rejuvenation treatments at the same time. And those are fine. We, we don't operate for extended periods of time in this outpatient setting we use, and we always want to be safe and effective in what we're offering. So combining facial rejuvenation with breast surgery requires obviously attention to how much time, the positioning, swelling, aftercare, any other considerations in the medical history and the patient's ability to recover should be addressed. And the patient obviously will need help. Many people travel here, they have a caregiver, or they will contract with a nursing service for help. We don't want to put anybody in a compromised position ever. Safety is always paramount. And obviously, the final decisions are made after addressing all the concerns and getting informed consent. Minimally invasive doesn't mean there's no risk. Obviously, energy-based treatments can involve, you know, some changes in the skin. They can result in some contour problems. and swelling and scarring like anything. And surgery brings its own risks, of course, including bleeding, infection, scarring, delayed healing, fluid collections, changes in sensation and symmetry. And there's anesthesia-related concerns, of course. And the purpose of discussing the risks is not to frighten anybody. It's just to better explain them so they can make their best informed decision. Healing also changes what we can judge and when breast shape evolves as swelling decreases, tissues settle, scars mature over a year. And then over that same year, the fat, if we transferred it, will stabilize. And facial swelling from any procedure can be temporary and make contours look irregular, but collagen remodeling is really a 6 to 9 to 12 month process. It doesn't happen in a day or week. If you're considering an explant, a lift, a fat transfer, or natural breast augmentation, ask your surgeon to explain what each part of the plan is intended to do. Ask what it can and cannot do. Ask whether a device is being used For the skin, fat, the texture, any other targets, and what is that device and its risks and benefits. Ask whether, if you have significant loose skin, is it better just to have a skin excision at a later time? And ask how fat transfer can affect the volume. If there's no skin tightening, ask whether combining treatments improves the plan. How much time does it increase in the operating room? And so the goal is not really to convince anybody to do anything extra. The goal is just to explain these exist as options to provide like a different treatment in an area that may have been concerned. And while we're taking care of one, provide options for the other. The goal is always just help understand that these are choices and how they fit together. But planning and discussion and obviously Allowing patients to make the best informed decisions is all we want. As always, our discussions are always educational only. None of this determines anybody's candidacy. They're giving you the the way to ask the questions. So at this point, we're going to go into Dr. Rob Circle. If you signed up, it's free to sign up. Go to drrobcircle.com/live. You can go right into the circle. We're going to do a live Q and A. But thank you all for joining me on Instagram, TikTok, and all the other platforms. We're not going to go in the circle. All right, all right. Are there any non-surgical procedures that help reshape the breast after explant? You know, that's a great question. It depends on the volume. And for, uh, non-surgically repaired breasts after explant, we have not done anything outside of A little bit of microneedling on a few patients, um, because most of my patients come from out of state. So the 2 options would be using microneedling and using, um, basically not BodyTite but the FaceTite probe because of its size. Those are options, and you can get results with those. Typically, because of loss of volume, I have patients want a fat transfer, so I'd always lean After explant to do that first to restore volume. Good question. Did you have any trouble getting into the live chat? I don't see a name, it just says member. Sorry, don't know who you are, but that's okay. Any other questions for me? Well, I tried to do that one differently tonight and it kind of backfired. I had, uh, put a ton of people on notice on Instagram and It stopped working, so that was not good. I tried. It's always something, but it's okay. All right, if there are no other questions, I'm gonna get out of here tonight because I am tired. Let me know if there are any other questions. Oh, so if it's just a little bit of volume, I would do fat transfer first, especially if it's upper pole, and then microneedling helps with the skin the most. So I'd have to see it to give you a better idea, but. Preliminarily, that's how I think. Where are you located? Are you in Texas? Debbie, where did you read that at? It's a great question, but where'd you read it at? That will help me answer it. So basically the answer to that question is no, that doesn't happen. The worst case scenario they saw in a year was 48% take. We have closer to 70 to 80% take in our experience because we do things a particular way. And I get DEXA scans pre-op. We get everybody prepared for surgery quite a bit differently, and then we make some real specific lifestyle modifications. I feel like that's the best way to help patients get better fat transfer results. So there's a lot that goes into it, but, uh, no, it just doesn't go away. Oh, yes, ma'am. Uh, Robin, um, there is a— I'll put it in here. It's a podcast I did with one of my breast cancer reconstruction patients. I'm sorry, explant patient who had a previous breast reconstruction who came to me to take it down. Her name is Sarah Minnick, and she's happy to speak with people. I've got her information. She prefers to be text first because she doesn't answer the phone because she gets too many robocalls, and that was her preferred method. I'm gonna put in the chat the Sarah Minnick podcast and It's a great show. She's a wonderful patient. She's happy to talk to anybody who's entertaining what she did, which was an explant and fat transfer after mastectomy. And then I did another fat transfer for her. So here's the podcast with her in it, Robin. And once again, I've connected with her and she's happy to speak with breast cancer patients about her experience with our clinic. She traveled from Nebraska. She's an awesome patient and very lovely to talk to. Super sweet lady. Of course. Yeah, yeah. Let me know if you have any questions. You can direct message me here in the circle. I check them pretty much a couple times a day. Obviously, first thing in the morning, I check everything. So that's easy before I get into a long day. But I always try to respond to everybody. And then once again, Sarah said she'd be happy to speak to patients, and she's an awesome person to get an explanation for. She's really lovely. I don't know if anybody sent me a direct message asking. All right, anybody have any other questions for me? Oh yeah, okay. How long is recovery after fat transfer? So Debbie, if you're doing an isolated fat transfer or an explant, it's a little bit different. So today I did an explant with a patient above the muscle and behind the muscle, and that makes all the difference for the chest recovery. Above the muscle, very simple, 1 to 2 weeks. Not a big deal. Behind the muscle, it depends on the muscle repair I have to do, and that can be, uh, I would give it like a 6 to 12 week recovery for just the chest muscle. Anywhere we take fat from, that area has to heal, and then where I put the fat, it has to heal. So those are a lot of different areas, and we, we recommend, um, the DEXA scan, which I talked about, doing the Sharp Method pre-op. I recommend some pre-op hyperbaric, and then I like a month of hyperbaric post-op. Everybody comes in my office the day after surgery. They walk in, they have treatments. They do that 2, 3 times a week, uh, the first week they're here. If they stay longer, they can do more. And to be honest, I have had a patient, uh, a doctor who's went and spoke on other podcasts about what I did for— I did an explant and a fat transfer. Lift and fat transfer for her, and she's in her—we'll just say between her fifth and sixth decades—and she did extremely well, had no pain. She states emphatically it was from hyperbaric. I always feel like everything's a combination of good nutrition, rest, proper supplementation, hyperbaric, and lymphatic massage. There is not an exercise pattern that will help reshape the breast. No. It's not like glute. The muscle's not big enough to help reshape, to be honest. That's a good question though. They're bringing the good questions tonight. Keep them coming. Debbie, where do you live? Everybody has to chime in on where they live. I'm in Austin, Texas. I get asked like where I am all the time. It's kind of funny. I'm a little curious sometimes about like how people can't figure out where I am. Cracks me up. Okay, everybody's in California tonight. All right, it's early for y'all. It's only 4:38 there. 6:38 my time. All right, just gotta keep rolling. Oh, Robin, you're in Birmingham. I've had several patients from Birmingham and from— oh, hi, Kiko. Kiko, I hope the message I sent you translated properly. Oh, North Carolina, awesome. I have tons of folks from North Carolina. Cool. Kiko's in Tokyo. I don't know what time it is in Tokyo, but I'm gonna look. I should know this, but I don't. It's 8:39 in the morning, 14 hours ahead tomorrow. All right. It's early for Kiko. Well, I hope y'all can make it out to see us. If you can't, um, always keep in mind that my team can run the Sharp Method program for you remotely, and that would be ideal. Yes, ma'am. I can see it on my world clock. You're just a minute ahead of my world clock, so you must have a fast iPhone. It just says 8:39 for me. Oh, you're welcome. Oh, good, Debbie. That's that's good. I'm glad to hear that. That's a very important test to have be negative. I just operated on somebody the other day with a big seroma who we're worried about. And yeah, I've only taken out one lymphoma case in the last several. Yeah, sure. Microneedling has been around for a long time, and it pokes tiny little holes in, but it doesn't remove any tissue. Like, think of when you get an IV or a, a blood draw. They poke you, they draw the blood out, and then if there's no bruising, the, the little puncture goes away. So your body has to heal the little puncture so it's invisible because it's small. That's what Microneedling does. It makes a series of micro punctures. Ours delivers heat and radio frequency at the same time, and that shrinks the tissue better. And that's how I think of Microneedling. Now Microcoring with Ellicor actually removes a tiny little bit of tissue, so that's very advantageous when you tighten skin. Stretch marks don't respond great to Ellicor. That will be something that if they get that right. Um, that would be very beneficial, but it's not quite there yet. Yeah, Debbie, we created the program to be able to run it remote for folks who are still having trouble. I think that's probably the biggest impact I can make for patients because obviously I can't operate on everybody and I don't have a specific protégé taking over for me. I'm getting older now, and, um, when I get busy, I have to have a surgeon come from California to help out who's familiar with us and we trust. Um, but my program can run remotely, and I think that's ultimately my biggest offering to patients, basically, is the Sharp Method. Hey, can each of you kind of tell me how you heard about the circle? That would help me. Oh, I'm sorry, what did I miss here? I do 3 days water fast 2 times a year. Does that help with detoxing the system? I don't know how much that helps, honestly, those different water fasts, because what we find is there's a lot of toxicity with PFAS or forever chemicals that come from herbicides or pesticides. And then there's lots of problems with mold toxins. There's also heavy metal issues. So the water fast itself wouldn't get those out of your body. Oh, okay. I understand, Debbie. Yeah, you must— you gotta be careful, of course. 100%. Most of our supplements are pretty basic: D3, K2, vitamin C, methylated B, um, If you're talking about my stack now, Cellcore has and can interact with things differently because it has binders and some other stuff. Can y'all tell me if, uh, any particular piece of content I made helped you learn about us better and, and better inform you to hop on the, the lives? I'm just curious. It's been a struggle to get this to grow, um, but I'm trying. Awesome. So Instagram, okay. Well, do y'all have any more questions? Let's see here. Okay. Well, I'm glad the breast cancer groups are not as odd as some of the other groups on Facebook. Instagram, okay. Well, we've turned a lot of attention there because I've been blocked on other platforms, but I haven't been blocked on Instagram yet. But if you want to share the content around, that will definitely help us. The important part is obviously just trying to get Everybody taken care of who's not doing well. That's the whole goal. Yeah, you just have to share the content or repost what we post. That helps it. You can like it and comment on it, but sharing it around and reposting it helps definitely. It's very hard right now to get like the attention. We used to get a pretty good amount just on YouTube, but YouTube stops. Like showing me in feed. And, many of you may know I had over 2 million followers and now I have 1.8 million and they don't like showing my content. So, it's a little odd. Yeah. I mean, you can get fat necrosis. I think the difference between how we approach it is I don't try to overgraft people and I try to prepare everybody really Well, with the Sharp method, plus looking at their toxicity burden and gut health and food sensitivities and all the other parameters, and then doing DEXA scans to look who like who is going to be a good candidate. Where we can get the fat from, and if they're just not in the best, you know, if we can't get them in what we feel is a good condition or good shape, then we don't do it. So we have a lot less problems with fat transfers. And I don't specifically have but a couple of necrosis cases. One in particular is a lady who had ruptured gel implants that became more like a cancer reconstruction and has a lot of other health problems. So I think all things being equal, when you get people in good condition, it's like I make the comparison, like everything's easier when we're younger, right? If we're all 20 and 30, then everything we do Ends up working easier. And as we get older, we need to have more and more things in our favor. So you can't have a lot of things on your list that are holding you back, otherwise it's a problem. All right, bye Kiko. That is our lady from Tokyo who tunes in all the time. It's pretty awesome. No ma'am, the issues are with all implants. I've taken out every single kind of implant. The exterior shell on every single implant made is silicone. So, even the fancy Rolls-Royce of implants as I read today online about Motiva, I've taken those out as well. I have one here on my desk. There's a Motiva implant. So, there's nobody or there's not going to be an implant that potentially doesn't react with a patient or their tissues because it's not their own tissue. So, that's Just basic. That's why I used to do autologous breast reconstruction using the DIP free flap. And, I would do cancer reconstruction with somebody's fibula to make a jawbone or the forearm to make a throat lining or new esophagus or whatever, whatever it takes. But, I would use your own tissue predominantly. So, the question is, will I need to gain weight if I am slim for fat transfer? No, you need to go get a DEXA scan first. And then have a chat. No, we hide every place that we take fat from. So if we take it from an inner outer thigh area, we put it in the crease under the butt cheek. If we take it from the love handle and back area, we take it from over the sacral area at the top of the butt cheeks. And then if we're doing the front, we take it from inside the belly button. Bye-bye, Robin. Yeah, Debbie, you need to make sure they didn't just do the DEXA scan to look at Uh, bone density. You want to make sure they looked at lean muscle mass and body fat. Yeah, I— if somebody's getting a fat transfer, I need to know the DEXA scan between, um, we'll say if someone has a problem with toxicity, they need to have it done sooner so we understand how to prepare them. So I try to get things done, you know, a few months in advance so we have time to set patients up for success. Rushing into surgery is not a recipe for success. So the more time we have with you, the better, to be honest. So 1 to 3 months, you know, you can get a DEXA scan anytime. Just have it on hand. It's not like it's going to go bad. I don't want you taking GLP-1s. So for everybody on this chat who's talking about fat transfer, no GLP-1 usage. It burns fat. It's very effective. I don't want you on it. I won't do your case. Oh boy. All right, y'all, we are rolling up on the 7 o'clock hour, so I'm gonna shut it down. Great questions tonight. Um, I'll take another question if you have it. Yeah, you could do a fat transfer for the breasts and the face, but you would not use the same fat that you're using for the breast. You would need to take it, um, you would take it in a smaller, uh, type of amounts because the face needs a different volume and a different package size of fat. That would be, um, the most important parts there. But yeah, you can do it, of course. All right, y'all, it's been great tonight. All sorts of great questions. I'm totally psyched at how good of a conversation we had. Thank you all for joining. This will be posted, uh, probably no later than tomorrow afternoon in the Circle. So if you need to rewatch it It'll be there for you. But thank you all again. Have a great night. Bye-bye.