Capsulectomy

Implant problems. So those can be capsular contractures, those can be malpositions. There are a number of things that happen, and there's a little bit of confusion as it pertains to capsule, capsulectomy, whether it's partial capsulectomy, a complete capsulectomy, capsulectomy that's intact. So we're going to do a little demo today of how we talk about it in the office and how I explain, explain the capsule and what is the capsule in general. So for us, every patient that has implant placed, and in this case we're talking about a breast implant, forms a little fibrous capsule, which is like a collagen sac around the implant. And normally this remains soft. So if that just goes. Goes throughout time and remains soft, typically people don't complain of or have problems with pain or distortion or a change of position. And so they don't typically seek out any help for that. Now, in a select group of patients, the capsule or the thin colonist sac around it gets thicker and it can change, tighten. So why does that even happen? What does that mean to the patients? What does that mean to the surgeons who are taking care of the patient? So the way I like to explain it, we're gonna do a little demo. We brought props today. So everybody's scar tissue, if we think about it, it normally is fibrous. And for illustration purposes, it's going to be basically white like this. And then when we take that out, we take it out as a whole to the best of our ability. If we can't take it out as a whole intact, we take it out as a complete capsulectomy. What we don't do is leave capsule behind, because I don't want to take something out here. We're going to just take out the device and we're going to leave this together. We'll talk about this. So here's a silicone device. Here's a silicone device. So if you just were to take this out and leave the tissue in place, a lot of times it looks like a little wadded up, crumpled up piece of paper like this. Now, there's a couple problems with this. One is the myth that it just dissolves. So that is not something that I found, and I do several thousand explants. So having done all those explants, I can tell you that that's not the case. And the reason I see it most commonly is the capsule is a little bit firmer, a little bit thicker maybe. And so in that case, there are a couple considerations. One that Tissue is not going to dissolve because your body can't dissolve it or resorbit or however you want to think about that. Two is last year, in September of 24, 2024, we published a paper that showed that 29% of the patient's scar tissue that we explant has bacteria attached to it. And we did this by checking the, the PCR analysis of the tissue. And so we feel that's the best, most sensitive way to find bacteria. So we did that. And 29% we found staph epidermidis and Cutobacterum acnes. So those readily produce biofilm. Biofilm is basically like plaque on your teeth. Now what that can do is interact with your breast tissue. So many studies have been done and several studies now show that that interaction between bacterial biofilm and the breast tissue causes an oxidative reaction. Now, not to go into that too much, but it creates something, oxylipin tenhome, which is a novel or a new biomarker. And it just is something that from oxidation, remember oxidative stress or something that's oxidative. We don't want a lot of, we want to have reduction or being a reduced thing. So all that being said is we know the bacteria interacts with the tissue. We know it affects the fatty acid, oleic acid in the tissue to form this Oxylipin 10 home. And then that Oxylipin 10 home can actually cause problems in our immune system and give us symptoms. So that's one reason that I don't leave capsule behind. The second reason is if the shell of the implant losing particulate matter, small little pieces of it come off into the tissues. This, your body recognizes that as foreign and then it wants to respond to it and get it out of your body. So it's a constant signal back to your body to tell your body like, hey, we need to get rid of this. So there's bacterial contamination, there's potential interaction from the immune system by leaving the scar tissue in there. And so this is why patients who come to us after having an explant, say under a local in the office, still have symptoms. In particular, we had a patient recently come from Utah who had a ruptured implant removed in the office under Local 1. That's probably very hard to do in general to get all that just material out. But imagine trying to get all the microscopic particulate material out. That's nearly impossible. So the kind of take homes for this are there's bacteria that can be stuck up against the implant on the scar tissue and it remains there. So that's constantly signaling back to your body and activating your immune system in its response. And the other is if any of that particulate matter comes off of the shell of the implant capsule itself, the actual surface of the implant, then that can stimulate an immune response. Because each of our T cells has a little receptor and it's going to recognize something that's foreign. And so if we left all that in our tissues, it's just reacting to it. And then there's. There's been a recent paper published about that interaction being more like a transplanted organ that's being rejected. So your body's not only making a T cell response, it's making a B cell response and a plasma cell response. So it's much more complicated than just take the implant out and the capsule all goes away and everything is fine. Many patients will still potentially experience symptoms because they have a low grade infection. So if the material is not removed, they can still have a problem with an infection. And then secondarily, if they're having an immune system reaction, like a rejection episode from a transplanted organ or that stimulation, their immune system won't calm down. They'll still have symptomology. So hopefully that raises the, the level of understanding of this because I don't want anybody to be concerned about the, what safety of capsulectomy because it's a very safe procedure to perform. There's not a issue with doing it, it's not a dangerous procedure. And then two, like, the reasoning behind it is very logical. We don't want to leave infected material behind and we don't want to leave material behind that has anything stuck in, in the tissues that's going to react with our immune system. So think of everything that reacts with, you know, or against us is considered to be foreign. Something like a fat transfer is not foreign. So fat can be transferred because it's genetically identical. Now it has to heal, it has to be placed in the right position, in the right amounts. But it's a very useful tool and augmentation of both the face, breast and buttocks. So everybody's heard of the Brazilian butt lift and everybody's seen facial fat grafting. Same thing can be done for breast enhancement with your own fat. We have a very specific way of doing it and working it up pre op so that we put patients in the best positions for success. Now that's using your own fat, so that's your own genetic material. And if everybody can think back to a time when for me personally, something fascinating happened in history is the first kidney transplant was performed between genetically identical twins. So identical twins, you can transpose organs, skin the tissues because they're exactly the same. And then non identical twins, which is the next closest situation, they need some form of help to prevent a rejection episode. So if it's from a kidney transplant, they need some type of immunosuppressant. And so the first transplant was done between genetically identical twins. So that's the only situation where you can put something in that's not yours and it not need a medication to block your immune system's reaction to it. So everything else we put in needs some type of help to block your body's reaction. Like, y' all can raise your hand if this makes sense. So what I'm trying to teach here is your body will always recognize something foreign because it has this elaborate immune response. It's the most aggressive and capable surveillance system in the world. Your, your body has all these T cells, and then T cells recognize all the different antigens as they're presented on different types of cells. And then that allows our body to protect us against, you know, whether it's bacteria or fungus or virus, whatever it is. And in this case, it would be bacteria, like I said, from the biofilm, which we showed last year in the study we published. And then this time, I think it's important to understand that any particulate matter, any matter coming off of the surface of that implant will get recognized as foreign and then that will create an immune response. So with that, we're going to take some questions. So. Okay, let me see if I can go back to all these. Let me see, does any. Are there any questions here on Instagram? All right. Currently pregnant and cannot wait to get an explant. All right, well, got it. All right, do we have questions? Can you explain how cancer can be caused by implants? Yeah, they don't know the exact mechanism of that, but those breast implant associated anaplastic large cell lymphomas, they think are more T cell based, which makes sense from chronic irritation, but they don't have the exact mechanism. And then the squamous cell carcinomas, I don't, you know, other than chronic irritation, I've not seen any kind of major improvement in understanding of why that happens. And then still, obviously the most prevalent thing we would see is a breast cancer. So. Tiffany Blackman's a patient of mine. She's shared her story on her Instagram. She's been on my podcast, I've been On her podcast and we found a deep lying breast cancer that still would be the most common thing. You would. Fine. Because the prevalence of that cancer is much higher. All right, let me see what else is here. And we have no comments there. Do we have any comments on any other platforms? All right, I expected more out of you all here. Pregnancy question. So when it comes to pregnancy, I've had patients get more symptomatic after they've delivered. So typically, obviously we don't operate on patients who are pregnant and then patients who have, you know, delivered who become more and more symptomatic. We try to get them taken care of as quickly as possible. If they're breastfeeding, we've had people hold, pump, explant and then return after they've recovered to breastfeeding. If your BMI is such that you're not a good candidate for fat transfer, you alaklate? No, I don't use alaklate. Is there ever a reason to leave the capsule in? So I personally don't leave the capsule in any patients because of the reasons I stated previously. Says I'm ready to get an explant, but I have high blood pressure. Can I still get surgery? Blood pressure just needs to be controlled. There are different ways to do that. We've controlled blood pressure of patients in and around the time of explant. Obviously because of complications that can come from bleeding because of higher blood pressure, you want to manage the blood pressure around the time of surgery. But yeah, we can do that. That's not that difficult. Typically. What anesthesia do you use for someone who's mthfr? So for those people who don't know what MTHFR is, that's a methylation issue. And so typically it just is more of a recovery issue. So whether you use a general anesthesia that combines the use of anesthetic gases or medications in that setting, we let our anesthetist who's done several thousand cases with us go ahead and guide you on and work with them on best case scenarios. But typically they can do it either way. So I'm not worried about that. 30% of the population easily has methylation issues, including myself. How can someone best prepare for explant? So the way we do it is we created the sharp method, which is our really preparation recovery program. So you can run sharp as long as you need to. If you go to the website, fill up contact form, they'll work with you on understanding better my sharp method and then get you involved with that. So when the time is Right. You can go ahead and explant. Are MRIs sometimes inaccurate? Can we talk about a positive and a negative result for implant rupture? So the best MRI is a devoted breast MRI where you're lying down and the breast is able to hang and show posterior surfaces to the best of its ability. That's where you'll miss a rupture most commonly. As far as positive and negatives, I mean, that's been my experience. I don't Worry about breast MRIs, honestly, anymore. I don't. I don't require them. It's a good question, though. We used to do that a lot early on. All right, what else do we have? We have Beth. Hi, Beth. We know Beth. All right. What else can we talk about? So. So Dominique is asking if mold is from implants. So I published a big paper last year to show that breast implants are not viewed as the culprit for mold. So it's always, first and foremost, your environment. To me. That's why we published a paper with almost 700 samples to show that mold is not something that is even remotely high in order of kind of risk. So it's always bacteria in our minds when it relates to implants, not mold. Mold is typically an environmental problem, either from a water leak in your home or your work, somehow you're getting exposed to it. There. Is surgery higher risk? No, explant surgery is not high risk. I had an MRI last year. They told me my implants are ruptured. How soon do I need to remove them? So if an implant is ruptured, I always recommend they, you know, try to get that taken care of in a relatively prompt manner. It's not an emergency. But if you had an MRI last year, that's already been quite a period of time. So I would fill out. Just go to the site to a little contact form. We can talk about it and try to. I'll give you a game plan and guide you. I was told I have a rupture for over six years. So because of the capsule, that's why it doesn't appear to change size. Yeah, I mean, that's fair. Implants that are cohesive gel implants like this one, typically if they ruptured, it's basically a silent rupture. They won't necessarily change size or shape because they don't lose volume. Had a double mastectomy in 2018, started testing high CRP in 23 with 8.9. Could implants be related? Yeah. I would do and look at everything else to make sure that there aren't other reasons. But of course, a high CRP could be related to it. But in our experience, we look at all the other medical factors first and foremost to make sure that there aren't other reasons, and then evaluate the implant. Where is my office located? I'm in Austin, Texas. It says, maybe I'm saying this wrong Nanise and she's in San Francisco or he's. She's in San Francisco. We have a lot of clients who've relocated here or visit us from the Bay Area. So we're always happy to see you and make sure, like we do all our stuff as in person or virtual. So you can easily, you know, get in contact with us. Go to DrRobert Whitfield.com and fill out a contact form about what your interest is or remember. We have books out about the Sharp Method, which is our surgical preparation recovery program. We have a new book out about breast implants, explant surgery and breast implant illness. We also have the Sharp Method, which can be ran as a group program. We have supplements that I feel comfortable with putting patients on and letting them run in the background before they ever have surgery. When they have surgery and after surgery, I don't stop supplementation like a lot of surgeons do, because I'm not worried about them. I've used them for the past several years. And then we have a complete testing program. We look at genetics, we look at toxicity, burden, gut health, food sensitivities, hormone metabolism, other inflammatory indices. These all help basically characterize what each patient's experiencing. Because just always, everybody should remember you're your own basic n of 1 and that means basically you're your own running biological experiment. I can't compare you to me or anybody else that I've taken care of. I've taken care of thousands of patients. I've done several thousand explants at this point. And Sharp is really our method to look at and characterize ways someone genetically detoxes looks at their genetic burden. We use a urine toxicity test for that looks at gut health, which is a stool test. So your poop gets tested, no pun intended. And then we look at inflammation from sensitivities in food and then other inflammatory indices along with blood work. Blood work in our patients is usually very, very normal. And many of you have been told you have normal blood work and nothing to worry about. Blood work is not super helpful unless you have other problems. I'm in Vermont, just trying to figure out how to come see us. Well, you don't need to just Go to the website, fill out a contact form, we'll contact you and then you can do a virtual. Somebody's asking if I accept insurance. So I haven't done any insurance work since 2019. So I stopped doing cancer reconstruction back in 19. I'm getting asked about doing explant with a fat transfer, either simultaneously or afterwards. You know, honestly, either way is fine. In patients who are low bmi, low body fat, I like to work them up and try to see if we can do that case at the same time or if we know we're going to shift volumes a lot. I like to try to put back volume if I can. That just helps with the kind of overall visual changes. I think that helps. I have a lot of patients with obviously body image issues and we want to avoid problems with that to best of our ability. So if I can do them simultaneously, we do. Otherwise we'll stage them and folks can have those done later, of course. Welcome to all the new people. I can't hit my phone all the time and wave, but we've went through capsulectomy. Why we do capsulectomy? I do a capsulectomy in every case. The point being to remove biofilm and any foreign matter left by the device. For someone with an autoimmune, which would you rate in order of priority to take care bii molden home infected root canal? Well, holy smokes, you got all the things. So mold in home would be the priority. If you don't get that taken care of, it's going to be really, really hard to do the others and infected root canal is dangerous. You need to get that taken care of. So I would do home root canal and then implants if need be. How soon can another fat transfer happen? After the first, you probably want to give it six to nine months. Typically I feel like just got to give your time, your body time to recover and then, you know, try to assess things. Everybody's going to be different, but certainly that's, you know, giving yourself time to recover, time to heal and see kind of the beauty of the body is healing is not something that's in a specific window of time. I try to get patients to look at things in really like 90 day or three month intervals because that's easier to appreciate a change when you're looking at it every day. It's very difficult. You're welcome, Dominique. I hope that helps. Now you have to make sure to. And I don't ever do this like either. Go to Instagram, Facebook, YouTube, TikTok and you know, Follow us along so you know what's going on. We put out a lot of content on average. How long does it take for your patients to adjust to their new body? Post expo? Yeah, that's a great question. Everybody's going to be different. It's easier when you have more tissue to begin with and less. Of course, that makes the adjustment quite simpler. If I have patients who should have had a lift and not an implant, then it's easier to explant them and just reshape their tissue. Yeah, Janine, it's always case by case. If you're talking about a very specific issue with low bmi, low body weight, low body fat patients, Always the hardest cases are the ones with the lowest bmi. So let's just talk about fat transfers and low body weight, low BMI patients. So everybody feels like they're heavy, they have a lot of fats, but in reality. So everybody understands this. One way to look at that, before you ever speak to anybody like me, is to have a DEXA scan. The DEXA scan will not only look at body body composition, bone density, lean muscle mass, but it'll give you an idea of body fat. And it's important to get your body weight at the time you do the actual DEXA at the place you do it. So it's accurate. I know because I did this recently and they're like, what's your body weight? And I just said, oh, I think it's this. And they put that in and it was off relative to what it actually was. So that can affect the results. So, Janine, the arms are not a great source of fat. So when we transfer fat from inner outer thighs, abdomens, flanks, bra fat areas, things like that, we want to, you know, provide a really good contouring result without creating new problems. And we transfer healthy fat into the space above the breast tissue below the skin, because that's where it belongs to. It doesn't belong in the breast tissue because that'll create cysts and it doesn't go in the pocket where you took the implant out of because it won't heal there. So, you know, in general, all things being equal, fat transfers work well because they're your genetic material. And provided we've optimized the patient, created the best environment, that will give you the best results. All right, we'll take a few more questions here and then we'll call it a day. We'll let everybody get their costumes on and go trick or treating soon. I know you, you all are anxiously awaiting that. What else can we answer? Hi, Betty on Facebook, on average, how long does it take to work anesthesia out of the body after eczema? The anesthesia you're talking about probably gases. Gases vary. But you can do IV sedation with propofol, be gone, relatively speaking, in that day, or within some 24 hours, probably. What percent of patients get explant and then come back for implants? Personally, I will not put an implant back in anybody. I explain I haven't placed implants for over five years. At this point, probably six years is more practical. And that's just a choice patients make when they come to me. So I don't have that number. Yes. Happy Halloween, everybody. Kathy, do you have a question? No more questions. Come on. Is this all you guys got? You're. You're already, like, ready for trick or treating? All right. It's very early in the day for the most, y', all, unless you're already in Europe. All right, anybody who just joined, let's make sure we. So do you not replace during explant? I don't ever replace implants. I haven't placed implants in over six years. How long is the explant surgery without fat transfer only lift? All of these cases take me between an hour, hour and a half per side. So we schedule between two to three hours for cases. Normally. It's a very short window of time. I know it sounds like a lot of time, but it's actually not. That's a great question. How long do I expect you to stay in town if you're coming from out of town? So we have patients in Austin for about a week. And the reason is in my office, I have a hyperbaric chamber. I have something called the human regenerator, of which we are one of three clinics in North America to have one. It helps really with think of it as electron transport, but really what I think about is if you are in fight or flight after surgery, which everybody is, we're trying to get you out of that quicker, into more parasympathetic state as quickly as possible. So look up the human regenerator. Tag us. Everybody will love that on Instagram. And then we have a red light. We have lymphatic massage from New Zealand with blowpresso. We have nanov therapy. More importantly, I have a whole group of staff who are. My staff are great. If you read anything written about my team, our team is phenomenal. I have several patients who have become staff members who've had X plants to go ahead and speak and guide you. In the process. Including Alex, including Chelsea and Gina and Stephanie. And let me get back to these questions here. I'm sorry, if you come from out of town, when can I fly back to Sweden? After explant and fat transfer. So if you're long hauling, I want people in town at least two weeks because the transfers back and forth are so long. So if you're coming from Sweden, there's a direct out of Heathrow. So if you go from Sweden to Heathrow, you can come direct or you can come from Amsterdam direct to Austin. If you have wrinkles after explant, are they likely to go away? Yeah, it really depends. That's why we do a lot of fat transfers at the same time, because that helps with that. But yes, some of those will go away, others will not. Do you rate peptides for someone with autoimmune? So Dominique, the thing with peptides is not whether they're good or bad for you, it's the quality of the source of the peptide. So PPC157 has been around forever. It's nothing new. We used to use it all the time. But in America the FDA started sending out letters and you know, now it's being looked at. Do you use bodies? Can it damage vagus nerve? I don't know that with that question. Hi Pat, good to see Dr. McGuire on lovely. I don't know what that other question was. Do you use bodies? Can it damage vagus nerve? Bovie. Does the Bovie damage the vagus nerve? No. So since Dr. McGuire joined, we'll go and recap what we talked about it. So we talked about biofilm as a really problematic substance that can be retained in capsule and then any particulate matter that comes off of the capsule can cause a T cell response. And there was a big paper published actually in the White Journal or Plastic surgery about the transcriptome and genes that are upregulated as a response to having the implant in place and what's going on at the tissue level of the capsule. How far are you booked out for an explant only? Taylor, that is a great question, but just submit a form. My team can help you with that. I have a lot of folks that schedule for me. I have actually not got a great idea about how far I'm at. Why do you not use Alaklay if can't fat transfer are there dangerous? I've not used Alaklay. I know what the substance is. It's lyophilized and I typically just don't put other materials back in my patients because they're already experiencing a lot of immune system activation, and I have no way to gauge how they'll respond to a new substance. So if I'm going to use something, I'm going to use their own fat because I know that's genetically compatible with them. It's a good question, though. All right. All right, y'. All, I want y' all to have a happy Halloween. We'll, we'll do more lives in the future. So thanks for joining us. Send any comments that we didn't get to to us and we'll respond to them. Okay. All right. It.