Capsulectomy Part 2

And I gotta get everything set up. Should be good. Everybody hear me? Chime in, do a little sound check, make sure y'all can hear me okay. I'm gonna double-check and make sure everything is streaming. Doesn't look like I'm streaming on Rumble. Okay. Hi, Leah. Awesome in the community. Danielle's there. Awesome. Very good. Let me see if some of the others are working now. Yeah, on Rumble I'm not streaming, so I don't know. I don't think we can do that. Okay, well, we can't do Rumble right now, I guess. Everything's a process these days, but, um, hopefully I can get that posted and have it up on Rumble. Rumble is pretty good. They don't censor me right now, which is nice. I have to say that I appreciate that, but we will check something out here in a second. So in part one, I went over, you know, basically how I think about capsulectomy and the formation of capsule would start shortly after surgery and Things that contribute to maybe a thicker capsule, things that occur around the time of surgery, obviously you're trying to avoid bleeding. The obvious other culprit that I think about is infection. So we're obviously taking precautions with that. And I mentioned in our previous live that when you go back through time and look at the literature, the things that changed, you know, capture contracture rates, really, that seemed to be the most influential were placement of the device behind the muscle. And, and I question that a little bit because I don't To me personally, I don't know that it changed much. It certainly made it harder to determine whether or not someone had a capture contracture. So I guess, you know, for all intents and purposes, that's how I think about it. You know, now doing whether it's like, if you think of like capsulectomies, there's patients who have implants removed who have absolutely no capsule removed. I don't think that's, um, it's certainly nothing I would do personally because I, I don't feel like that's going to serve the patient. I think many people should understand that we published a very large series of scar tissue sample specimens that were examined through PCR analysis in September of '24. So 694 consecutive samples showed that 30— I'm sorry, 29%, not 30— 29% have bacterial contamination. Dr. Bonnie, I have no sound. Is that what you said on Instagram? Somebody tell me if I have sound or not. I'm sorry, chime in. Bonnie says she can't hear me. Is that true? Somebody on Instagram, let me know, please. Dr. Bonnie, can you hear me? Somebody give me a thumbs up if you hear me on Instagram, please. Okay, Belinda can hear me. Dr. Bonnie, can you hear me? I have the volume all the way up for Instagram. Thank you, Danielle. I don't know, Dr. Bonnie, um, if you are in Dr. Rob's circle, you have to unmute the live stream to hear it. Anybody who goes into the circle has to unmute the live stream to hear it. You have to click on it and unmute it. Okay. All right. So in September of '24, we finally got a big series published that showed that PCR-tested samples had a 29% rate of bacterial contamination. So I get asked all the time, is mold a problem on the implants, or are fungi a problem on implants, or is there, you know, mycobacterium like tuberculosis on implants? Are there parasites on implants? And so the short answer I can say is, in our experience, which is the largest published experience in the world with explant specimens being tested with PCR, that it is two dominant types of bacteria: Staph epidermidis and Cutibacterium actus. Those are just the facts. And the previous standard set by the paper published after we funded research, it showed that it was 48%. I felt that was too high. So to recap, our personal experience is 29%. So I feel like that is a, a real number that I feel comfortable always citing. Uh, we did it consistently, we did the same way, we used the same lab, and 29% is what we found. Now that's not to say I've never found fungus. In the first 1,000, I found 5 cases of fungus, but that was it. Um, I have found no, uh, Mycobacterium cases, thank goodness. So that being said, like, what role does that play in symptomology, how someone feels, what's going on? And so there are some caveats. So, oh, good, Dr. Bonnie. Awesome. I'm glad you can hear me. So what is the feedback loop or what does that matter? So We talked about it earlier and I did a podcast today about it, but I have a little implant with a sticky note on it. The sticky note represents the bacteria stuck inside your scar tissue, which is the white wrapper, and it's on the surface of the implant. So if we were just to open a patient through their old incision and take out the implant but leave the scar tissue, and in 29% leave the sticky note, which represents the bacteria, that could be left inside and be like a retained, um, uh, infection. Think of it like that. So that you didn't really remove the problem completely because it's stuck up against the inside. And so if that's happening, we know that there's this interaction between the bacterial biofilm and the fatty acids in the breast tissue called oleic acids, and there's an oxidative reaction that happens and creates a product called oxylipentinhome, which has been researched and found by Dr. Mathun-Sina. And so I did a podcast with him, and I talked about his paper because I find it to be a very, very significant paper in the literature, and so much so that people have written commentaries about it to show the feedback loop and everything. So Ultimately, there is hopefully down the road going to be a biomarker you can get a blood test for and then have a little bit better idea of what's going on. To date, that test is a research test, not a commercially available test. So then, okay, so that's, we'll say 29% have this low-grade bacterial contamination or low-grade infection. And we don't know how that's influencing each patient. So there's that component and maybe that bacterial component. And I don't want to— ruptures and leaks and things that do with silicone are different, but you can have shell breakdown or gel bleed. Without an overt rupture. And I think that's a more nuanced discussion. So what I want to do is I'll take some questions on Instagram and, um, Substack, and then we're going to go into Dr. Rob's Circle, into the community, and I'll take all questions. It's free to join, and it's not hard to join. I I know Jess from Dallas is having trouble joining, but we're going to help her. I hope she got in touch with my office today, 'cause I feel bad that she has not been able to hop on. Does anybody have a question about what I said currently? And since I have Instagram, on. I'm just seeing if there's a question here. Okay, I don't see a question on Instagram. So I know it's middle of the day, I get all you folks, um, out in, uh, the U.S. that are busy working, have people overseas. So it's okay, hop on if you can, join us in the circle. We're going to go in there and do a Q&A and talk about, uh, talk about bacterial contamination. And I'll probably mention some things about, uh, silicone, silicone ruptures, gel bleed, but we'll do that in the circle. I'm going to end the stream outside and