ENCORE: What I've Learned From 500+ Breast Implant Removals

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Dr. Rob Whitfield, the board certified plastic surgeon specializing in explant surgery Breast implant illness is a topic that is not often talked enough about, especially in medical community, but is something that affects many women. In this podcast I will be discussing the latest research, treatment options and personal stories of women who have undergone explant surgery in an effort to heal breast implant illness. In this podcast we'll explore the symptoms.

Of breast implant illness and delve into.

The latest surgical techniques for explantation and the recovery process. Whether you are currently experiencing breast implant illness or are considering explant surgery, this podcast is a valuable resource for anyone looking to take control of their health and wellness. So let's dive in.

I've done thousands of microsurgical cases. We've done over 500 explants now. In about 2016 client found me on the Internet and came for a consultation regarding her breast reconstruction. She had an existing breast reconstruction of a implant, I believe. This client put me on a forum or discussed me somewhere and that's how I became to be someone who was getting referrals for breast implant illness. Complex breast problems related to implants. She was from Georgia, she came, she had mostly complaints about fatigue, just didn't feel well. She no longer was interested in having her reconstruction, which I had faced time to time over my career and certainly help patients with that process of either removal or adjusting reconstructions. She had a large amount of laboratory testing regarding both her hormones and heavy metal toxicities and she had one specific request that I do her reconstruction removal with an en bloc technique. That was an unusual request. I knew about IMPLOCK technique because mostly I'd done oncologic reconstruction during my career, so I thought these things were really reasonable. We did her workup and basically her laboratory analysis was normal and physical examination was normal. She had no evidence of capsular contracture or fibrotic changes. They hadn't had radiation therapy in the past. So we developed a surgical plan for her that would help her move forward. A lot of people want to know how I ended up doing complex breast reconstruction or why that was my avenue, especially if they knew me. Starting out when I was younger, basically going to college and volunteering in ICUs in Las Vegas. I became very interested in surgery working in the intensive care units and specifically the surgical intensive care units and got to observe all sorts of different types of surgery, orthopedic surgery, oncologic surgeries, cardiac surgeries, and really became enamored with cardiac surgery. And so once I got into medical school I Thought that would probably be my avenue. And it was about two, three weeks into medical school, I got a call from my sister and she had been diagnosed with breast cancer and wanted to know, since I was her little brother in medical school, what should she do? And having been a medical student for all of three weeks, I immediately went to my professor, who that day actually was an oncologist who was teaching us. So he was a clinician. And I spoke to him after class and he said he would talk to one of his colleagues where my sister lived and arrange for her to be seen. And that was very gracious of him. And I was able to fly home and be with her for her first chemotherapy infusion, which was quite interesting experience. So early on we had challenges with taking care of folks in my family with breast cancer and other forms of cancer. Actually toward the end of my third year of medical school, I got a call from my mother. She was having difficulty, had abdominal pain. And so she was going to see a GI doctor and have a workup. And that didn't really show anything, but she kept having pain. So I implored her to get a CAT scan, and her doctors helped get her a CAT scan. And she had basically metastatic cancer. And she had had a hysterectomy when I was very young for a cervical cancer. This is a recurrent form of that cancer. It was biopsied and there was nothing more. It's not a surgical problem at this point. It's more will it respond to chemotherapy and radiation therapy. So she began those during my fourth year of medical school and didn't do well in the first three or four months. So I moved back home and stayed with her and had all of my surgical and other clerkships changed to be at home in Las Vegas with her. And I got to work with probably one of the preeminent plastic surgeons in the United States, definitely at that time, if not the world. His name is William Zamboni. Phenomenal plastic surgeon. When I was the, at that point, the only chairman of a surgery program who happened to be a plastic surgeon. Phenomenal in terms of technique, brilliant problem solver. And I was a fourth year medical student learning from him. And he was literally like the number one role model you could have as a plastic surgeon if that's what you aspire to be. But back then I was pretty stubborn and I just wanted to do heart surgery. I went into general surgery training, which was the traditional route, in 1996, and I trained at Indiana University for six years. About halfway through that period, of time in training, it became apparent that cardiac surgery was not exactly what I wanted to do Based on what was happening with both fields of cardiology and cardiac surgery. And my most favorite aspect of it was pediatric cardiac surgery. One thing led to another, and I did a year of really vascular laboratory training. And in that lab year, I really liked working with an operating microscope and under a microscope in general in the lab. And then it just became a natural evolution, actually, in the microvascular surgery, which was commonly performed for oncologic reconstruction in plastic surgery. So it became the field of choice for me was plastic surgery. I could perform oncologic reconstruction with microvascular technique. You could perform reconstruction for trauma and other either serious injuries or infections. And I stayed at Indian university for another two years and trained under Dr. Coleman. And then as I was leaving, I wanted to get additional microsurgical experience. So I went and spent another year with Dr. Zamboni back in Las Vegas. And so they're bringing it all full circle. Once my sister was diagnosed with breast cancer and elected to have mastectomies, Dr. Zamboni did her breast reconstruction, and I stayed with her in the hospital during that time. I've always had and always will have a very big spot in my heart for breast cancer patients. Breast cancer survivors just were shaped by our experiences, and that's certainly a big one in my life. After I completed my training with Dr. Zamponi, I took an academic position helping train medical students residents, started a perforator flap fellowship. And then I like to go into private practice here in Austin, Texas, and join the group to perform microvascular breast reconstruction. And so the kind of clients I would see or routinely find me were for complex breast reconstruction, revisions of breast reconstructions using microvascular technique, evaluation of complicated breast problems, or capture contractures. So we took her to the operating room and performed an en bloc technique to remove her reconstruction. She had a medical history that required her to stay in a hospital overnight due to cardiac condition for monitoring. And so that was done in a hospital. And in her planning, she reiterated how she wanted to en bloc capsulectomy. So once again, en bloc just means taking everything out like an Easter egg, undisturbed. To me, it's not a common way to go about removals unless you're doing things in oncologic terms, which I had done obviously, many, many years in my career. Now, every time I take down a reconstruction, traditionally, all the material gets sent for evaluation, Both pathologic examination to make sure there's no recurrent Cancer. This could be in the scar, most likely where the mastectomy was performed, but certainly could be on the surface of the capsule that was surrounding the implant. I would take swabs or quantitative cultures with small pieces of the capsule scar around the implant and have those evaluated. And so I did this patient's case in the hospital. She was discharged the next day. She had drains in place as I traditionally did at that point when I'm taking down a large reconstruction. And after this was performed, I followed up on her laboratory analysis because it's still in the hospital, took a little bit of time to get things back and saw her postoperatively to get her drains out and reviewed her laboratory analysis prior to that visit. And she basically had an infection. And so much to my surprise, this is on a CLIA based lab and I'll differentiate those from what I do now shortly. But in a laboratory analysis like this, you have to have over 100,000 bacteria in a specimen for the lab to be able to call it and then give you sensitivities. And this organism happened to be E. Coli, which is typically found in the urinary tract or the GI tract, taken back by this information. I shared it with the client and I treat her with antibiotics based on the sensitivities. And so after a two week course of antibiotics, she returned. She was doing much better and her number one symptom was gone, which was fatigue, which makes sense because the entire time she was combating and dealing with an infection.

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And certainly I feel as a very experienced plastic surgeon that I had missed this, but I didn't know why I'd missed it because there weren't any physical findings, there weren't any laboratory changes. It was just her symptom of fatigue that was basically. I didn't key in on that. Moving forward, I never wanted to miss something like that. You can't really afford to be unable to recognize problems like that. Even vague things need to be evaluated. And certainly listening to your client and trying to make sure that you're not missing something like this is incredibly important. So this experience shaped how I took care of all my future clients. When the complaint was evaluation for breast implant. Whatever the technique used for or diagnosis they had is irrelevant. It's just what symptoms did they have and should we be evaluating them for something like this? So when you're removing a reconstruction, typically the patient's obviously been explaining the recent benefits of initial reconstruction and not having a reconstruction and the psychosocial aspects of that. So when they arrive at a decision to take down a breast reconstruction, I found that they're far more at peace with this. From an aesthetic standpoint, this will be a flat, the chest wall will be flat. We take down and reconstruct the insertion of the pectoralis major. In this setting, it is different than in a cosmetic setting. Typically the releases are different with respect to a tissue expander or implant based reconstruction versus just a cosmetically placed implant. So the pec is easily or should be more easily attached back down to its origin. Also, because this patient ended up feeling so much better afterwards, I think it became less of a aesthetic concern. Bottom line is after her reconstruction was taken down, she felt better and can move on with her life. Aesthetically, she was comfortable with the appearance and that's the most important thing. After this case was performed, I began to have patients slowly come to me asking for this technique and referring to their diagnosis or what was wrong with them as breast implant illness. Having had this experience where I did not or could not identify an infection on this patient until it was subsequently removed and examined, I wanted to make sure I didn't have this experience again. So if anybody came in with these complaints of really debilitating fatigue, even if they had completely normal blood work, I was suspicious. And you always have to have an index of suspicion in order to find something. You'll miss 100% of things you don't ever look for. So if that's not in your differential, that they could have an underlying infection because they have extreme fatigue, maybe they're suffering other malaise, joint pain, muscle pain, hair loss. And these are not attributable to anything. All the laboratory analysis of the blood work, including hormonal levels, both thyroid and sex hormones are normal. All these things can be normal and still have these symptoms and it leaves them at a loss. And many, many times I think clinicians are frustrated because they can't find the answer. Even though sometimes it's as I found staring me in the face. As I've already detailed, my experience is unique in terms of how I trained. My intent was always to be a complex microvascular reconstructive surgeon. I liked to solve big problems, do big cases, and regardless of the challenge, I was with training and creativity and I love to solve problems, I was up for it. And I did that for just a large portion of my career. So when I got asked to start helping with clients doing en bloc capsulectomies, of course I didn't think it was out of my ability. Just recently had a patient with a radiation fibrotic area and she came to me from Florida to be evaluated. And basically she came from my opinion to get it reinforced of how it should be done and whom should do it. And if you've not ever taken care of somebody with radiated tissues and don't understand technically what you're doing, you can cause a great deal of harm. So my experience both with general surgery, plastic surgery, microvascular surgery, over a decade of reconstruction, I've done thousands of microsurgical cases. I've done over 500 explants. Now, regardless of the need, we're just trying to do the best and take care of the patient. I think it is helpful to have someone with more expertise to do this so that it's getting done properly doesn't have to be revised or redone, which I've done several of those as well. We certainly in the experience over time we're trying to achieve the best results and provide the highest quality of return to wellness as well as overall aesthetics. These are very complicated situations and I've pressed the envelope envelope to really provide the most benefit on both aspects. And we're always trying to learn more and get better. On our next episode, I will talk about several more patients who were pivotal along the way and how their cases led me to look more closely at labs and rethink how and what we were testing for.

Thanks for joining me today. I hope you found the information and stories shared on this podcast. Helpful and informative.

Remember, taking control of your health and.

Wellness is key to recovery from breast implant illness. If you're looking for additional resources and support, be sure to visit our online store, Dr. Rob's Solutions at drrobsolutions.myshopify.com you'll find a wide range of wellness products and supplements to support your journey to recovery. From specially formulated detox supplements to personalized skincare products, we have everything you need to aid your recovery. Visit Dr. Rob's Solutions today at drrobssolutions.myshopify.com thank you for listening and we'll be back with another episode soon. Remember, you're not alone in this journey, and together we can overcome breast implant illness.

Take care of Sam.