Episode 19: A Breast Explant Journey: From Sickness to Restored Health with Candice Barley

Before we get started today, I wanted to tell you about a way you can speed your healing and to begin reverse aging in your body. Reducing inflammation is especially important for women with breast implant illness. In fact, one of the most important pre explant surgery steps we take is to get rid of as much inflammation in the body as possible. So I've created a special inflammation support bundle to give you everything you need to reduce inflammation as quickly as possible. Don't let inflammation hold you back. Visit drrobsolutions.com now and grab the inflammation support bundle today again, you can get it@drrobsolutions.com I'm 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'll 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'm very excited today. This is my very first guest on my podcast and it's Candace, Candace Borrely. She's an actress, a mother, she recently moved from Los Angeles to Austin. So I want everybody to give Candace a warm welcome.

Well, thank you. I'm very honored to be here and yeah, it's just been incredible journey and I'm excited to talk to you. This is just kind of organically come about. I've only been sharing for about four weeks, really publicly. I did share initially in a red carpet interview about a week before my explant surgery because I was so sick and I was so tired of what I felt like the truth that had been kept from me because I had never once considered that it could be my breast implants that was making me ill.

Well, you know, honestly I never thought I'd have guests on my podcast, but then we started communicating and we met and it seemed like a very natural fit for us to have you come on the show and be the very first guest. So let's go back to the beginning and tell us a little bit about your journey and we'll just let that evolve so the audience understands why you're on today?

Yeah, absolutely. I had children young. I had my first at 20. I had my second at 22. And after breastfeeding two children, I was left with no breast tissue, and I mean, none. I was, I think they say, a triple A, but even that didn't really work. And I still had unhealed trauma from being bullied as a kid in middle school and high school and had a horrific time where girls would bully me in the locker room like out of a movie. I thought I had recovered from that, but once I was flat again, I just wanted to feel feminine. I decided to get implants. That was in about 2003. I only wanted to be a B cup. I got them that saline mentor round, whatever, the smaller 250ccs, and within about six months, started experiencing significant chronic fatigue. And to the point that I went to the doctors and said, I think maybe I have a thyroid issue. I'm so tired I cannot stay awake. And they said, oh, it's just because you have two children under four. But I had two children under two, a newborn who was sick. I was breastfeeding around the clock, and I was never this tired. Something's wrong. Well, all your labs look fine. So two years later, I was doing some yard work, and one of them ruptured. And so I was panicked. I had a flat tire. So I went back. They exchanged both implants at the same time. Said, oh, we need to pump them up a little bit. Went up to 300 something. And within about six weeks of that, I began having restless leg syndrome, where it just felt like there was tingling in my legs, especially at night. Kept me up. Two years later, I had another saline rupture. I was riding roller coaster for my son's birthday. They did a double implant exchange. After that, I began having even more symptoms, Started having heart palpitations. My skin was breaking out. I was just not feeling well. The chronic fatigue increased. I was doing all kinds of trying to be healthy. Things would get better, then they would get much worse. Then when they offered gel implants again, I think that was around 2011, I switched them out for the gummy bear gel implants. That is when I really took a turn as far as hormone issues, gut issues. I could hardly eat anything without my stomach bloating up and everything that you can check off on the box of BII symptoms I began having. And so I really dug into doing cleanses and trying all different kinds of things. And I would get a little better, and then I would get much worse until finally I was bedridden My liver enzymes were through the roof. My spleen, my gallbladder, my kidneys, all of my labs were horrible. My liver enzymes were doubling every four weeks. I was scheduled for a liver biopsy. I couldn't get out of bed. I couldn't stay awake for more than three or four hours. I had full body tremors that started just as internal tremors and eventually got to the point that my legs and hands would shake without me being able to control it. I was a wreck. And that's when I discovered that it was potentially my breast implants.

What year was that?

June 28, 2019 is when I got my explant. And because my liver was in such a poorest state, I was concerned about general anesthesia. I had never had all the testing done to find out. I did find out. One test, which was the mthfr, found that out that I had that gene mutation.

There's something unique in your story that having listened to over probably a thousand of these types of stories, the liver enzyme changes is super abnormal.

Really?

Yeah. That is a supremely uncommon finding. The majority of patients who I've seen with this issue, Breast implant illness is what we're discussing. It comes with a lot of what are just as you described, a lot of vague symptoms that are associated with lots of other things, like toxic mold exposures or environmental toxin exposures or Lyme disease or somebody who's had little ones and they're fatigued from taking care of their kids or they just don't feel well from a thyroid condition or something like that. But to have really abnormal liver function tests is a very bad sign for everybody who's listening. Your liver is basically outside of your skin, which is the largest organ in your body. The largest organ inside your body is your liver. So it handles and detoxifies the things that you get exposed to. And Candace already mentioned what has become a very nouveau riche thing to discuss, which is mthfr, a mutation in your methylation pathway. And listening to Candace talk, she definitely is someone who can't methylate well. Restless legs, nerve symptoms. There are very consistent problems that I see with people who don't methylate well who have breast implant illness. So that's a really incredible story and turnaround, like an end organ type situation, which is supremely just uncommon in my experience.

Yeah. The other thing was my cholesterol was through the roof because I wasn't being able to process fats, even though I was on a Mediterranean diet. Like, I ate avocado and salmon, and I was Doing all of the things correctly that should have been helping, yet I was getting sicker.

As you mentioned, you went to probably several doctors along this time that you're, you're having these symptoms. And I know from my perspective why I do what I do, but it's a experience laden issue for physicians of any type of. And physicians don't really have this experience because they don't understand or haven't been taught about this as a, as a problem. And so when you have somebody show up like you, who a hepatologist, which is a liver doctor, would say, wow, Candace, you're really young. Were you a drinker? Do you have hepatitis iv? Drug abuser? These are all the questions I'm sure you were asked.

Right. And I drank zero alcohol.

And when you denied them, they would be like, you're lying.

Right. You know, and none of the doctors ever brought it up. It's, of course, always on the paperwork. Have you had any surgeries? And I'm like, you know, breast augmentation here, rupture here. And then I was also. I didn't mention that I had, for years had inflamed lymph nodes underneath my armpits and burning.

Oh, you didn't mention the burning. Where's the burning at? This is a key thing. You have to describe where the burning is.

Yeah. So the burning was at the very edge, outer edge of where the breast implant is under the arm. I had it significantly more on my left side, but I always had it on both sides. And I had lumps that I would have to routinely get ultrasounds for because they would be like, these don't feel like normal lumps. And they were always inflamed lymph nodes. I even had to get MRIs. And before the explant, they wanted to see if they were ruptured because of my symptoms were so significant. I did it without the contrast dye, but they were not ruptured. There was no gel bleed, nothing like that. The remarks were that I had very thin capsules, I had severe muscle atrophy, my pectoral muscles are stitched to my second rib, I believe was as far down as we could get them. Couldn't raise my arms past my shoulders for a good six months.

Let's parse out what you said. So it's super important for both women who follow you and for those who are going to come see me or are going to listen to this. So let's take. You had burning pain and where was it? It was at the level of the Nipple. And it went towards your armpit.

Correct. It was kind of a radiating right around the outside edge of the implant or where your breast tissue would be, not directly under your armpit, but more to the outer edge.

So it's really common. So that's the 12th intercostal nerve. That's what gives a lot of sensation to the nipple. And you mentioned women who don't have sensation. That means when the implant was first placed and that pocket was stretched open, where that nerve's path was, was stretched as well. And nerves don't like to be stretched, cut, bruised, battered in any way. You'll get wicked nerve pain. I've had women tear their capsule and affect that nerve during Pilates or yoga and have excruciating nerve pain, but that's a common problem. The other reason women who have that symptom have it, who share your genetics, are as. They don't methylate well. And you need to be able to methylate to help resolve nerve irritation because it's part of the DNA repair mechanism. The other thing you mentioned was with lymph nodes. So I get this all the time. And as. As we've all been taught and conditioned to worry about is a lymph node in an armpit on a woman automatically means you have breast cancer.

Right.

So those are always going to get evaluated, as they should. But you had reactive lymph nodes, so you had, after that many surgeries. I don't have a way to forensically do this, but I guarantee you as much as I can that you had biofilm on your implants. So biofilm for everybody in the audience is a bacterial, fungal, mycobacterial. It's a contaminant. And so when you have a contaminant locked inside a space in your body, your body knows that, and it tries to eliminate it because that's infected. And so your body's way to activate your immune system is it revs everything up. And so Candace describes severe fatigue. There's lots of reasons to have that. But think of how tired you are when you're sick. And she was sick for multiple years, and she's having systemic signs of sickness. And they're related to how her lymph nodes drain. So they drain towards her armpit as the breast does. And so those are all reactive. And so not to get, you know, too into the wheeze, but you can imagine somebody who has textured devices over a long period of time, constantly activating their immune system leads to an irritation, which activates their lymphocytes then they get, basically can develop a lymphoma. And there's a lot of things obviously that need to be in play, but you will have these types of immune system consequences. And they're all very like, they're common. If you've heard these explanations and they're very clear. If you just listen to someone like Candace describe them, they all make perfect sense in what she's experienced and what she's gone through. So I didn't mean, I didn't want to interrupt you, but that gets me all like, oh, no, I know all those.

You know what's something else that's been very interesting to me, especially as I've researched and healed and worked with different naturopaths, is understanding detox pathways. And the entire time I had breast implants, I could not sweat. And I thought it was, I always thought it was like very ladylike, like I superpower. I don't sweat. But when you're working out and when you're doing all these things and now understanding how the lymphatic drains and the importance of your body's ability to sweat to push those toxins out. Within eight weeks of getting my surgery, my labs had returned to normal and they canceled my liver biopsy. I had finally gotten in with the endocrinologist, which I had been waiting to get in for, for months and months and months. And this was post explant, even though I'd made the appointment months before my explant. And she said I had to triple check because I thought that this was a mistake because your labs look like that of a 90 year old nursing home patient. What did you do eight weeks ago? I said I had explant surgery. I had my breast implants removed and she didn't even know how to respond. The proof was in the blood work for me and how I began feeling. Now, because I was so sick, I had a very difficult time recovering from the general anesthesia. I was slurring my words for weeks. But as my liver started functioning better, as I started adding in different detox protocols, within six months, the tremors were completely gone. Within six months, the restless leg that I had had for 15 years was gone. The entire time I had breast implants, I could not sweat. Let me tell you, after I got my implants out, I could sweat. But the smell that was coming, it was like burning plastic. It was a chemical smell for a good six months. That was shocking because it's not something that the human body should be able to smell like. It smelled like Burning plastic, which was so crazy but incredible, the body's ability to heal and try to push those things out.

Even all the audits we've done of cases we've had, it's very difficult in a non research environment like ours, a aesthetic surgery environment, to get the data regarding what's in the space at the time. So I can tell you for, for our audience, I know what type of biofilm is there in my audit, but I can't tell you about any kind of heavy metal or other chemical that's been given off at the time that's trapped in the capsule, which I think is important. But it's really hard to get that information in a tangible way. And anybody who's ever listened to me speak knows I, I only speak from as much evidence as I can provide someone. I don't, I don't speculate on things. The detox pathways, those are interesting. Probably in your experience since you had to go this alone for most of the time and get help from a variety of providers. But I think I find that more frightening for my clients than anything. So I became certified in toxicity just to help them navigate that better. So why don't you go ahead. And I'm sure that was quite the. Not to minimize the journey to explant or things that happen after. But when you talk about detox, I think that's a. Like it's Pandora's box, basically.

Well, absolutely. And everyone's bio individual and has different things going on in their systems. And so it would be really wonderful to have access to individualized care dependent on what you are dealing with and how your body, what those detox pathways look like. But for me, I feel like had I known what I know now, but there was no support offered for when you have implants or if you're sick with implants. And so I feel like I could have not gotten to the state that I was in had I known that was what was going on through different testing and supplements or different things that I could have done to support my body once I was getting sick or having those symptoms. Until I was able to get explant. I went to a really excellent explant surgeon, but it's just like, okay, they're out, you're on your own. Now what? You know, how do I support my body? How do I start to recover? I wasn't aware of different food sensitivities that maybe I needed to be looking at. I didn't know exactly how to support my gut microbiome. And so one issue that was difficult for me after explant was because my liver was in such a state of distress. I had a very difficult time recovering from anesthesia. And part of the issue was also being on the pain pills, which created extreme, extreme sadness, depression, uncontrollable crying, which is not like me. I was so happy to have had the surgery. And so I wish I had known that there was other things that I could do to better prepare myself for surgery. And post recovery, I had drains. I ended up getting an infection within 24 hours of getting my drains removed, which again, was painful. Then I had to be on narcotics again and more antibiotics and all of that. I would love to hear your approach to handling that so that you have minimized those issues.

I think all of us who practice surgery are taught a particular way and we have to adapt to what your clients. Steve, like you. So I have a protocol that we follow for medications. It's outside of our holistic protocol because there are still things that I need to do from a surgery standpoint to provide you the best peri or around the time of surgery care as possible. The way we set up our recovery program with prescription medications is to do multiple things. It's to reduce what women have a really significant problem with is nausea. So I don't ever want to hear that my patients experiencing nausea and vomiting in the recovery room. If I have any way to avoid that, I want to do that because that causes other things downstream that we don't want to have like bleeding because your blood pressure gets high. It's a lot of stress too to vomit. It's. So we want to avoid that. So the night before surgery, we provide medication so that you take it before surgery. So they started the night before and they just carry it out after the procedure or the treatment we're doing for them. So the other way to help with in general, what's going to happen after surgery, which is inflammation. So we'll use an anti inflammatory and what we use is a Cox tube inhibitor and it's called Celebrex or Celecoxib. So why is that important? It's meant to really help and combine with the protocol work synergistically to reduce your need for narcotic. So what else can we do as practitioners doing the surgery? Well, in the case I use a lot of local before I ever make an incision. So local anesthesia is provided to diminish the pathway or the pain pathway response that your brain gets right, you're under anesthesia, but you still have pain and then we'll go to the next steps in my program, which is to take Exparel, which is a long acting local anesthetic. And now that's before you ever wake up. You've had your incision made, you've had your surgery done, then your whole entire pocket is cleansed with a solution of lower ph so that we take care of any biofilm and then we block everything. And so we're not done, but we're getting close to being done. We're closing and the anesthesiologist is getting you, you know, ready to emerge from anesthesia. We wrap you with an ACE wrap. But what I do in the interim of this ACE wrap and the, the layers of it is I just put ice packs over the chest. So ice is still the best anti inflammatory known to man. All the expensive athletes use it, so you can too. So it's pretty rare that my patients ever rake their pain above a 2 or a 3 in recovery. Wow. So you don't really need to slug somebody with medication in order to get their pain under control because there's quite a bit done to avoid that in the entire process before you ever got back to recovery. So in a hospital based recovery system, you would have gotten narcotic long acting, you would throw up, you would just lay around, you'd be really sleepy, groggy, constipated. So in our environment where we want you to be able to get home or to your hotel, because I have a lot of people coming from out of state, you have to have a program or a process in place that allows you to have a patient wake up, hopefully experiencing absolutely no nausea, very little in the way of discomfort. And you have this window of time where all of our local, that short acting is working so you can get to your hotel or back to your home and you're comfortable. If you then get there and you're having some discomfort, I don't say take a narcotic. I say, as I've done in my pre op appointment with you, I said now have extra ice packs. Those work wonderfully. So if you're cold and numb in that area, you're not going to experience sharp pain. It also really helps with nerve pain. So those are all strategies and techniques we use. Probably a little bit different than you experienced.

Definitely. Most definitely.

So for everybody, we'll go back to 2019 with Candace and she's decided her implants are the root cause of her problems and she's decided to have an explant. And can you elaborate? Maybe on that. Maybe not that sentinel moment, but the time around that decision and. And what you thought about that.

Yeah. When. When I realized that it was my implants, because I had had every other test done and nothing else was adding up, there was a sense of relief to have an answer. I was surprised with myself that I had not ever once considered that it could be my implants. I had frustration towards doctors and surgeons at that point because no one had ever mentioned it to me that it could be a potential. I was only ever told that breast implants are safe. Unless you have a silicone gel rupture, you won't have any issues, which just even implants of any type. It makes sense that in certain bodies and in a lot of bodies that you are going to have inflammation and issues from any type of device in your body. So I was pretty surprised at myself that I was like, how come I never considered that? And then fear. I felt a lot of fear. I. I started doing research. I went down the rabbit hole. I joined Facebook groups. And while I did get some good information on that on those groups, I also began to realize that I had more and more fear growing inside of me on a lot of those. While they mean well, and I think they're getting important information out there at some point, I think it's important to walk away from that. Because when you are seeing over and over that you've got toxic bags in your body and you see the chemical soup of implants and you see skull and crossbones on all of the memes, that is not a good place for you to be in your healing journey. So it was important for me to realize I was healing from that moment that I became aware that it was in my implants and to stop researching. I tell women now it's important data for you to have. Once you have that data, you need to move on with what you can do from there to support your body. Don't just keep going over and over. So it's very important to give yourself grace and take a deep breath and find someone that can help support you during that process of preparing for explant. As far as regrets, I don't really believe in regrets. I used to, but as I've gotten older, I realized that every single thing that I've done, I've learned something so profound about myself and about life and about healing. And had I not been through this whole process and something I haven't even touched on is what I looked like after explanting and having to go through that Journey of living with my body for a couple of years in another state of distress. But I've learned a lot, and I've grown a lot as a person. And I don't think I would have been able to evolve like that had I not been through this situation. So I try to tell women to find the goodness, even in the hard and scary times that they're going through, maybe with their implants, and to know that it will be okay and it gets better for sure. And now that there's so many resources and doctors that believe women, that was the other thing. It was very hard to find a doctor that would listen to my symptoms as an explant doctor, that there's doctors that'll take out your implants, but they say you're going to look terrible and you're probably not going to feel any better because it's not this. That was very hard for me. So it took me a while to find a surgeon that just performed explants and saw that his patients were getting better and understood the importance of removing the capsule and all of those things. So I'm just really relieved and happy at the opportunity to be able to share that there are doctors like you out there that will listen to them and do understand.

Well, I think you highlighted a couple points, and thank you for saying that. It has. The measure of admonishment I may have gotten from my professional colleagues is nothing in comparison to having to ponder doing what you had to do. And I find it difficult for women to find support, whether it's from their friends or their family or their significant others or spouses. I feel like that is a. It's pretty precarious for some of my patients, and that leads to even more anxiety or the concern or being ashamed of what's about to happen or the appearance change. And so I think it takes a great amount of courage to do that. You have to have support in order to get through that process. We can support you and we try to help, but it's a long, long process, as I'm sure you can highlight in detail. But who supported you through that, if you want to share that?

Well, I was single. I am single, like it was. I had been married for 21 years and I have three sons. One that's still young. He was 12 at the time that I had explant. And it was mostly my mom that was able to support me and my best friend. My best friend, actually, she had breast implants. She was having treatment resistant depression. Nothing worked and was having migraines. To the point that she was being hospitalized. When I discovered breast implant illness, I said, I think maybe it's your breast implants. And she was able to get in two weeks before I was for explant. She actually took care of me in my hotel room while she was recovering as well. But we were both two weeks apart, so it was really friends. But as far as, like, you know, having to see yourself after and go through all of that, it was all on my own. I think it was important for me in my development as a human being to go through. But it is wonderful if people have a significant other or someone that can support them through those. Those moments. But ultimately, it's your body, and you have to live in it and go through that. But I don't want women to feel fear for that. I was so grateful to be able to get my health back, and so I knew I could figure out all the other parts of it as time went on. But your health is most important.

So that's a very important point that, you know, I try to drive home with clients and loved ones if they're with them at that time. Like, if somebody's really suffering. And you are definitely one of the secret patients I would have ever had come across, I would have not offered you anything, you know, but an explant, because I would have thought everything else would have been not in your best interests at that time. And I would have had that discussion with you as I have had with many clients. Like, if you had came in with the, hey, Dr. Rob, I know you do fat transfers at the same time, I would have had that chat with you and said, no, Candace, we will not be doing that for you at this time. You need to get quite a bit better. And then, yes, I'm happy to do that for you and take care of that. So thank you for sharing that. I know that's a super difficult thing to talk about.

Well, I feel very fortunate. I'm grateful for my health. I'm grateful to just feel good again. So I definitely. I'm open and like to share because I want other women to know that healing is possible, that getting your life back is possible, because it does feel like your life's taken away when you get to that point, but also that you don't have to get to that point if you know that that's potentially what's going on, that there are ways to treat that before you get to that point. Once I decided that it was time to move forward with explant, that that was definitely the decision that I needed to make. I started researching and, you know, like, most people Googled explant surgeons. And. And then I was on some Facebook groups and different things, and they. They had their own list of surgeons. And so combining the two, I set off to try to find the right surgeon for my situation. So I met with different surgeons based on Yelp reviews and these Facebook groups that have their own list. And when I would tell them my situation and my symptoms, they would say, well, yeah, I can take your implants out, but you're probably not going to feel better because there's no proof that implants cause these issues, and you're going to look terrible. So that was extraordinarily heartbreaking. I continued my search, and I ended up getting a consultation with one of the very top, very, very excellent explant surgeons, who is very heavily promoted. I was excited about that. During my consultation, I felt very brushed off, and I knew that they would do an excellent job, but I didn't resonate or feel a connection. I want to feel comfortable going into this scary surgery. In my mind, I met with another surgeon that was not, again, was not on this Facebook group and all of the other certain sites that have been set up, but had good reviews. And I saw that he only did explant and that his background was in breast reconstruction, especially to do with mastectomies. He did fat transfer. I was not a candidate for fat transfer at that time, financially and with my health situation. And as soon as I spoke with him and he listened to my symptoms, and he said, I have many women that come in with very similar symptoms, and their implants are removed and they get better. And he understood and agreed that he did his best to do en bloc, but he said, it's not always. If you get a little tear or whatever, then it's not considered complete. En bloc, it's very difficult. My capsules were very thin, so we did a total capsulectomy. And I just felt. I knew in my heart this was the person that I was supposed to get surgery with. He was booked out for six months, and they then had a sudden cancellation, and I got a very quick turnaround. Had to get my labs done and everything, and I was in there within two weeks. And it was done, performed in a hospital, which was nice with my situation, and the surgery went fairly well. I had a lot of issues with recovery from the general anesthesia just because of the situation of my liver. So it took me weeks to recover from that. But I'm 100% positive that had I gone to someone that didn't believe in taking out the entire capsule, didn't believe in testing, that I would potentially still be struggling with issues. So that was very important to me. And I think that should be the deciding factor for sure, on looking for an explant surgeon, someone that listens to you, that understands that women do get sick and are sick from their implants and will support you in taking out your implants the correct way.

So a couple things you said. So when a surgeon talks about appearance changes after or doesn't necessarily have recognition of what happens afterwards, I would say to the audience that's something that would raise concern for you. This is not a new entity. It's been established and discussed at FDA hearings. Second thing is that you mentioned somebody who had done reconstruction as part of their career. So if you've done that as part of your career, you know how difficult that situation is for a patient who's facing a mastectomy and a reconstruction or the choice not to do that. And so many times it's not well known in this country, but the majority of women don't get reconstruction. So as someone who did those cases for long periods of time of their career, it resonates when you say that that provider listened, which they should. Obviously, that's the first thing you should do, is listen to what's going on and try to recognize how you can help and then provide a plan that makes sense.

Yes, absolutely. And it was interesting to me because the surgeon is incredible, but yet he was not on these boards that are supposed to have, like, the best explant surgeons. So I had to really recognize that and understand. And it's hard because there's a lot of women who are looking for explant surgeons. And I think there's a lot out there that are on certain sites and different things based on someone's opinion. So as an explant surgeon, what are some of the things that women should look for as far as accreditations or history to find an excellent explant surgeon that's going to make sure the capsules are removed and be able to handle reconstruction if they're able to do that at that time?

Someone with a background in reconstructive surgery or reconstructive microsurgery? I think that term microsurgeon has been used, and maybe not appropriately in these instances, because, of course, you don't use an operating room microscope to perform this procedure, which is basically the definition of doing microsurgery surgery. You can't see without Visual enhancement, if you will. So I. I made my living sewing little blood vessels together with essentially suture that's finer than your hair. And that's why you needed a microscope, because you had to magnify it in order to see it. Now we all have little special magnifying glasses. It's like wearing readers fancier, and they cost more money, but that's how you do more and more focused work. And I've never used an operating room microscope or what they call surgical loops or jeweler's loops to do an explant. So I always found it interesting on your. As you used in your example, these different boards that classify surgeons as microsurgeons, because I am a microsurgeon by training, and I used to train microsurgeons. So I always found it fascinating when I knew none of the people on those lists, given my history. So I think, just as you've highlighted, it's more about. In terms of background. I think having a reconstruction background makes it easier for me because I did cancer for the majority of my career along with cosmetic surgery. So I think you have to listen and understand. And each case is a little bit different, obviously, and we've worked hard on different technical aspects of it to make it safer and easier and certainly limit the amount of discomfort patients. Patients have when they're waking up, which is the most important thing.

And, you know, recovery was a little rough. I had. I got an infection from the drains.

All right, we're gonna have to talk about the drains.

Yeah. And that was one thing which, when you don't have all of the information, I was like, oh, and I know that the doctor has to do drains. If they don't do drains and there's something wrong, you know, you gotta do drains. Well, I got drains. I had them for three days. Everything had been going fine. On the third day, had. That went into the office, had them removed by the surgeon, and within 48 hours, I had a fever. The area was red, and very obviously infected.

Yeah. So just so all the listeners understand, all of the studies suggest that the use of a drainage ultimately is associated with a higher rate of infection. And so let's just talk about why we would use drains in the first place. And I've used drains for breast cancer reconstruction, for tummy tucks, for breast implant removals. So I. I will just give you my. My 2 cents on. On why you use them initially as a surgeon, because you don't want to leave a space that's open to fill just with fluid and develop what's called a seroma cavity because then you have this fluid buildup. And so I would argue it this way. I've gone to not using drains, except for in really specific instances. So if I have a extra capsular rupture, which means your implant capsule, your scar has been compromised by the rupture. That usually means the gel or filler of the silicone device is now extravasated or leaked through your capsules in your breast tissue. That is a very unfortunate situation that I don't find very often anymore. But in that situation, I am very apt to use a drain because I cannot get the pocket devoid or cleared of materials easily, because breast tissue is not something you can just magically clean and, oh, it's fine and be done with it. Now, the other time I've used the drain. Now, drains don't stop infections, they don't stop bleeding, they don't stop you from getting the seroma. Just so that everybody's clear. We hope that they do, but that's not ever been proven really. So if you have a particularly problematic case and there's a propensity of bleeding for reasons beyond your control, maybe it's difficult to control their blood pressure. Maybe they just are somebody who has bled more during the case, maybe they're more inflamed. You never know the given situation. So I don't want to be throwing blanket statements here, so I will use them in those cases. But most of what I do is create an environment where I don't have to by lifting up the fold so that the fold will rise, disrupting that lower area so that internally it will drain. And that may sound like heresy, but I don't use drains and tummy tucks either. Haven't for a long time. So that you can do with a progressive suturing technique. And you can also do the same thing I just described, which is undermining and basically internally draining it, which is your body's gonna. If you will absorb the fluid and then eliminate the fluid provided, several things are in order. Right. So I put patients on a particular diet that's higher in protein. I try to make sure the foods they eat don't create more inflammation or more edema or fluid. And we use supplements and we use anti inflammatories and we use ice. I mean, we're doing all these things in conjunction with compression to help mitigate fluid production. If you have a multimodal approach, you'll do better. And some thin people, tiny little bmi patient will produce a lot of fluid and you'll be like, oh my gosh, how can this tiny person produce all this fluid? Well, if they don't compress, if they don't use ice, if they don't use their anti inflammatories, if they're not following the diet, they don't have enough protein in their diet. I mean, there's, it's, it's pretty predictable who will do that. So as much as I can do to help, I need a patient who's really switched on to help themselves.

Definitely have to take responsibility. But it's so incredible to me that you offer all of these protocols and even just saying like, hey, if you up your protein and you reduce inflammatory foods, you're going to have a better recovery.

We'll get back to this show in a moment, but I wanted to share something that I think can really help you. You might not be aware, but part of my work as an innovator in the cosmetic surgery space is to create products that will give my patients the best possible outcomes and restore their health as quickly as possible. I can't tell you how critical it is for all of my patients to actively work to reduce inflammation in their bodies. We do this through diet and supplementation. In fact, I've created a special inflammation support bundle for my patients and now you can have access to it as well. One of the reasons this bundle is perfect for my patients is that so many of them have pill fatigue. It's just not going to work for them to have a handful of pills each day to reduce inflammation. So I made sure to include the liposomal version of many of the vitamins and minerals within the bundle. You'll still get the full absorption of these supplements in your mouth without having to go through your gut first in order to be absorbed. You can get the inflammation support bundle@drrobsolutions.com and begin to feel better when you make the supplements a part of your daily health routine. The website again is drrobsolutions.com I can't wait for you to get this help in your hands.

So after explant, I knew it was important to just let my body recover from surgery. So then after the eight weeks when my liver enzymes and everything had had balanced and my other symptoms were starting to possibly get better, that's when I started going, okay, maybe I need to look into doing some, some liver cleanses. And eventually I discovered, you know, liver supporting herbs and teas and supplement lines. And so I definitely went that route and worked with a naturopath I did vitamin shots for a while and then I began doing saunas. So I would take binders. I have a personal sauna at home and that really accelerated my detoxing and my healing. So that's been really incredible in my detox and healing toolkit. Again, nutrition. I follow mostly a Mediterranean style diet. I don't eat processed foods. I really don't eat gluten at all. I have the celiac marker but not celiac. But I don't want to activate that. I don't do dairy. I have zero gut issues anymore. Pretty much the entire time I had implants. Even before way before I ever had sibo. I would bloat. Everything upset my stomach. I don't have those issues anymore. And I'm able to exercise. I didn't have the endurance. I had muscle weakness. That says something else. That was was surprising to me and I wasn't expecting was. It took me a good nine months to really heal my pectoral muscles and almost two years before I could do push ups. But it does heal, so that's really incredible. Even though I had muscle atrophy and my pectoral muscles are quite a bit higher, I can still do all of the pull ups and push ups. And so that's really wonderful. And I think also has to do with a surgeon that addresses that at the time of explant.

Well, you had this interesting condition. You know, you basically had anhidrosis, which is your inability to sweat. But it was induced, it wasn't natural because now you can sweat. And although I've seen a lot of extremely strange things with patients who have breast implant on the Sudan undergo explant, I haven't had that as a specific constellation of symptoms.

Yeah, I didn't even know it was a thing. I hadn't sweated in so long that I never even thought about it until I started sweating again. I didn't think of it as a condition. I didn't know it was not a good thing that you're not sweating because that's how your skin is able to detox. So now that I'm able to sweat, I recognize how severe of an issue it is. It truly was.

Well, I'm sure Candace has actually done a great deal on her own to help herself in terms of internal healing. So she's changed her diet and balanced herself out, I guess. I mean there's lots of books written about just correcting Hashimoto's with your diet. So I'm sure the majority of what you've done with yourself you know, over time you've used food to heal yourself and as well as protocols and supplements and things of that nature.

Right, right. I work with a thyroid specialist and so I take very few things. Any of them are just supplements and other low dose medications that are just good for reducing autoimmune reactions. So I feel great. I don't struggle with it anymore. I get my labs checked again in a few days. But hormones are a little, you know, I'm 45, so this kind of fluctuate. So we're always riding the wave on those.

Yeah, I feel that, that recently we've really honed in on hormones as well as we had always been pretty strict on our nutritional parameters. And as you highlighted, many women on those forums have tried to adhere to those. And it's not that they're missing the mark. I think all of it needs to be taken into consideration and they would get a better outcome.

Well, I mean, you're going to spend so much anyways to get fat transfer, but if you want to have the best outcome and results, you need to make sure these other things are balanced. It just makes sense so that you aren't stuck in a situation where you have to do it, balance those things and then do it again. Because ideally one round is that's hard.

To do things the second and third time for sure. Your case is complicated for the audience. As a surgeon, I would say the best time to do something is the first time. Each and every time I have to operate, it gets more complicated just because of the things we've highlighted. Your blood flows to those regions where you operate or have to operate. They don't get better with surgery. Fat transfers are a little bit different because they're providing, as I mentioned, a environment because of the stem cells around the fat cells that actually get transferred. And there's been so much research done about this. It was one of my research focuses when I was in an academic job. You can get some really profound results. There are some guidelines and almost like your own internal rules you follow. I have a certain set and I just try to, in summary, clean out what I consider to be the variables. So if I eliminate food sensitivities and balance a diet higher in protein and we can say higher in fats, which is fine and my patients don't have other toxicities or we're addressing those toxicities and their pathways for detox actually work and they're methylating, then we put them in the most favorable position to both have a successful explant and fat transfer. Which I do a lot of at the same time. I know that's not necessarily the most popular thing around the United States, but I do a fair amount.

So ideally, that's what I would have loved to be able to do. But. And I know many people just by that point, you're just like, I want to be done. But it has to be someone that has a high success rate at doing that and has also checked all these other protocols and issues that you do beforehand. So I think that's why you're able to do it. For sure. Yeah.

I think, you know, I've been really fortunate. I was trained by people who are the folks who basically came up with how to keep people alive with IV nutrition and little neonates. And so they forced us in our training program to learn how to take care of all different sizes of patients and how to do that and calculate their protein, calories and everything. So I give them a ton of credit. I think we all get taught to a certain degree that is necessary. How much we implement that in our own practices or if that's our own interest. I have a great deal of interest in nutrition. I'm very gluten intolerant. So is my daughter, so is my son. And to genetic things. So, you know, everybody's got their own personal reasons why they do things, but very close and near and dear to my heart. And you'll wonder why the plastic surgeon's asking you about your diet, but that's why.

Right? And I had to do my own. Well, working with the niche path and stuff, that where I discovered that I had the MTHFR issue. So that answered a lot of questions. But it's great to have one place that you can go and have all of these instead of always having to be your own detective, which I learned a lot that way.

And I know you've become a health coach.

Well, I had to get better. One of my favorite quotes is, I didn't come this far to only come this far. So it was like, I am going to get better. I'm going to get my life back. I got this part done. I know that there's answers out there. So, yeah, it's just really refreshing to be like, oh, a doctor that understands that.

Well, you know, the other reason we did it too is I had a couple patients make themselves really ill doing detox on their own and then call me and really they were unwell and I would ask them what you were doing. And they had got a detox protocol and started it with a practitioner or Maybe not a practitioner in instances and that they'd become ill. And so I was like, oh, wow, I don't want to do a treatment or a procedure or. And then have my patient go out and get sick afterwards, because then we couldn't help them with the next step. So we started using different practitioners. And then Covid happened, and then we lost a lot of those practitioners. So I became the practitioner for all of that. So that was a byproduct of COVID.

I don't know that this has anything to do with BII or anything, but I was always cold, which can be thyroid, and it did affect my thyroid, but my implants were always cold.

Yeah. And now that is very common. I get that. Either cold hands, coolness of the breast. That's always something that, for lack of a better term, I equate to what's going on. And a lot of times I've found in my practice folks who have infections that are occult or hidden. Your body shunts and tries to protect you, and it takes blood flow from your extremities. And that's very natural. And you'll see people who are really ill, they'll have diminished blood flow on their extremities or when we're giving them medicines to help keep them alive, essentially, those medicines cause constriction and reduce blood flow in their extremities. And then, like you said afterwards, what happened after your explant with that problem?

Well, I still continued to have very restricted blood circulation in the area. And I attribute that to having had five surgeries. And now.

Well, not in the area, but your extremities in your hands and feet.

Oh, yes, all of those things completely. I did no longer had numbness in my hand. I would have. Where my fingers would get really cold and very numb at the ends.

Right.

Burning, all of that completely resolved rather quickly.

I'll point that out for the audience. So she's basically reiterating what I just said. So where she was operated on, she had reduced blood flow because she had surgery and had surgery multiple times there before. So I always tell my clients, each time I operate, I don't improve things. Right. I don't improve blood flow, I diminish blood flow. That's part of the process. And then by removal of what I presumed was a problem for her, either with an occult contaminant or what have you, that her body was always trying to take care of, she shunted towards that, towards her chest, and that made her extremities cold. And now after surgery, that NIDUS or that occult problem with inflammation is gone. So the body relaxes, if you will, and improves blood flow to the rest of the extremities. And then of course, the area that you're talking about is your chest. So if you feel comfortable explaining kind of the process that you had to go through for that, I'm sure that was a difficult one in terms of having the previous surgeries and then this surgery.

Yes, for sure. I talk to a lot of women as well. We don't really get nervous for the implant surgery, but when it comes to explant, it's very, very nerve wracking and, and it has to do a lot with what am I going to look like. And so I have to say that was very surprising. I had very thin capsules, which I don't understand all the reasoning behind that. I've heard some different things with collagen synthesis and that sometimes women that have thinner capsules tend to have like higher toxicity and the thicker capsules help a little bit more. Have you seen anything like that? I'm curious.

Yeah, I mean it's all really anecdotal, the thickness or the thinness. So what does that really portend for the, the patient? And you know, I don't ever really subscribe to. It's just one thing that causes any given problem. There's got to be lots of issues that lead to what you're experiencing. So you had a lot of different surgeries. That always makes me nervous. So from the time I would have met you, having had three surgeries at that point, it would have been like, oh yeah, I expect you to have a problem and your symptoms would make sense. I would consider, like I do now, all the things that you know now, because I already go through those now and I look at food sensitivities and hormone imbalance, endocrine abnormalities, gut microbiome issues, toxicity issues with mold and heavy metals and environmental toxins, because those play a role, like you're an actress, you've used makeup for many years and makeup is very toxic. There's a lot of phthalates and makeup. So I find that extensively in patients and those are carcinogenic in some instances. So we haven't even talked about genetics. But just listening to some of your story, lots of patients don't methylate well. That makes their detoxification process more complicated. So I just. Thick or thin, if it's implants from the 80s, usually they're ruptured and leaking and have calcified capsules. So they're the hardest or the thickest of all. And then it's everything down to basically something that looks like cellophane. And if you're like that, it's harder for surgeons. So I think, you know, in your instance, if you had a thin capsule, what does it portend? Give credit to your surgeon for trying to get all of that material out for you and then cleanse the pocket so that whatever's affecting you, if it's in the pocket is gone. And that's what I think's important.

Yeah. Wonderful. Well, I opted at the time not to get a lift. Well, immediately I was like, oh, maybe I should have gotten a lift. That would have probably made them look better at this time. But as time passed, I was glad that I did not because I have such limited breast tissue. And the only breast tissue that I have is at the base of the breast, which is where a lift is. That area is triangled out. Right. And brought together.

Or so it depends. I think really when you look at the four basic lifts, there's a crescent lift, which just helps adjust nipple positions of one slightly different asymmetric versus the other. Then there's what's called a donut or a periareolar lift, and that's really just to concentrically tighten towards the nipple complex itself. And so in a smaller breast with just a little bit of excess skin, that's more suitable. And then if you have a wider breast or a really wide implant that's really hyper expanded the envelope, then you would use more of a vertical. You would take out a component in the bottom and narrow it and lift it vertically. If it's just a skin excess issue, then you can still do the vertical, but you're really not taking breast tissue out because as soon as you take that skin off, you're basically looking at the patient's implant capsule.

Wow. Okay. Well, that's interesting. I know that there are a lot of surgeons who, even with a reduced amount of breast tissue like your a cup or smaller still cut out that tissue to, to sew that together.

So you're just literally a pancake if it's super wide. If you don't do that, then you have a really floppy skin on.

Oh, then you have kind of the rectangular or.

Yeah, you'll have a think of it like a really empty breast at that point. If you have, say, a larger implant and very limited breast tissue and it's really stretched you out. You started from an A and you went to a D. So that is going to leave a whole Nother problem if you don't do something with the skin. So it's a little bit of damned if you do, damned if you don't for us in my profession. So all we can do is be too big or too small, too loose or too tight. Yeah, that's all in the client's perspective, right?

Yeah. Well, I hadn't really discussed that. I had pretty severe adhesions and I went back for I think two or three sessions of adhesion release where.

Oh, no.

Yes, where they numb you up. So more lidocaine in the area and then take. I don't even know what it's called. It's a needle that looks like a blade.

Rigote knife.

Yeah. And just would stick it in there and go back and forth and the snapping and the crunching and the pain, I mean, and it would help a little bit. Tiny bit. And then it would be like go back and cup. And so I had the big like inappropriate looking suction cup things I'm doing at home and then had holes from where we did that. So it would just look like, I mean it was, it was bloody and messy and all that to say none of these things really helped with the adhesions.

Right. What Candacen is describing is called a scar release. And basically the rigotomy is. Famous surgeon in Italy established one of these. Technically you're doing scar release and you're supposed to do fat beneath that scar release in order to prohibit the scar from forming as dense or in the same position. So think of it like you have a depressed or tethered area and then you release it and you put fat beneath it so that it cannot tether again. So that's a very standard reconstructive technique for both radiation injury adhesions from surgery, or in our case, we did it a lot for cancer reconstruction cases. So what she's describing is a very commonly utilized technique to break down scar. But the next step is to place something as a filler between that. So think of fat as one of the oldest fillers we have. It's the oldest natural filler really. And fat brings with it its own adipose derived stem cells. So those stem cells are what help support and develop the ability for that depressed area to not stick back down. So she had poor blood flow. And what she brings with it when you add fat to it in the right setting is a way for new blood flow to develop in that area so it doesn't adhere back down. So when you do it without, you can have a result. But remember, she's had three operations. Now this is a fourth intervention and a fifth intervention. And however many interventions you do without changing plan A. Plan A doesn't work if you don't change it.

Yeah, it didn't maybe 10% improvement, but the issue was that that area would just adhere back down eventually. I knew fat transfer was going to need to be an option and so I found a fat transfer doctor. I didn't want to go back under general anesthesia even though my liver was well. And I just had so many surgeries at this point that I wanted the least invasive way to handle this. And I had realistic expectations. I only wanted to be an A cup and to just have uniformity. If I lean forward, you could see that my skin was adhered to my chest wall. I found a fat transfer doctor in LA that had excellent reviews as far as fat transfer to the breast and the bum and awake. My mistake was in not asking or not even realizing the importance of someone needing to have extensive experience in fat transfer after explant. Because obviously there's a matrix of scar tissue there.

Yeah. When you have those percutaneous releases, those areas develop more scar. Each intervention, without a filler placement or fat transfer or something to buffer it, you get more scar. So what you're going to describe next is pretty predictable.

Right. So proceeded did the awake fat transfer. About 300cc's of fat was placed, which.

Is a large volume for you.

It is a large volume. I was surprised because again, I was. I just wanted to look natural, normal. So they sat me up. When they looked at all the fat they had placed, I don't know what it looked like, but they said layer back down because I'm awake, but I'm highly drugged. But essentially what the issue was, I guess it just looked like pin tucks everywhere they placed this fat scar tissue. Then once they sat me up, pulled in all of these areas causing deep dimples where the scar tissue was. Then he went back in with a smaller cannula and started to just. I had, you know, 150 holes all over my breasts as they went in individual in each one of these spaces, trying to break up the scar tissue at the same time as injecting small amounts of fat all over. So my best friend was taking care of me again and I was doing okay. And then the next morning, you know, I texted, said, does this look okay? Looked kind of red to me, but of course I had surgery. It's probably going to be red. I never saw him again. Before I left town, I was There another three or four days had just virtual check ins at a week. I said, I'm larger than after surgery. And he said, great, you're keeping the fat. That's great. And I'm like, how is it possible that I'm a larger. He said, well, you know, it's. You probably still have swelling. And so a few more days go by and I'm like, yeah, I'm not feeling good and I wear an OURA ring. And so my temperature before this had dropped really, really low, like extraordinarily low for like three days. And my respiratory rate was really high and all of these things. But he was like, you don't have a fever, right? No. And then I got a fever and they just kept getting bigger. I sent pictures. He said, okay, yeah, again, this is to be expected. I had a lot of scar tissue start on this antibiotic. Didn't get any better with the antibiotic. Fever kept going up. So did the breasts at this point. They are bigger than my implants ever were. They were red and shiny and awful looking. And I kept saying, like I said, they feel like they're filled with air, like helium. Like they're not heavy, they feel like they're blowing up with air. It was so weird because they felt like bouncy, like a balloon. So eventually another round of antibiotics. By this time, we're three weeks in. I'm so sick, I can't get out of bed. Super red. It gets passed over to a different surgeon who sees it and says, you need to get on a plane right now. You could go to the er, but they're not going to know what to do with you. This was Christmas Day. I had to get on a plane and fly back to California and meet the surgeon at the office. He tried to aspirate with large needles. We did get a substantial amount of fluid, but not enough. So we said, let's see how that does. And then sent him pictures the next morning. And he checked in with me like every hour. He said, you need to come back in. And at this point he made two little incisions on each side and it just poured out liquefied fat and infection.

Just for the audience. So a couple of things Candice said was her temperature got really low and she kept getting asked if she had a fever. So the prelude to get in a fever, you get chills, right? And then her respiratory rate was going up. So had they checked her blood work at that time, she would definitely have had aberrant blood work. So her blood, her white blood Cell count would have been higher. It would have been pretty obvious that she had an infection. These are things like in a hospitalized patient you would recognize pretty quickly because the nurses would be like, hey, Dr. Rob, the temperature's really low, her heart rate's elevated, her respiratory rate's elevated. She has an oura ring on. So she knows this. Anyway, so she's got her own monitoring device on. And basically now she's describing a closed space infection. So what I tell folks, try to envision a honeycomb. And this honeycomb has been broken up, but you still can't get everything out. So when the surgeon tries to get things out, he doesn't know where it is. It's a huge maze to get stuff out of. And they're fortunate that they got enough out so that she could actually then, with the help of the antibiotic, I hope, get healed up. Because this can become a life threatening condition for someone if it's not taken care of.

Yeah, that was the issue with trying to do it with large needle was it was a honeycomb. So we couldn't find where the pockets were, even though we knew that there was a lot in there. So we ultimately creating a large hole and incision. And then manually, first of all, a lot poured out. But then he had to manually express the remainder of the liquefied fat. And then of course took samples and swapped all of that and sent that to the lab and then was able to determine what kind of infection it was or bacteria. And so then I was put on another two antibiotics there. So I was on four antibiotics within three and a half weeks. And then after that point, by having to manually mash out that fat and infection, it somehow created like my skin felt like there was literally a sponge sewn in there. It looked, they called it orange peel skin.

It was just, it's called peau derange. So the dermis is, got fluid stuck in it and it feels boggy or soft. So we've described this on the show before, but where you put fat is between the skin and the breast tissue. Now, in a really thin patient like Candace, there's not going to be a substantial layer there. So invariably you're going to be rubbing up against the breast and that space, you're going to be in the dermis, just beneath the skin. So that the skin is composed of layers, epidermis, dermis. The dermis is where the blood flow is. So you actually want to be very close to that area. But that's when you have an infection from fat transfer or just when fat transfers are healing, we see it in revision lipo a lot, where we have to undimple skin that's been contracted down from scarring. You'll have this bogginess. And it looked like poterage, which is orange peel, basically.

Yep, that's exactly what I had. That has been a process to heal that, which I talk about a lot on my Instagram account, and how I found something that really helped me with that and helped restore the blood circulation to that area. And so at least everything looks better. Substantially better. From where we were at, I would say I probably retained like 15% of that, which the only place it retained was at the bottom. The only area I had breast tissue anyways, so lesson learned.

Yeah. That's a complicated thing.

Yeah.

And maybe we'll just do a simple physics lesson here on the show. So we're gonna use a couple. We'll use some Sharpies. Those are easy. So when you're doing fat transfers, there's some. Just basic things to remember. We're all taught how to do them. Remove fat with one instrument, a liposuction canula, and put it back with another instrument called a fat transfer cannula. There are varying sizes, but just for illustration purposes, if you take something out with something that big and put it back in with something that's smaller, you just have this disparity in pressure that it takes to put it back. And the smaller that device is that you put it back with, the more pressure you exert to put it into the space. And the more pressure you put on things, the less control you have. And when you don't have control, no matter how good you are, no matter how talented you are, you can't get it exactly where it needs to be evenly distributed. So what I tell people and what I've shown you in the past is whatever you take it out with needs to be the same size as you put it back. That gives you your best chance to evenly distribute the fat across the area that the. In this case, I want it to go. And I, a long time ago, used to use the technique you described. It's a hard technique to get just right. But I did that over over a thousand cancer patients, so I was very versed in doing that. And then we have Wells Johnson fat transfer equipment now. So we have this very posh system that holds it. And as I remove the fat, it's collected and kept safe. And then we were able to, with a nice little roller pump, put it back in with a fat transfer cannula. So that we're in, we always are hopefully going to be evenly distributing the fat. Of course, we're not in there with a camera looking at it, but you can feel it. And you're not applying extra pressure to push it in where you're trying to put it, which is when you use small cannulas, especially in scarred up tissue, you can extrapolate how that happens very easily.

So do you think it's because maybe the fat was damaged as it was going in there, so then it didn't have a chance to take, and then because it liquefied, it grew an infection or what? What do you think happened there?

I think anytime, you know, you describe it when you have a heavily scarred area, I'll just use the most extreme example is a scarred radiated area. If you release it, no matter how much you release it, it's still like a trampoline. And then you put fat in there. There's only so much expansion tissue can, can have. And as they sat you up and looked like some of the areas didn't expand, I think that's probably a time to pause and reflect and say, maybe don't need to put more there, maybe just need to release the scar as it's been released in the past. Because that's kind of the moment where I would probably change my tact. I have these numbers that run through my head along with the voices, and they tell me what I should do and shouldn't do over years of doing these. And I will stop, as some of the best people in the world have taught me, is like, it will only expand so much. And the more you expand it. This is not lip filler.

Right?

Lip filler and cheek filler is not dynamic. Fat is, but it's also highly compressible. So you can kill it and that will create more problems for you. So you get yourself into catch 22 when you add more and more fat. Many, many clients ask me to over fat transfer them in order to get them a better result, which, if you just follow what I said, doesn't work. It can't. You only have so much tissue expansion and when you reach that, I mean, you stop. Doesn't matter how much fat you have. That's not the point. The point is to safely transfer that. So although I think there's a lot of very qualified practitioners, I would not say it's always that easy to get that and know when to stop. I think that's just something I've been fortunate with over time. I've done so many of Them, right. I know by tactically how it feels, how it looks like. If you see the skin, get pot orange in it, you know, it's time to be done.

Right? And from my understanding, in order to avoid fat necrosis or oil cysts or things like that, and I may have those, I'm not sure, but after explant, there was areas where I felt like maybe fat, gut or breast tissue kind of got stitched in a weird place close to the scar. Luckily I had a baseline ultrasound before this procedure so that I have that to at least have as a baseline and then I will do another one soon.

Well, she brought up some very good things. So I get asked a lot, like, what's my take rate with fat transfer, how often do I get fat necrosis, how often do I get sis in terms of take, which is, you know, you want to say how much you have over time. I'll qualify it like this. Between the ages of 20 to 30, you should be upwards of 80%. And I'll highlight why I say that. So fat works really well in premenopausal women. So take for instance one of my holistic mommy makeover patients. They don't want a tummy tuck, they don't want breast implants. They just want me to do body contouring to give them the best shape. They want to go from a four to a two and they want their breast size to improve. And fat is a very good tool, very good filler, and you can get really nice results. But you have to have the protective effect from estrogen and you have to counsel them on their diet and they have to have hopefully a lifestyle that they don't smoke and drink and have other issues that make it complicated for them to take care of themselves. Because all those things, you can have wonderful surgeons and nurses and anesthesia and everybody can take really good care of you. But you mentioned before, you have to take responsibility in the maintaining their results. Now, when you get into the 30s and 40s, depending on, have you had children, have you had some other disruption in your endocrine system, have you developed food sensitivities, do you have leaky gut? I mean, there's a host of problems that seem to develop quite quickly in the, we'll just say the 30s, and you can get yourself into a little bit of a pickle with those if you don't look carefully. And I will say that, you know, people don't like you looking and asking them about these things. Most of the time they find it to be a little Intrusive. But I basically lay it out, like, if you want this procedure, this is why I asked these questions, to get these results, which I feel are better than most. And so I think if you can get good results in cancer patients who basically have their estrogen blocked, which I did over a long career, and taking care of cancer patients, I think in the healthy patient, you better dot your I's and cross your T's and make sure everything's checked off so that when you do that, you're giving that woman the best opportunity to have the result. Like when people say fat transfers don't work, I just kind of say, really? Have you ever seen anybody's Brazilian butt lift? Now, I will say in the breast, it's under a lot more influence of estrogen. That is your butt, but's different your butt. You can put a large amount of volume in, and it seemingly does very well.

What you said is profound. I don't know that many doctors and women getting fat transfer have connected estrogen with the breasts. Because I know, like, some women who are like, I'm eating lots of protein, I'm eating lots of fat, because a lot of times they're told to eat a really high fat, healthy fat, but they're doing, like, the fat bombs, or it's coconut oil and almond butter and all of these things to really try to up their fat so that they. Their fat keeps after their fat transfer. But if their hormones haven't been addressed, that is why, like, that's making so much sense to me, because I am on these fat transfer boards, and they're like, I did all the things I ate exactly what they said, but I feel like they went down a lot. That makes so much sense that it would be an estrogen issue.

And I want to say it's not just one thing. Maybe they did eat everything. Right. Maybe their hormones were close, but not quite right.

Right.

We know providers who don't like the fact that I balance hormones as a plastic surgeon. But that's okay. I mean, my entire career has been taking care of really severely injured burn patients or cancer patients. And I can tell you for a fact, there's plenty of studies that show that wound healing is improved when anabolic steroids are used, of which testosterone is one of them. So when folks want to get on me about that, that's fine. I have broad shoulders. It's okay. If you take care of people long enough and recognize the patterns. I understand your endocrine system as a female is very complicated, as you know. And the Better position that system is in, the more comfortable I feel that you're going to have a good outcome.

Right. And I know many women, me included that when your body is in an inflammatory response and state for so long that eventually for me it turned into Hashimoto's and for many women it does as well. Luckily I've been able to balance that. I don't struggle with the Hashi very much anymore at all. I'm not cold all the time. Also all of the other things that I had just not only from my implants but that were thyroid related along the way that no one ever connected for me.

Moving forward, what do you think is the next step for you in this journey?

Well, I'm supposed to get did pay a lot of money for my failed VAT transfer. So I'm working with a different surgeon that is taking over and I is going to help me out. But I'm only doing a very small amount. Like we're doing like 100cc's we're just filling in. It's almost like a fat transfer to the face because we're just doing like a couple areas that have dents. I do not want to mess with the area anymore. I've accepted where I'm at. So it's just so that I can wear V necks basically. We're not trying to do anything other than fix an indent essentially. So I'm fine with that. I would be more concerned about trying to put in that again. I think that unless I was to come to you, I don't think I want to go through that again. And as you know I'm a difficult case so and just focusing on other aspects of my health and you know, I love to work out and fitness and my body is important to me. So I'm very excited about all of the different holistic, non invasive devices and things that you offer. So at some point I'll probably. I did have three children and I gained £75 with my first. So while I work on abs I still have loose skin and you know, the arms have gotten looser and then where I had fat removed from my legs, you know, there was no skin tightening done with that. And just that at my age all of the skin laxity things become and I don't focus too much on that. It is kind of part of my job to some extent. And because I'm able to play younger I like to be able to act in those roles as long as possible. And everyone in Hollywood does it. They just don't admit to it. So I have no problem sharing those secrets with women as I'm able to do them.

Yeah, I think Candice highlights something that, you know, she's done a lot of internal healing and she feels very good and comfortable. And I really appreciate her actually discussing everything. It's not easy to come on a show and discuss things, but these are the realities that happen over time. And no one's ever walked into my office and asked me to make their skin looser or give them fat. It's always make my skin tighter and better in appearance and reduce fat in these areas I don't like. So our focus has been to develop a completely non invasive and minimally invasive line of treatments to that end and use the best products. And I feel comfortable both in how we address skin tightening in a non invasive way, minimally invasive way, and then, of course, surgically. But I would say that the way we do it is going to be different, Much in the same way I approach an explant patient with all the effort spent basically on the five ways we take care of an explant patient, with food sensitivity testing, an entire blood panel, and hormone balancing and toxicity testing, and looking carefully at the gut, microbiome and genetics. When we look at skin tightening, your genetics dictate a lot of this. So there are genes, the Fox3 aging gene, which has been studied extensively. Now I can do your genetic testing and unfortunately tell you if you're more prone to wrinkles or not, and will you lose your hair or not, and would you benefit from these supplements to help you methylate better or detox better. So genetics always play a role. But to be insightful and, you know, understand when you come in, I've spent a lot of time over my career taking care of patients and developing plans and proprietary treatments. But really, I think probably the strong suit is combining and not being afraid to combine things to get the best results. So whether it's a skin tightening treatment, I'll just let you know when you go. Whether you go to me or someone else in Beverly Hills or anywhere in the New York or for that matter, anywhere in the world, there's always a limitation with, with a single modality. So if someone says, I'm going to use this device and it's going to heat this up and it's going to cause this result, you're not 20 and you're not 30. Things like that work extremely well in that age group. Why? Because their collagen level is so much higher and the elastin level is so much Higher Elastin is what gives you a snap in your skin. That's what retracts. The skin collagen level goes down after the age of, we'll say 34, and it's on its way down, sometimes earlier. But that's what leads to the appearance change and laxity and aging. So the ways we combat that are. And I get asked every day, Dr. Whitfield, can I take this collagen supplement or can I drink this collagen supplement? Candace, you can eat and drink collagen all day long. I don't know if your gut can absorb enough collagen to make an impact. What I do know is in my very large number of years of experience is if you poke a little hole in skin, it always heals unless you're dead. So if your skin tightens from healing, which it always will, that's called the basically wound healing or injury hypothesis. I know that if I use this modality, coupled with this modality, coupled with this modality, no matter where I use it, it always works. And the products I use always work because they're studied with those types of modalities to stimulate more collagen synthesis. So for everybody, the take home message is if you want your skin tighter, you use things to promote collagen synthesis in the skin. And I'm not here to disparage vital proteins or anything that Jennifer Aniston is getting paid to pedal. But I can't tell you how well you'll do with that. And my wife is no different. She's like, I drink this, I want to drink this, it will help me. I'm like, I love her to death, but I don't know how much she'll absorb. I mean, on a whole, collagen is a very big model. But I know microneedling works, I know radio frequency skin tightening works. I know the things I do with liposculpture work. I also have a great cellulite treatment that it's not one tool. I'm not going to name any products that have been out in the past that say they will get rid of it or a current injectable product. I'm not going to name either. But I have a way to do it with energy based technology and microneedling and product. And you can tighten the areas all over the body and make them look more youthful in appearance.

I've seen your cellulite work is just absolutely incredible and even look like it seemed to help with stretch marks, which I've not seen anything help with stretch marks. Ever. And it's generally because they're just doing one thing, which is very interesting that you're talking about combining all of these.

Different things since you brought up a stretch mark. So everybody needs to know what a stretch mark is, since we've gone down the rabbit hole. A stretch mark is a tear in the dermis, which I mentioned earlier. The top layer of the skin is dead, that just prevents you from basically evaporating. The middle layer is the dermis. And so when that tears from rapid growth, which happens to women in puberty, basically by the time they get to 8th grade sometimes they've already grown to their maximal extent from the at the waist, we'll say. And that's why women get exceedingly tall very quickly versus the boys of the same age. They'll get rapid expansion which will cause stretch marks in the hip, thigh, buttock area. And then if they go on to have children similarly, they can have further stretch marks, but they still have that area around their hip, thigh, buttock region that leads to laxity and appearance changes that are unwanted. And that's where I've concentrated a lot of work to both help, you know, my cosmetic patients and every patient of mine is a cosmetic patient. Because I did their explant doesn't mean they can't have or get better appearing skin anywhere on their body. And those are ways to do it. And I combine things because I've learned over time it's very difficult to get a result in that setting with one particular modality. If you use for skin tightening, especially multi modality therapy and the appropriate products like I like elastin regenerating skin nectar because it's proprietary method of stimulating collagen synthesis. So most people don't even know elastin as a product because it can't compete with something like whatever l' Oreal or Revlon on a television network or any kind of ad platform because they don't have that kind of capital. But their chief medical officer is a plastic surgeon. When I decided on what line I would carry, principally in my office, I spoke to the plastic surgeon who runs their studies. They're all wound healing studies. So it all makes very good sense that it stimulates and increases collagen synthesis and helps heal a wound more rapidly. So basically like you described with, you had poor blood flow and the product you used helped increase blood flow. That's what all these things are. I would not say they're all masquerading about them, but the majority of them offer very little in that right before we wrap up today. Don't forget to head over to thedrrobsolutions.com and pick up the Inflammation Support bundle. I've put this bundle together after working with thousands of women with breast implant illness who wanted explant surgery. Reducing inflammation is always the first step we take. Now I'm offering the same solution to you, so go to Drrobsolutions.com and get yours today. 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 Solutions today@drrobssolutions.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 Sa.