Episode 61: Can Breast Implants Be Removed Safely?

Foreign 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. It's Dr. Robert Whitfield. Thanks for joining me for another episode of my breast implant illness podcast. Today we're going to talk about can breast implants be removed safely? So I get asked about this routinely because I have patients both see me obviously for initial consultation, whether in person or via discovery session remotely. But on second opinion, that's I'll talk about this more. I get asked all the time, you know, is this really safe? Because they've went to a different surgeon who says it's unsafe to remove the capsule. There can be complications, including injury to surrounding structures, you know, especially the lung. And so I think we need to debunk this. I've been on several summits and spoke about this, but this procedure is entirely safe to do. And so we'll say you should have a skin site infection or an infection at your incision less than 1% of the time. And for clarification, I stopped using drains a couple of years ago. And in that time of just an explant with no drains, no other procedure to perform, I've had one infection in a couple of years, so that's well below obviously 1% because that's basically 1 in 100. And when it comes to injuries to the lung or something of that nature, I've done over 1150 explants at this point and I've had a handful of instances. So we'll say five instances in those over 1150 at this point where there's been a entrance into the chest cavity. So it's different than injuring the lung because you're not injuring the lung, you're creating a opening in the chest cavity underneath basically where the intercostal muscle is, because you can't go through the actual rib, you have to go between the ribs where the intercostal muscle is. And it's, it's not that it's an injury to the lung. And so that's a misinterpretation of that. You're violating the space where the lung is being held. So if you do that, you close it by evacuating the air and creating a seal or you put in a small catheter to get the air out through a one way valve called a Heimlich valve. And the patient would need to be followed up with chest X ray, typically that day and for subsequent days after, make sure the lung stays up, which it will. You haven't hurt the lung, you just introduced a small amount of air in a space around the lung and that makes it partially collapse. So that's really the big issue like a lung injury. Is that going to happen? So that's super uncommon in my experience and folks who do reconstruction for a living in general. I did that for the majority of my career really taking care of cancer patients with breast cancer, head neck cancer and sarcomas to rare tumors of the muscle and bone and fat. But when I would do breast cancer reconstruction using the dip free flap, we were constantly removing rib cartilage and looking at the space where the lung is contained without violating that space. And then I did that, you know, over 1500 times without a problem. So, you know, when people say, you know, this is not a safe procedure, that's not accurate. We'll launch a training program to really help train surgeons to do explants. It's not something that should be worried about from a surgical perspective with appropriate knowledge and just using technique and instruments, I believe it's totally safe. The kind of, if you want to say, newness of the procedure from an aesthetic standpoint is potentially an issue. It was much easier for me to transition to, to doing explants as a reconstructive plastic surgeon for majority of my career because I predominantly did, as I mentioned, cancer reconstruction. And I was looking at these tissues and working in this area all the time doing, you know, complete capsulectomies and reviewing entire implants with materials intact. And so this was not a unusual addition for me. I was already doing this and I'll, I'll just kind of lay out how I look at this and as a surgical plan for me. So if I have a patient who comes in, has a lot of symptoms of BII first, we don't plan the surgery for them more than we plan how to just really care for them both pre op during the case, provided we do that, and then afterwards. And so that starts with my heart program. Let's accelerated recovery for explant. And really what it boils down to is identifying as many of the root causes of inflammation as possible and diminishing those around the time of surgery, as well as balancing out hormones, improving your diet, just looking at whether it's inflammation or toxicity factors, coupled to your pre existing, you know, genetics, that really sets you up for success. And once we identify and decrease causes of inflammation, you know, system wise, you start doing, you know, much better, your liver will function better. So things that really affect explant patients, you know, types and durations of anesthesia. Some people don't do well with general anesthesia, and that's mainly because their detoxification pathways in their body aren't functioning at a level that they need to. Some of that can be genetic predisposition. But much of the time they're dealing with so much inflammation, either from their diets, their environments, or from obviously in this case, we're talking about implants that it's really hard for them to recover. So I try to get people in really a better position preoperatively to undergo this procedure or any procedure I do for that matter. You know, once we've got that organized and we've evaluated your labs, we would make dietary recommendations. We have a nutritionist in our office and a couple team members who've had explants and breast implant illness. So they're very familiar with both the diet, lifestyle and supplement modifications. You need to get this done in a way that's going to put you in the best position for success. So we'll have organized the majority of that beforehand, as many things as we can modify for you to improve the way you feel and decrease your inflammation so that you feel better prior to surgery. We want to do that. Are you on a journey to healing and wellness but feeling overwhelmed and unsure of where to turn? Look no further than Dr. Rob's Solutions. At Dr. Rob's Solutions, we understand the unique challenges that come with breast implant illness, which is why we offer a wide range of the highest grade supplements, medical grade skin care and lab testing and harp options to aid in your journey to recovery. Our supplements are specially formulated to support detoxification and aid in the healing process. While our medical grade skin care products are designed to nourish and protect the skin, we also offer a comprehensive lab testing to help identify any underlying health issues that may be contributing to your symptoms. And for those who are ready for explant surgery, we offer harp options as well. Don't let the uncertainty and confusion of breast Implant illness hold you back any longer. Trust the experts at Dr. Rob Solutions to provide you with the resources and support you need to take control of your health and wellness. Visit our website today to learn more and to order your products. Take the first step towards healing and wellness with Dr. Rob solutions@doctorrobsolutions.my shopify.com I do these cases predominantly under general anesthesia because predominantly I'm doing a complete removal of the the material intact. It's referred to as en bloc. It's just a pathology term. But I'm trying to remove everything intact. I've had two patients have cancer, one had a, a lymphoma and one had a breast cancer. So I don't take these procedures lightly. Want to make sure everything's taken care of properly so that at the end of the timeframe of recovery, there's not a concern. Is there any, you know, retained materials? I do have a lot of patients referred to me that have retained capsule who still have symptoms. So we want to make sure that's not going to be an issue. The incisions predominantly, if we're just doing an explant, we'll use the incision that was used for the placement. The only instance where I can't do this is an axillary approach. I cannot remove the capsule and the implant intact through an axillary approach. It has to be either imf, which is under the fold, or periareolar, which is around the areolar complex and nipple. But that has to be for a smaller device. Everybody's heard of Danica Patrick having her explant done. Colleague of mine did that in Arizona. Use perioral approach. I've done that as well. Works well for smaller implants. And then, you know, I get asked, oh, how long is it going to take? On average, you know, it's a couple hours. Two and a half hours is typically what we'll book for an explant. And if we're doing lifts or fat transfers, obviously we add more time for that. I do a lot of simultaneous fat transfers for patients who we've modified their inflammation and put them into a position to really have optimized their results for fat transfers. Fat transfers work great. I think the things that you really have to understand are you have to have your patient optimized liver and kidney function, hormones, great balance in their diet. Diet has to be on point, right? We want to make sure that we set the patients up for success. And by modifying, you know, diets and lifestyles, decreasing stressors, you know, Putting people in more of a parasympathetic state, decreasing their cortisol modifying, you know, what could be an estrogen dominant situation into reducing that with supplementation in a holistic way. Really set you up to have a great result with fat graft. Fat grafting is the original filler. And, you know, when we do the fat transfer, whether it's breast or buttocks on younger patients, works extremely well. The thing for the breast explant situation is, you know, we're taking a lot of volume out at one time. So I'm estimating how much I can put in. I'm evaluating the space as I do the transfer. And you can fill the space between the skin and the breast because that's the fatty layer with only a certain amount of fat, you can't keep adding fat to it. So if you do that and respect, you know, how much skin stretch there is, you'll have a very, very low fat necrosis rate, which is what everybody's worried about. It will not change the appearance of mammograms because it's in the fatty layer. It's not putting it in the breast so it doesn't cause mammographic abnormalities. This has been done in breast cancer reconstruction for decades. I've done over 1500 fat transfers just for cancer alone, and several hundred more obviously in this setting. So I'm very comfortable performing those. And that thereby transitioned us to like, what are the next steps if someone's unhappy with their aesthetics, which can happen. And so you can have a looser skin envelope, you can have even asymmetry, because maybe you got implants obviously to take care of an asymmetry. So by augmenting the breast, you're masking asymmetry. So when we, you know, do an explant, we're identifying these areas that were treated initially for that purpose. And I usually will go back to, and lean on fat transfer to help with that. You can always do different skin lifts. If you have enough breast tissue, you can modify that typically with a vertical lift, which gives you the lollipop scar, because that allows you to reshape the bottom of the breast. I don't preferentially like using, and I don't use anchor scars or wise patterns because it flattens the bottom of the breast. And so if you had a preexisting incision underneath the bottom of the breast, I wouldn't actually use that in a vertical and make that a T because that it changes the shape in a manner that I don't want. I want a nice shape for the bottom of the breast. I don't want flattened at all by a horizontal scar. So these are all things I take into consideration when I'm helping both discuss options and try to get patients feedback about aesthetics so that we can come to a conclusion that gives them the best possible situation for both the obviously healing journey after explant, but the esthetics, which are super important from an emotional and physical standpoint for them. And so, you know, I think it's important to find a provider who recognizes breast implant illness as a real entity, has a plan to support you both before, during and after surgery. If you can't find that, but are comfortable with them as a provider performing your explant, you can always reach out to us. We run a remote program with HARP so patients can take advantage of our experience with our Holistic Accelerated Recovery Program, and we'll do everything we can to support folks on their breast explant journey. 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 youm'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.my shopify.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.