Robert Whitfield MD explains what the implant 'capsule' is (scar tissue the body forms around any implanted device), the timeline of its formation, and common symptoms from thickening/scarring (pain, firmness, nerve symptoms). He describes patient anecdotes and his FDA testimony in March 2019, summarizes research showing bacterial contamination and cancer associations in capsules, and argues strongly that complete capsulectomy (removal of the capsule) should be performed at explant because capsules can harbor bacteria and, rarely, malignancy. He cites a prior paper reporting 48% contamination and his own submitted study (~700 samples) reporting a 29% contamination rate.
Questions this video answers
March 2019.
48%.
29%.
About 700 samples.
Chapters
All right, welcome to this episode of the Drive to X Plan. Today I've got a very interesting topic to take capsule out or not take capsule out. And all of the, you know, technical aspects around it get debated a lot. It's obviously I get a lot of direct messages from everyone asking, is this necessary? And then so let's just talk about what is the capsule. So an implant of any type can be placed. Hip, knee, breast, dental, neurologic stimulator, cardiac defibrillator, they'll all form a capsule around them. That is your body's natural reaction. It forms scar tissue around any foreign body. First and foremost, everybody has one. Now think of sheets of paper, think of like magazine pages. So everybody will have a different thickness of capsule. There are a variety of factors that affect, that don't need to go into them. So everybody has that. When we are, you know, going, going through the process after augmentation, typically patients have swelling, especially if it's placed behind the muscle. It takes weeks to months to completely resolve. Sometimes, sometimes implants are sitting really high and that's very concerning to patients. That's usually the pectoralis major. The muscle is really holding it up due to swelling. So many times patients would benefit a large amount from muscle relaxation and then the implant can drop. One of the things that can be done too is a post operative bra that has a strap that helps keep them from rising as high. So this capsule, which is developing as soon as you place an implant, happens within 24 hours. Actually it can be thicker, thin, it can cause all sorts of other symptoms depending on the width of the implant. The width of the implant dictates a lot of this because a big wide implant on a small person will actually potentially irritate tissues and nerves that are not on the chest, but more on the side. Think of more. We call it the serratus anterior area. But now you're going to more of the armpit and affectionately, it's called the side boob. End up slaying. So we don't ever want to create that. And so many, many, many years ago when I was doing breast augmentation and when I was doing breast reconstruction, we would work diligently to keep the breast implants out of the armpit. So it didn't create that effect. That area can develop a lot of scarring and nerves can be irritating and people can feel a lot of sometimes pulling, sometimes aching, sometimes throbbing, burning. I've even had people report like a deep itching pain. Those things are usually to me from scarring and Irritation of the nerves in that area. So I actually had a patient who was working out one time and ripped their capsule and irritated that nerve and had really depleted, debilitating, really bad nerve pain. Nerve pain will usually wake you up at night. Nerve pain is more like an electrical shock or tingling or pins and needles. And if it gets bad, it can be unrelenting. Obviously, capsules can become firm and hard. If anybody's ever seen any of my videos, one of my videos that's on TikTok has 4 million views or something. They really calcified scar capsule. And that's just a reaction of the body to whatever the device is. The, the surfaces of devices, if they break down, if they leak, if they're super irritating, people can get more of a response. So those can get really hard and thick and firm and all that. So why does this matter? Okay, so back in 2019, if you Google me, you find my FDA testimony in March of 2019, and I stood behind a lady in line and she got up and gave testimony how she had had explant surgery and they had left her capsule on her chest wall and it had anaplastic large cell lymphoma. So I'm following this patient's testimony and I'm listening and I'm wondering, why on ear would that happen? Because it's not that difficult to remove capsule, mind you. My whole background's in oncology, reconstruction and cancer care and microsurgery and things that most people who operate for a living in plastic surgery would never do, never have the skill or expertise to do. So I heard this woman's testimony and I had already been explaining people for a long period of time, since 2016 actually. And so when I heard this in 2019, I'm like, well, that was all avoidable. So when I got up behind her, if you want to Google and hear my testimony, I say, as the president elect of the Aesthetic Research Foundation, I will make sure that we do research, one, to understand this process better, but two, to avoid situations like hers. Now, my sister recently died of breast cancer recurrence. And I would have been really irritated and upset if someone had done a surgery like that for my sister. So cancer is obviously a problem with either there's breast implant associated lymphomas, the breast implant associated squamous cell carcinomas now, and I've had a breast implant associated B cell lymphoma, which the folks it didn't really want to talk about. So cancer aside, like, why else would we take capsule out? Well, in A paper published by the research done based on my testimony, how I said I would get, you know, more research put forth. A group submitted a grant, and they showed in the paper that was ultimately published that 48% of the patients had a bacterial contaminant. 48%. Okay, if that doesn't shock you, I don't know what will. So I know that number was too high because my personal experience was much different. So we recently submitted for publication my paper with 700 samples approximately, and the rate is 29. Okay, so if we say, you know, there's a certain percentage, albeit very low, that have cancer, and then there is a percentage, we'll say 29% in my paper that have a bacterial contaminant, and in some people that may be an infection, but it doesn't have the signs and symptoms of the standard infection with redness of the breast or a fever or something like that. Okay, so now we're almost up to a third who could have a really bad problem. So why would we leave the capsule where that is? Because the capsule up against the implant is where these problems are. It's been shown in multiple studies, including mine. So why would we leave the capsule? Why would we say that part taking part of the capsule is. Okay, so I guess to me that doesn't make sense. And there's not really a way to make sense when all the literature supports the capsule having the contaminant or the cancer. So many of you follow me on Instagram and other platforms and you'll see a patient of mine, Tiffany Blackman, who I found her breast cancer, and I found a deep breast cancer in here, and I took it out. Now, it wasn't inside the capsule. It was outside the capsule. And it wasn't a lymphoma. It was a breast cancer. So let's be perfectly clear, like, this is not a game where you're parsing out whether or not you should do something. So it's my strong feeling that if you're going to do this procedure safely and effectively, you should be taking the capsule out, because that can harbor bacteria. I have a lot of patients who come to me with remission, remaining symptoms. And based on what I've just said, you would understand that if they didn't have their capsule removed, they could still have symptoms. So anybody can make an incision and pull an implant out in their office under local or with sedation, but that's not the same as doing a capsulectomy. And I'm not sitting here, and I'm not going to argue about techniques and slaying used to describe how the capsule is removed, because that ultimately is not the point of this discussion. So I think everybody wants to follow the science and they throw that up at me all the time. So I've done thousands of these. Very comfortable with doing them, very comfortable with doing and removing all of the capsule because of the findings and the science. So let's just try to do the right thing for the patients.
