Ozempic, GLP-1 agonists & explant surgery for breast implant illness with Dr. Robert Whitfield

This is about why I don't want my patients taking GLP1 agonists. So I'm Dr. Whitfield, I'm a board certified plastic surgeon, breast implant illness expert in Austin, Texas. And you know, I get asked this routinely, are GLP1 semaglutide wegovy mungaro acceptable prior to surgery. So when you're coming to have plastic surgery with us in Austin, an explant procedure with lift or with a fat transfer or just explant alone, we can't have you on a medication like semaglutide Mongol or wegovy because these medications actually change behavior. So they modify behavior in a way that one you don't feel like sometimes you want to eat. It has a physiologic consequence in terms of delaying gastric emptying and some other consequences beside that. So for instance, I'm going to the surgery center today. I had patients in town yesterday. We did some of their pre op finishing touches yesterday, had discussions around, you know, what we expect postoperatively, so in order for any of our patients to really go smoothly through the process that need to be able to eat and drink properly after surgery. And many patients kind of struggle on a western diet to get in a protein intake in the first place. So in simplest terms for us, we try to get folks at least doing a gram per pound of body weight in protein a day. So if you weigh, you know, 110 pounds, that's 110 grams. And that, you know, why do we make it that way? One, it's easy for everybody to remember and if you're achieving that much, then I have really no doubt you'll be able to recover. It does come with a little bit more of a challenge in terms of digestion. So taking things in terms of digestive enzymes that have more proteases in them is part of what helps patients in terms of recovery, helping them eliminate. So, you know, taking things to keep their bowels moving will help. And we don't start this the day after recovery. So from the time I begin working with patients, we upregulate how much protein we want in their diet, which is not dissimilar to what you should be doing. If you're taking ozempic wegovy mungaro, you do want a higher protein content in your diet. There's been a lot of pressure, a lot of media around muscle loss. And so we don't want anybody from a practical standpoint losing percentages of muscle. And we can just tangentially go into that we don't want that because as you lose muscle mass, your relative risk of injuring yourself will go up. Right. As we get older and we become either less mobile or from a gait perspective, or unstable on our feet, we don't want to have lost any muscle mass. In fact, you want to build muscle. So I always encourage our patients at our timeline in recovery, using and lifting weight when appropriate, is the best form of exercise as well as walking. So back to glucagon, like peptide. So there's this interplay between glucagon and insulin. Glucagon raises blood sugar, insulin lowers it. So this, this peptide, whether it's Ozempic or Wegovy, it, you know, basically forces a limited amount of glucagon and it circulates for a longer period of time than your natural response. So that's really, you know, part of the secret and the way look at it long term. And I like thinking of this long term because I know these drugs work and they, they work. Honestly, the most difficult thing ever to get modified in medicine is behavior. So you may go to the doctor and they may tell you to adapt to certain lifestyle changes, make circum certain recommendations about what they call sleep hygiene. And if anybody's in my show before, you know, I talk about sleep quite a bit. And the nuances of sleep are very important. So you get enough rim and not REM and the depth and quality. And so you get enough cycles of sleep. But the nuances of modifying behavior so that people are not eating late at night, so that, that stops a certain binge behavior. So imagine how many times you may have been out or may have been hungry at, and you wouldn't have fast food. Or if you're at your home, you went to the kitchen and you got into the cabinets and you got something sweet or you got chips or some sort of snack. So now these drugs, Ozempic, Longora, Wegovy, they actually. That impulse is taken away, that drive to snack or binge or whatever you want to refer to it as. And some people, that's a really a genetic predisposition and they have no control over it. But now with these modification, these medicines that actually modify behavior, there is a level of control that's never been exhibited before. And so when I think of this, you think of, like I said, fast food. The amount of people who are not having fast food at night is going to decrease. So when you don't eat late at night, a lot of good things happen for you by not eating late at night. And certainly not eating junk food late at night. There's not going to be blood sugar spikes late at night. You're going to have longer time to digest your food, which will help physiology quite a bit. And so if you listen to me, I talk about something called heart rate variability quite a bit. One of the main drivers in decreasing heart rate variability is eating late. So just take something that simple, right? That's going to promote a better health for you, a better recovery for you, actually a better night's sleep for you because you're not apt to or now prone to snacking at night. The that's such a big, big change. Imagine all the people who had limited ability to fight off that urge and now for the first time ever, ever, they don't have that. So that kind of behavior modification is incredibly important in these current dosing patterns. Certainly you get some delayed gastric emptying, there can be difficulties with the pancreas. So you have to be mindful of that. But as a surgeon, when I said like we don't want you eating late, obviously the night before, that promotes better digestion. But for surgery, we don't want you eating late the night before surgery because you could come to surgery, have a full stomach and that puts you at higher risk when they're actually putting you off to sleep. So with those medications, I prefer that they have been stopped for at least three to six months. And in our practice, because we do so much work with fat, fat transfers, we're constantly trying to reshape the breast and we do a lot of body contouring, so doing a lot of fat removal and you know, predominantly it's for recontouring and reshaping and volumization of the breast. We don't want any other influences on the fat, how it's going to heal. So in those respects, people have to one want to be more at their ideal body weight if at all possible. But if they have been on a weight loss journey and then plan to go have an explant surgery, I really want them off that medication at least three to six months beforehand. So I know what is going on with them in their think of their physiology. So we know their body weight is stable, this is how they're eating and drinking. We can hone in on their dietary parameters that we want in terms of nutrition. We can look at all of their laboratory analysis and if they have nutrient deficiencies, help address those. We do always put our patients on inflammation support bundle through our line because it's been curated to not only support Immunity but I don't stop supplementation prior to surgery. I'm comfortable with level of antioxidants. So, so we have no problem performing surgery. The support of immunity as it relates to recovery is important. So I don't want to stop that. That should be running the entire time to help promote better recovery through better immune support. Then in addition post op there'll be det. And currently you know, we use a functional approach for detox using different supplementation through holistic supplements. So getting back to post op, we certainly don't want anyone on a GLP1 agonist post op because that will modify their behavior and they won't want to eat and we need them to eat to recover. So. So you know, having a protein shake is important, but that is not going to supplant having enough food in the diet. So food is medicine in this response to surgery as it is in every instance. What we get through our diet ends up being utilized by the gut. GLP1 predominantly is made in the gut lining. It has receptors all over the body and it's going to be shown to have wide ranging effects. More and more studies are coming out and it has this anti inflammatory effect which would make sense because it lowers glucose. But as I said before, like it's long term downstream side effects to me, like when I think long term or if you lower glucose and affect diabetes in a meaningful way, then a larger number of patients won't progress to what we call end stage renal disease and dialysis. If you're not progressing to that, then you're not going to progress to kidney failure and need a kidney transplant. So those patients who would have been relegated to dialysis and going there, you know, on a schedule like Monday, Wednesday, Friday or Tuesday, Thursday, Saturday, that won't be the case anymore. That will drop down the transplant rate for kidneys will drop. And then in addition, if there's obviously not as much end stage renal disease and if there's not as much end stage pancreatic disease, because frequently there was kidney pancreas transplantation performed and if there is less. Overall dysfunction in both the kidney and the pancreas. You know, when I think of those long term downstream consequences, the amount of severe end stage disease changes. Now I know Those medications are one, they're not new. GLP1s have been around for 15 years. This new round has gotten everybody's attention and there'll be more and more medications, you know, a simple come off patent. So then those are going to become medications that are chronically used for Weight management and how you deal with and approach obesity would be very different. It's very much going to be a tool now that, for instance, in bariatric surgery, you know, there will probably be a lot less bariatric surgery, but doubt that bariatric surgery will completely go away. Bariatric surgery has been done for decades. It was done in my training, it became, you know, more and more popular throughout the 90s and 2000s. And it would be. Ideal if someone didn't get to 6 or 700 pounds. The consequences on someone's body physiologically are that is so hard for them. So that can be. Decreased so that someone doesn't get to that point be truly amazing. So, yeah, I think the GLP1 agonists, they certainly are not going anywhere. They have all of these really significant upsides and I'm not down on them at all. They're, you know, so far, You know, I think no drug, like I said in the beginning, has ever modified behavior like this in such a positive way. And you know, I go back to all those things, you know, we talked about before, that help with recovery. So, you know, having a meal earlier and not craving and snacking at night, that will help recovery, promote better digestion. If you're making better food choices, then that's going to help as well. And helping support patients, you know, keeping weight off afterwards, that would be, you know, obviously the long term goal.