Recovery Following Breast Implant Removal [Part 2]
A podcast episode by Dr. Robert Whitfield describing recovery after breast implant removal (explant). He explains that symptom improvement can be immediate if infection was present but often unfolds over months; he uses a 3-month window to assess recovery and evaluates at 6–12 months for outcomes. He discusses the importance of complete capsule excision to avoid persistent inflammation or spread of biofilm, the role of hormone optimization (including plant-based bioidentical pellets and attention to estrogen/testosterone balance) for healing and maintaining results, and the use of autologous fat transfer (placed between skin and breast tissue) as a natural filler — noting equipment (Wells Johnson machine), experience (≈150 transfers/year), and typical benign complications. He advises waiting 3–6 months before routine mammography after explant (6 months to be safe) and states fat transfer does not preclude breast cancer screening.
Welcome to the holistic and scientific podcast with board Certified plastic surgeon Dr. Robert Whitfield, Austin's natural choice for plastic surgery and the expert in smart laser and energy treatments.
Today we're talking about what happens just after explant surgery or breast implant removal surgery. What I would like to do and set up an expectation for patients is if, say for instance, you had a severely infected implant and I took it out, you may in fact within a few days feel super because I took out an infection. But in reality I find it's far more complicated. Just a discussion with a patient last night describing to me just, she came to me, she had an explant and then was told afterwards that it was incompletely excised the capsule. And so it's always a disheartening situation because the patient still had the same symptoms but better, if you follow. So brain fog was better, energy level was better. Maybe about a month or two afterwards she got kind of a rebound effect and went back to feeling poorly. And that's when she sought us out and wanted to get a second opinion. So I talked to her at length and I said, well, in my experience this can be a real stimulating environment if you leave capsule behind. I think the fallacy is one, your capsule doesn't resorb over time. I was taught that that doesn't happen, especially if it's a thickened capsule. If in fact you had biofilm at the time and it was incompletely excised, you've just now spread the biofilm all over the place and into the breast. She had significant pectoralis major pain, the big muscle of the chest because a wall of it was stuck up and under the muscle. I took all that out, did all the testing. There was still inflammation in the tissues. On our pathology report, no cancer. So from a long term health standpoint, very good. And I could not find additional evidence of biofilm. And I spoke to her recently about her genetic testing, which we've done, and she asked Me, you know, Dr. Whitfield, when am I going to feel completely better? And my answer is always that. How long did you have the problem if you had implants? 10 years. I can't solve that problem in an hour in the operating room. I can do your surgery. I can put you on the correct path to get better and help your body heal itself. And I like to use the three month window to really evaluate how well someone is doing because at a week, obviously just had surgery. At a month people are better, but invariably you have to get back to life. And in reality, most of us do too much. We try to do too much after we have something as complicated as a surgery like this. Now we have this great device to help enhance lymphatic drainage. In addition to our wonderful therapist who I'm overworking, but nonetheless, we found more ways to help you recover once again, trying to make bigger difference as quickly as possible for you in recovery. So when you get to that three month window, you're really, really seeing change. And then at six months and nine months and 12 months, I'm really looking at how much response did we get in the tissues say if we didn't do a fat transfer? Are the aesthetics where we want them? Is everybody comfortable if they're not? And I've had this happen before, there's a lot of psychosocial issues. There's a lot of like almost body shaming that goes on in this, this timeframe where they're upset, they got this, made this choice, they feel guilty over it, they wish they could have done it naturally. And because I do a lot of natural transformations, they're like, I didn't know about this option. I didn't understand the fat transfer was an option for me. If I could have had that, maybe could I avoid this? So there's a lot of that. As we get older, we typically don't get thinner. Our metabolism slows down and women, they're becoming postmenopausal. So hormones change and we look at all these things and optimize the position. Because to do fat transfers effectively, I think you got to have a lot of things in proper perspective, like your diet has to be high enough in the appropriate macros so that you can maintain a result. I don't want somebody going to have a fat transfer and then magically the next week going on some strange low carb diet that doesn't help take care of the result. Having your hormones balanced is a really critical component to both recovery and further treatment with like a fat transfer. And so I, I explained this to women and routinely I, I'm asked, you know, why? And, and estrogen's been bastardized because of breast cancer. So obviously everybody's concerned when I say, you know, we gotta evaluate your estrogen, progesterone, testosterone, and we gotta have it at a certain level. And because of that associated with breast cancer, everybody's very concerned, obviously. So we check all the levels and I tell them what I would do. And so part of my commitment to balancing hormones is making sure the testosterone level is high enough. And I typically won't give back, or if I do give back, it's a very small amount of estrogen. The point being, you need some estrogen to help maintain this result. You need a certain amount of testosterone to help you from a energy perspective, cognitive perspective, libido, hair growth. You do need these things. And I see them often just overlooked by other practitioners. And they're a critical component to both day to day wellness. But when I'm doing these complicated reconstructive type procedures or aesthetic procedures where I really have to have everything in balance, it's necessary to look at that. And if, if need be, I treat that. And I use bioidentical hormone pellets that are all plant based. So once again, we're trying to stay as holistic as possible in our approach. And I did this case yesterday, and she has a great result. So she's got body contouring, so her waist is more narrow, her shape is better. Just think of it as when you reduce someone's breast size, why wouldn't you reduce their dress size? Because then the appearance change, it becomes a beautiful transformation, not a, wow, this is really devastating. So if I make you smaller from top down, because I just had to take out the implant and I provide some of that volume back with the fat transfer, that's a beautiful transformation. And I think a really big example is a client of mine I had the other day. She's very happy with her result. And obviously I see people in their most vulnerable all the time, but she was so happy with her result. She put on her bra and had everything organized. Look how great I look now. It was so important to her because she was so worried about appearance for herself and for her husband. And it's a big, obviously a big leap of faith to trust me, but I'm very committed to provide the best, not just programming for this to get you better from a health standpoint. But it's very important that we get the appearance and the physical change the best we can for you so that you feel the best. And when you're in clothing, you, you, you look and feel like you're confident. I mean, what's the point? You did this maybe in the beginning because you had a confidence issue. And so on the back end, now it's looking like God, why'd I do this? It's caused me all these problems. And so I've adapted what we've done for years for cancer patients to help these cosmetic situations really not be the biggest problem. And so once again, I'll reiterate, fat it's really the most flexible, best natural filler we have available in the right hands. Done properly, it's, it's going to give you a great result. It just does. So that was a good moment. I, I don't spend and you can't spend time as a surgeon patting yourself on the back, but that was a very like, wonderful moment for us to have and share with our client. Just to pick up on our discussion about what to expect afterwards. I get asked routinely, when can I have a mammogram? When is it safe? Typically if I'm doing just an explant, we'll give that a 3, 6 month window based on how you're feeling. We don't want to disturb the recovery process of the tissues. If you want to be safe, I would say six months. If there's ever a concern, obviously we get that done sooner and they can obviously use ultrasound or MRI in addition. And then if I'm doing a fat transfer, there's a great deal of concern due to breast cancer screening. Is this going to create a problem with my mammogram? And so my answer is wholeheartedly no. This was studied extensively and has been done in breast cancer patients for decades. We need to stop with the Google research and the Facebook group research and just science has already evaluated this. The fat is put between the skin of the breast and above the breast tissue. That's where the fatty plane in every breast is. It's different in everybody, but that's where it goes. We don't stick it inside the breast because that would make cysts. Now, of course, little bits of fat could not survive the transfer process. They could become slightly firm. You could even get a little oil cyst. These are also not complicated issues. If you speak to your practitioner and their experience in understanding this. Having done over 150 fat transfers per year for breast cancer patients for well over a decade, I've seen all those problems. Taking care of all those problems. Many things have to do with the experience of the practitioner and how they're providing the fat transfer. We use the best available equipment. We have a Wells Johnson fat transfer machine. Please visit my Instagram. My social media has made tons of videos about our use of this device and how it gently, after we remove the fat, process it and place it back in, in the appropriate place for you. So much like I wrote the safety transfer paper for buttock augmentation. One of them, I'm sorry, not the paper, but one of them many years ago. Like one where to put fat for the buttock that belongs where the fat is. So don't point liposuction cannulas or a re injection needle in the wrong position. Keep it in the correct plane, which in this instance is below the skin and above the breast tissue and fill it. And if it's a buttocks, then we keep it above the buttocks muscle and in the fat plane and we fill it. This is not rocket science, it's fat transfer. So if the provider you're communicating with is uncomfortable or inexperienced, then please just contact us. I'm happy to speak with you about this. It's not a complicated process. When done, even do fat transfers in my office under local. So I mean to summarize, fat transfers are very safe with limited problems afterwards and they provide an enhanced a way to give a very beautiful holistic transformation after an explant or in the case of a holistic mommy makeover. On our next episode we'll explore the similarities between mold Lyme disease and breast implant illness. I'll try to clarify and help you understand these mysterious conditions.
Dr. Robert Whitfield is a board certified plastic surgeon located in Austin, Texas near 360 and Walsh Tarleton in Westlake. To learn more, go to DrRobertsWitfield.com or follow Dr. Rob on Instagram @DoctorRobert Whitfield. Links to learn more about Dr. Rob's smart procedures and anything else mentioned on today's show are available in the Show Notes. The Holistic and Scientific Podcast is a production of the Axis T H E A X I S dot IO.
