Simultaneous Fat Transfer with Explant Surgery

Take questions and hopefully be as helpful as possible. All right, we have a bunch of people hopping on already. That's great. Hi, everybody. Hi. Just a couple more minutes. We'll let everybody hop on. We just did this case we're going to talk about this morning, so it'll be fun. So the way we're going to set it up is I'm going to give a presentation about simultaneous pet transfers with explant surgery, which I did this morning. Then we'll take some questions regarding that. There's been quite a bit of kind of back and forth about this the last several weeks, so. All right. How we doing? Somebody ready? Okay. Hi, everyone. I'm Dr. Whitfield. Thanks for joining me live to watch. We're going to discuss simultaneous fat transfer and explant surgery. My poor practice in general is focused on breast implant removal, explant surgery, fat transfers, caring for patients with chronic inflammation from breast implants. So today I want to go through how I think about patient selections, optimization, and then execution of fat transfer simultaneously with explant surgery. And we're going to discuss, you know, what it is, why it can be deemed controversial, what it makes sense to me, and how we approach it differently than other practices. This is an important conversation because many women are considering explant surgery also concerned about how they're going to look afterwards, especially with the big changes in volume that can happen. And can a fat transfer be done and can be done safely at the same time? And, you know, the answer is different for each person. Each person is their own individual, their own biology, and the preparation, the surgical technique, and how they're prepared and recovered is very important. Fat transfers on a whole are not new. Surgeons have been using them for well over 100 years. In the early attempts of fat transfers, just because of a lack of understanding about how to handle the fat, the blood supply, the optimization of patients, and overall just understanding of graft survival. The cases didn't go as well as. As they could have. But over time, like many things, techniques evolved, both the removal of the fat, the processing of the fat, and then the placement has become more and more refined, and so the outcomes are more reliable. So that. And I've done presentations about this. You can go to my YouTube channel and find them. I have a YouTube channel just devoted to fat transfer, and then I have a larger YouTube channel with 2 million subscribers that discusses explants and has our podcast and all the fat transfer shows as well. But here's the key point. Fat transfers work best when the individual is Prepared properly. And that becomes even more important when we're combining explant surgery, which itself, especially my patients, they've come in with usually a fair amount of inflammation that's chronic, and we don't want them to have anything but the smoothest possible course. So some will say that you should not do a fat transfer at the time of explant, either due to toxicity concerns or the tissues themselves. But in general, I think of it as, you know, working with the patients to help with their inflammation and then properly prepare them. And if we can't get the patient prepared, then they're not going to be a candidate. And we can do it as a delayed procedure, but we want to, one, decrease their inflammation. And then when we transfer, have enough volume to transfer, place it in the correct space beneath the skin above the breast, and then do it in a really clear and concise manner. And if you approach the cases like that, I think that puts the best interest of the patients at hand. We don't approach expand surgery as just a expat procedure with no optimization or preparation for the patients. We actually are or careful or work up. Many patients come to me that the patient who I took care of this morning, who had a simultaneous fat transfer and explant actually came in from Canada, and they came in specifically for our programming that helps reduce inflammation, really get their immune system prepared for what can be not a longer or difficult case, but still each case is stressful to the patients. And I really, if I can get a patient properly prepared, I prefer to do simultaneous fat transfers. They make a lot more sense to me in the carefully selected patient. So I want to do it to help preserve breast shape and volume, really help reduce the big change that you see visually by explanting and then potentially avoid a second surgery. It can be very, very helpful emotionally for patient to have volume restored at the same time naturally. But the selection of the patient's critical. You know, if anybody has heard me discuss, you know, how I think about this, the number one thing in any recovery process is sleep. And I make a big deal about that plus the nutrition level. So we look at everybody's diets pre op, we put them on a higher protein, healthier fat diet, try to cut out bad carbs and gluten and dairy and things like that. We want to decrease their inflammation. So we look at how they genetically detox and then we look at a toxicity burden test. We want to help as much as we can reduce that toxic burden. We have specific protocols based on what we find we look at a get test knowing that that's just a Kodak moment in time. But if somebody's got a really, a specific set of problems in the gut, Candida overgrowth, H. Pylori, very potentially a parasitic problem, we want to help with that because that, that will allow them to eliminate waste more easily after surgery, become hopefully less constipated after surgery. And that, you know, having your liver and your gut work in concert, especially after surgery, is imperative to, you know, healing. In terms of what we do, we don't use drains for surgery at all. And, and we'll go into why I started that. I actually started it with fat transfer patients. So there's a lot that goes into the prep of our, our patients. We do look at hormone balance as well. I don't want to forget to mention that because, say, if you're really, really low in testosterone or really, really high in estrogen and low dhea, all those things, you can work on those with patients before they ever show up and get them feeling quite a bit better. Just with some simple tools, either simple supplementation, alterations in sleep pattern, alterations in diet and timing of when they eat, those can all be helpful to reduce inflammation, really help with some potentially metabolic problems they're experiencing. And that will all put the patient in a better position for fat transfer if in fact you deem them a candidate. Fat is a living tissue, so when you remove it, it has to heal into position. So always put it back in the place where it belongs with other fat. So I don't put it in the breast, and I don't put it in the breast pocket. So we just happen to have a implant here. And I covered it with a little towel to represent the capsule. So when we take all this out, we don't then put the fat back where we just took this out of. I think there's a, somewhat of a misperception about that. So the skin that covers the chest covers the fatty layer. So we put the fat in that layer. So it's beneath the skin above the breast tissue. It's not in the chest muscle. It's not in the old breast pocket. It is beneath the skin in the fatty layer above the breast, not in the breast. So the acquisition of the fat, the processing of the fat and the placement of the fat back is actually relatively straightforward. We are trying to be gentle with acquisition and processing always and then placement back. We don't just see patients and schedule them for fat transfers. Like I said, we work them up preoperatively. We, we want to reduce their systemic inflammation, really try to get them feeling better, optimize their nutritional status whenever we can. I'm a big proponent of higher protein intake. I don't think in general, we get enough protein in our diets. And then once, once again, I mentioned sleep. If you can't sleep, you can't recover. So it's a misnomer to think you can get four or five hours of sleep and actually recover after any kind of procedure, especially what we're describing. So prioritizing sleep, getting enough nutrition in place is paramount. And then, like I said, we don't use drains. Now, the reason I don't use drains actually started with fat transfer patients. So I'll go off script for a little bit. I had a patient come to me, and they knew I did cancer reconstruction, had done many fat transfers over my career for cancer patients. And they came to me and they said, hey, I just want to have my old implants taken out, and I want a fat transfer. I don't have breast implant illness. I'm just. I don't want implants anymore. And I said, no, I don't want to do that. I wasn't comfortable with doing that at that point. And they kind of kept after me and after me, and finally I acquiesced, and I did that for them, and they had a really good result. The problem at that point was I still use surgical drains. So we had a patient who had a fat transfer and then had a drain tube in the old breast pocket. And then I had them in a liposuction garment, and I had them in a gentle wrap for their. Their chest. It was just too much stuff. So ultimately, as we did more and more fat acquisition from the flank areas and the abdomens, we would connect those spaces, and then we knew we didn't need to use a drain anymore. So I haven't used a drain for these cases intentionally in several years. There'll be a time when then someone has a ruptured silicone gel implant or something like that, and I feel it's indicated, and we'll use it. Healthy fat graft comes from healthy donor fat. You need to place it in the appropriate recipient site, which I said is beneath the skin above the breast. And then you want to have the patient as healthy as possible. Somebody is, you know, really, really suffering with chronic inflammation, and we can't get a handle on it for them. It's not in their best interest to have a simultaneous fat transfer in those cases. We actually will do it in a delayed manner. We'll have them work with my team. Many of you know that I have an entire team devoted to taking care of patients. It runs my Sharp program, which I wrote the book about. So anybody can explant actually with somebody else and still work with our team. You can also go and do the, the Sharp course online. We have a little mini course for that as well. All right, we'll get back to it here. So the reason, you know, I wrote the book Sharp about our methodology is I'm not trying to hide anything. We're very, you know, open about, you know, what we've done with Sharp. We feel it's the right way to prepare patients. And from a program standpoint, we're always looking to improve it. We already look at genetics and toxicity burden and gut health and food sensitivities. We always are trying to get people in better hormonal balance and we try to supplement them properly, not over supplement them. I actually operate on patients on supplements. I don't stop them or discontinue them. We balance out what I'm comfortable with. So we use things like liposomal zone, sorry, liposomal C, D3, K2, glutathione and methylated B. And then we have a couple simple powders that we use as well as protein powder. We want everybody to get as as much nutritional absorption as possible. Many of the patients I take care of had a lot of problems with just gut problems. Maybe they have constipation, maybe they have difficulty with just the digestion of foods in general. So we try to make it as simple as possible. It's going to help them in terms of recovery. If they can really be consistent in those habits of sleep and nutrition, proper hydration, getting enough protein, amino acids in there, it'll reduce inflammation and speed the healing process. So we feel very comfortable with the Sharp method as it pertains to all of our patients. But in particular for fat transfer patients, we also have some very specific guidelines that we use for fat transfers that are unique to my clinic. Because in my clinic I have the human regenerator from Germany. I have a vertical hyperbaric chamber. I have flopresso machines from New Zealand to help remove fluid rapidly after surgery. And those are done in conjunction with nanov at the same time. And then of course we have a big 6 foot tall Joovv red light which is great to help reduce inflammation and promote healing. We want to make the fat transfer process extremely predictable. And I feel like following the short method and the way we prepare patients does make that more predictable. For patients, the idea that fat transfers are either hard to do or they won't last or unpredictable is I don't think appropriate. I think it's not the right message to send. The patient thing, it's more about identifications, patient selection, preparation, minimizing tissue trauma, really being respectful of blood supply, placement of the fat. I avoid overfilling to avoid problems with oil cysts and necrosis. I try to be very strategic with my placement and don't, I don't over graft to try to avoid problems, of course. And the, the way I think about it, either for cosmetic breast augmentation or for explant and simultaneous fat transfer. It's a great tool to be able to do that and provide that for patient patients. It just needs to be done selectively and carefully in the cases and you can get really nice results. And so that everybody's clear. I don't offer this to every single patient. They run our program. We look at the data, we discuss what we feel is the best and if we can get the patient prepared, inflammation lowered, really set them up for success, then we'll offer them a simultaneous fat transfer. If not, then they can explant and then have that at a later time. That's absolutely fine. That's not a failure. That's just doing it when the timing is best for the patients. And that's all that's important. So if you're considering explant surgery and wondering about fat transfer, there is no universal answer to this, but simultaneous fat transfer is possible, is safe. When done correctly, you can get very nice results. I think the preparation is, is paramount to improvement in outcomes. I have very specific criteria that I follow now that I won't discuss on the live. I think the tools and technique matter, of course. I think your recovery program for patients is incredibly meaningful, especially in this procedure. And I look forward to continuing to push the envelope and make that a even more attractive program for patients. I think that that would be an ideal thing for us to be able to add to always offering patients. Many patients come to me who had augmentation and now want explant, who were never offered a fat transfer. They didn't know it was a procedure they could have. So I think patients deserve that conversation. They need to understand their options just to be clear for them so that they're very, very well informed, informed always. And with that we'll, we'll stop and I'll answer some questions and we'll see who is, we'll go to tick Tock first. Let Me see. Let me scroll back here. Let me. Who has a good question on Tick Tock? Oh, we have a lot of people on Tick Tock. All right, let me see another question. Well, thanks everybody for joining. I don't see any questions on Tick Tock. Let me go to Instagram. Let me see here. We have a lot of people watching. Somebody's asking a question about for breast left, how long normally until scarring lightens. Scars mature over a year. I don't ever, I don't ever get too concerned in the, the beginning about that. You got to give it time to heal and recruit. All right, Ms. Martin, I will see you next month. Yenny. Yes, that's what I did this morning. I took out a set of implants with the scar tissue and I did a simultaneous fat transfer and I actually did a lift as well. So I routinely do that explant and lift is the most common thing we do. And then I certainly would like to be able to offer fat transfers whenever possible. That is an excellent option for restoration of volume. If you don't have breast tissue due to cancer, can you still have a fat transfer? So yes, predominantly what I used to do was post mastectomy breast reconstruction, fat transfer. So if you want to think of it, you can add volume over the top of the device and then over time get enough volume that you can take out the vise or you can do a removal and fat transfer at the same time. It varies but yes, you can do that. So that I got asked the question about downtime. That's a good question. So the downtime for an explant depends on where the implant is. If it's above the muscle, it's a one to two week issue. If it's behind the muscle. The muscle, if we repair it has to heal and that takes multiple weeks. It doesn't mean you can't do anything. It's just you want to be respectful of the muscle repair. Now when we move fat around, the fat takes a good two to three months to settle in. In the position we place it and the areas that we take it from need to heal, of course. So we promote and recommend more and more lymphatic massage for that post op for sure. And I always prioritize hyperbaric oxygen in patients that we do fat transfer. Would you recommend waiting for explant and fat transfer? If I still want more kids but feeling BII symptoms now, so that's a difficult question. I've had patients explant and go on to have more children. My Client Lauren Bostic went on and had another child recently. And so it's a personal decision, of course. So this is a good question. This is. This always comes up. Is this effect breast cancer screening? The answer is no, it doesn't. As long as it's placed in the fatty layer, does not affect breast cancer screening at all. So Anna's asking, do you do fat transfer only when you do en bloc or can you do it with total capsulectomy? So you can do it with either. No issue. Yes. You could teach and not use hand weights or resistance bands. Yes. Yeah, you can accommodate. You know, basically what you need to do in terms of activity level. Remember, like your arms are going to be fine. I just have them go out to 90 because if we repair the pec, we don't want you going up and stressing the repair. That's all. You know, I have people, they're worried about doing their hair and stuff. Y' all know I have long hair. It's just tucked under this blue cap right now. What else do we have? Any other good ones? Come on, I got you all at a weird time. It's. What is it? On the west coast it is what, 1:30, 2:30. And then on the East coast it's 4:30. All right, what do we got here? I have a few folks on Facebook. Nobody is asking a question though. Come on, Jessica, you can ask a question. Or Melanie, let's see on tick tock, do we have anybody asking a question? Everybody's just saying hi to me. Hi. Automatic. So I got here late. Oh, you want to maximize fat retention. That's a great question. So I think there's this, this conversation around fat transfers that they don't last. They're going to go away or some magical mythical thing is going to happen to them. So if we maintain our BMI and go up potentially, like put on muscle, put on healthy fat, put on, that will help us maintain a result. If we create a calorie deficit or over train or under eat or that combo and drop our bmi, then we're more likely to endanger results. What's the question? Cav mama. I plan to have a fat transfer. I feel like, oh, here it is. I had an explant capsulectomy 4 weeks ago and my lower left side had capsule retention. I did not notice until the past week and is showing deformity in and above the area with some deep dimples. Yeah, basically, if we have contour problems, we just correct them at the time of the fat transfer and we can Address skin at that time, too. I. I try to balance out the procedures. We don't want to, you know, have to continue to do more procedures if we don't have to. The. The most, you know, efficient way I can do it for patients. I try. So today, the patient who came in from Canada, we did a vertical lift, and I did a fat transfer. Everybody's different based on what they need. If somebody wants a really, really elevated nipple position, the only way to do that, you know, for me personally, is with a vertical lift. And then that takes a wide breast, narrows it, and then you add volume, especially in the upper two thirds. That's a nice restoration maneuver because that's where you typically lose the most volum when you explant. And then if I have somebody who just wants a cosmetic breast augmentation with fat transfer, which we. We've done recently, I was hoping some of those folks would hop on as well. It's a really nice way to augment those patients. It's a good contouring procedure. So, yeah, I think it's a very useful procedure in my hands. All right, what else do we got here? No, I don't use compression bras after fat transfers. I let people use camis. I don't want anything tight or restrictive. I don't want anything denting the fat. I don't want anything potentially changing position and. And injuring the fat. So I just take it easy. Yeah. I mean, if you've had them for 12 years and you don't want them anymore, then it's time to just have a chat. Hi, Brittany. Thank you. Any other good. Hit me with some questions here. Last time we answered questions, I felt like, for, like, an hour. And tick tock is not up. Here we go. Tick tock. Do you recommend a fat transfer versus an implant? So I don't place implants anymore, Mara. So I do fat transfers. I do explants, I do lifts. I do reductions, But I don't place implants anymore. If I were to do an augmentation, I do it with fat. Amber has a really good question. Any thoughts on very slim people who want fat transfers? Oh, okay, Deanna, I'll see you tomorrow. So, yeah, that's important because you will get told as a. A thin person that you can't have a fat transfer many, many times. And I found that to not be the case. So once again, it goes back to patient selection. I also like patients to get a DEXA scan that allows us to look at their skeletal muscle mass, allows us to look at their Body fat and their bone density. And in the time of the GLP1 agonist. If y' all are considering fat transfers, please do not do GLP1, GLP1s, or semi glutide tirzepatide. Those things are really effective at burning fat. And I don't want anybody who wants to come have a fat transfer on those drugs. They work really well. Really, really well. Giordano, we don't have a specific test to know if the chronic inflammation associated with implants is purely the cause of anybody's symptoms. I have thousands of cases and tons of experience with it. So I think there'll be, you know, more and more work done in this, but it's not going to be some easy test that's available to figure that out. Where do you get fat from? Do you recommend tummy tuck to get more from thinner body? Now, I don't actually like tummy tucks. I think the scar is ugly. Yeah. Fat transfer patients do get the benefit of body contouring. Think of it just like when you do a buttock augmentation. You're trying to reshape the waist and inner outer thighs, and that helps provide a better shape for the buttock. You're doing the same thing for the patient having breast augmentation. I don't know this. I don't know if it's Bibiana. She says she has motiva implants from six years ago. Now she has liquid in both breasts. Do you think that can be inflammation? I don't know what liquid means, but if there's liquid around an implant, I would make sure and get that evaluated. That should not be there. Oh, that's a great question. Jess is asking, does the lipo hurt? So the patient that came in from Canada, there are three ways to get a fat transfer done by me. You can do it under complete local anesthesia. You can do it under local with IV assist, which is a medicine through the iv, kind of like Twilight. You probably heard of that. And then the third and final way is to do local with general. Now, when I do an explant, I don't do explants under local anesthesia. So the patient had a general anesthetic to get the explant portion done, but could have had the fat transfer under local. So that's a great question, Amber. Amber's asking, everybody should listen. Listen to this question. It's very good. Thank you. Amber, on average, how many times do you need to do a fat transfer to get good results? She says she has heard Some had to do the procedure twice. Yes. So think of a fat transfer as dependent upon your expectation and then how much fat someone like I in my position can transfer for you and get to heal. The reason you may need another procedure is you just may want to add more volume. That's. That's basically it. Remember, the volume of an implant is fixed. The fat transfer has to heal. And it's not fixed in a bag. So it can't just push out and expand and fill. It layers out. It's soft and natural. But that's a great question. Thank you for asking that. Awesome. I'm going to go back to Tik Tok here and see if we got a another question. Bold North Tracy says I need an explant but can't have anesthesia. So we have done. For patients who have either brain issues or neurologically, their providers have wanted them not to get anesthesia, we've done those under local. That's a very specific set of circumstances. We work with our anesthesia team to help provide that service when needed. Oh, I see Ms. Alex has joined. Hi, Alex. Who else do we have here? Now? Nobody's asking any questions on Facebook. I don't know if that's a Facebook problem or me on Tick tock. Lori is asking, would fat transfer be an option after mastectomy and explant of reconstructed implants? Yes, it is. But that's a very specific set of circumstances. Remember, the scale skin doesn't want to stretch as much because they had all the other surgery. So there are different ways to do that and it really would dependent on the experience of the surgeon you get involved with. I don't do any of that anymore. But there are different ways to do it for sure. Evelina got a fat transfer into her lips, but it dissolved. I would not fat transfer lips. I don't think that's a great idea. And I don't know why yours dissolved. Usually fat heals extremely well all over the body, especially the face and the lips. Okay. Oh, we got two questions over here. Let me see. What's your recovery protocol for just a fat transfer? That's a very long, drawn out question. So is this Dr. Stillert from the Netherlands joining us here? Is that correct? All right. Or is he Belgium? I'm sorry, Sillard's Belgian, I think. Okay. Do patients have to be careful with lifestyle to preserve the fat just after surgery, when healing or forever? Is there a risk to lose the fat permanently at some point? Like if you lose a lot of weight? Yes. If you lose A bunch of weight either through caloric deficits, GLP1, or just probably through any kind of rapid weight loss, you're going to lose fat. I mean, that's, that's going to happen. So I don't encourage anybody to get a fat transfer who's going to go on a weight loss journey. That doesn't make sense. All right, let me see. I'm make sure I got a. Oops, hold on. Trying to make sure I get everybody's questions answered. Why do I not like lip fat transfers? Because fat molecules are large molecules and I don't like transferring large particles into three dimensional spaces. Like your lip doesn't make sense to me. I like maximal control of things and that is not something that you can control. Well, All right. We have someone from Ireland. Awesome. Thank you. Amber's asking should she try to put on weight? So I think the best way to think about this is you need to make changes in your lifestyle that are consistent with what you can maintain over time. You don't want to increase calories, increase healthy fat, intake all these things and just maintain it for six months, nine months, a year, 16 months, and then go off of it because then that will potentially compromise all the work you've put into it. So once again, when it comes to fat transfers, what I tell folks basically is you can't and should not do things that are going to be of such an intensity that you're going to burn a bunch of calories and or potentially, potentially harm the fat. So things that make sense to me are resistance training, weight training, walking. Those are practical things like interval training, high rock cycling, running, things that burn. High intensity workouts. They don't make sense for this, to be honest. Oh, here we go. What is it called when you do plastic surgery on the face on each side? I think somebody's asking about a facelift. We're talking about breast surgery here, not facelifting. All right, let's see if we have anybody over here. All right, what else do we. Y' all can't be my co. Co host. I don't know. I've never been asked to be co hosted so much. All right, any other questions I can answer? Hey, before we wrap it up, I want to remind everybody that we have tons of free, free resources. So if you just comment or DM guide on Instagram. Instagram or Tick Tock or Facebook or YouTube, my team will send you a link to download a free guide if you want to take any of the courses. We have ten dollar mini courses on bii Fat Transfer and the Sharp Method. And then we have both books available now. So I have the book about sharp, and I have the book about breast implant illness called Breast Implants Explant Surgery and Breast Implant Illness. And we have our group program for sharp. And then, of course, if anybody wants to travel in, we do virtual consults. But like I said, most of my clients are actually not necessarily in Texas. They come from all of the U.S. canada, Mexico, Europe, and we have our folks from Asia and we have some Australians coming, so we're looking forward to that. Any last questions before we hop off? Oh, wow. I have a whole series I missed here. Hold on. I'm sorry. All right, what protocol do you use for someone with itp That's a specific medical one. You have to. We'd have to talk to your doctor about that. So Jen is asking, do we recommend hotel or Airbnb? Everybody's a little bit different. I have, like, a whole group of folks who really pamper our patients through Airbnb, so that might be the favorite. Right now, Jess has animation deformity. And can that be fixed in the meantime while I wait to do an explanatory fat transfer? Animation deformity. Usually you got to correct the. The animation to form by changing the position of the device. So if it's below the muscle, you go above the muscle. So if the person gains the weight back, they won't gain it back. Also in the breast. Right. I don't know the beginning of that. Somebody had an explant and there was a rupture on the Right. And. Yeah, I mean, you're gonna have inflammation for sure. And having a rupture is never, never good. So I'm sorry to. Okay, I think I got those. All right, let me get back here to. I want to make sure I get. Oh, I have somebody with a new one right here. Need assist remove, and I need to know the process. Or maybe that's not the subject. Why you didn't answer? No, this is not a cyst removal live. We're talking about fat transfer of the breast. Sorry. All right. Just making sure. If somebody had a question that I can answer on all of the different platforms were good. Really disappointed with my YouTube folks today. What is going on with you all? Only the TikTok and Instagram folks are lively today. All right. You don't use a fat transfer to lift the breast. You use a fat transfer for volume. It's not a lift procedure. You said Jess is asking about motiva implants. I did a live last week and spoke about Motiva implants. There's a motiva implant right here I took out to somebody a few weeks ago. So they had a capture contracture from Motiva. Amy wants to know how long does it take to completely recover from explant surgery. So if you just gave me a patient to explant above the muscle, one to two weeks behind the muscle. Takes weeks for the muscle to recover, but the patient will be fine. And then we do a pretty long process for the quote unquote, working with my team and doing the sharp method for post op. So that's a whole like 9 to 12 month program. And then we run a separate post surgical recovery program with our medical team. So it's about a year we're involved. Amber says she has dense tissue and countless cysts in the natural tissue. Yeah, I've seen that for sure you have a lot of pain if you have a lot of cysts too. By Jess. Yeah, Vivian, if you just go to the website, Dr. Robert whitfield.com you can schedule a discovery call with the team. So yeah, you can. You can go over that with us. A fat transfer. The question is, will the fat transfer be more above the nipple to add rounded volume? Is that possible? Yeah, if you just think of a breast, 2/3 of the space is above the nipple and about a third is below or a quarter is below. So the predominant place you can put fat is above. Amber, you don't want to take out cysts and things when you're doing an explant that will cause more trouble. So no, you wouldn't do that. All right, let me see if I got anything else. Over here. On Tik Tok D dous is asking if having b mastectoman want a smooth, flat appearance without any concavity. What do you ask for it? It's called an aesthetic flat flat closure. Shayna. Yeah, we reduce the areolar size for sure. Jessica's asking about fatty liver disease. I mean, that's as the principal cause. I would not say that's the cause though, Nash or nfa. Lds. You know, there's a host of reasons for that. Oh, who else do I have here? Do I do surgery in my clinic or hospital? No, we don't operate in the office. We use a surgery center. All right, did I get everybody's questions answered? If not, raise your hand real quick and we'll try to get the last few out here. I had a lumpectomy and no one will do plastic because I had so much, much radiation. Wendy, are you in the United States. Now? Wendy, I saw you. Okay, where in the United States? Georgia. Go to emory. Are you in atlanta? Go to emory. Megan wants to know where am I located. I'm in Austin, Texas. How do you guys not know this? Come on, now I gotta fire all the marketing people. If you don't know where I'm at, where. Where I'm at. Or I guess I got to do a better job. So we're in Austin, Texas. Megan, you're in Houston. Well, you can come see us. That's not far at all. What's your. What's your hold up? What causes getting blood and clots? Yeah, I don't know what that's about. Sorry. Why does everybody want to be my co host? You can't be my A co host. What else do we got here? Let me double check. YouTube is dead as a doornail today. What is going on with y'? All? Goodness gracious. Oh, Jess is asking about the liver. Yeah, we would have to look at it, Jess, but we have a lot of people have sluggish livers for a variety of reasons, and we do explants with them as well. I just. I had a patient who had quite a bit of enzymatic elevation that we took care of recently. Megan, what is constantly having inf. You mean inflammation? Somebody's asking what kind of doctor am I? I'm a plastic surgeon. Laura. Yes. Message us and we'll give you recommendations for someone near you in la. I have someone for you. Yeah, message my team. Okay. Or DM us on Instagram or Facebook. What else? What else do we got here? Jenny's another from Houston. Everybody's coming up from Houston now. That's awesome. Linda's in Auburn. I had somebody. One of my patients just drove in from Alabama yesterday to see us. She's lovely patient and we always look forward to helping whenever we can have tons of great patients that come in from all over the country. It's. We're really blessed. It's fun. My team is great too. Y' all just don't know. The team I have is awesome. First rate, front to back. Everybody's good. Deal. My gals really take great care of everybody. How long till someone can go back to weightlifting? So Jordana is asking about weightlifting. So if you're not doing an explant, cosmetic augmentation and weightlifting, we'd put you on probably the six weeks, mostly because of swelling. And then if you're doing an explant procedure, you couldn't do, like chest until we Clear. And we have a protocol for that. Did we actually get somebody from YouTube doing something? No. Wow. I have 2. 2 million subscribers on YouTube and none of y' all are asking any questions. That's brilliant. That is brilliant. Okay. All right. All right, what else? Let's see. Just want to make sure I got everybody's questions answered. Jacqueline says I want my implants out. I just can't afford it. One is hard as a brush baseball and causes pain. In those case, Jaclyn, I don't know where you live, but I would recommend talking to our team. You can have a discovery call with them and they can guide you a little bit. There's different options. Some. One group we're working with right now has no interest financing for a year if you qualify. So there's options. I know it's a big deal that may not work with us. I don't know where you live. Where are you at, Jacqueline? Jen, she's asking, do the doctors you recommend offer the same therapy services pre and post op? Some of it they do. Not all of it. We've invested heavily in our clinic, so you're not going to find a clinic like ours. We have a human regenerator from Germany. We're one of three clinics in North America. We have three flopresso machines from New Zealand. We have a vertical hyperbaric chamber, 3 nanovs. We have a 6 foot tall Joovv red light. And we're always looking to add more to help patients recover faster. Jacqueline, where are you at? Did you tell me? Arizona. Okay, Yeah, message us. I have a couple people depending on where you are in Arizona. Scottsdale. But I get a lot of people that come to me anyway from Scottsdale. So do I do thigh surgery? No, I don't anymore. No, I don't. I don't know that the question is about scarring, but I don't know what the scarring question is. Is it possible that you place the fat directly where the breast is folded? We'd have to see it, but yeah. Typically we can help with any kind of contour problems. We can help mask them. If it's scarred down, we can help lift it, we can fill it. No, it's not common to have a suture abscess 14 weeks post op. Those are suture granulomas and they typically happen earlier, but sometimes the sutures just don't dissolve. We use monocryl. So, Ashley, what was your question? I didn't say it. Just re. Ask it. I'm looking at this now. Just re. Ask it. I didn't see it. Amber. I don't know. Can the cuts be removed? Amber. Amber. Amber. I don't know how many questions I got asked about Amber. Do you take insurance for explant? No, we haven't taken insurance since 2019. Ashley. I stopped doing cancer reconstruction back in 2019. Sorry I missed that. I don't use prp. I recommend if you can at all possible use your own stem cells. Misses Andrade, I had an MRI one year ago and I was informed both my implants are leaking. I need to explain. But live in California. How long do I need to be in Texas? I do have someone in LA if you want to DM us, Mrs. Andrade, that we can send you to so you don't have to travel. Of course anybody can travel to me. But just give us a DM and we'll. We'll try to help you out. Jacqueline is six months out from explant. Feeling great. Awesome. Anybody who travels and. And has surgery with me stays in Austin about a week. You can stay longer. I have somebody in from Germany right now, is going to be here a month. Recently had an explanation on July 24th. Before and after. I'm still experiencing joint pain, fatigue, brain fog. Well, that's why we have a pro. A program to look at everything. I'm not certain in your instance what's going on. So. Yes, that doctor is running our Sharp program. Yes, there. That's part of it, yes. Oh my. What is this doing? I just got asked to drag a puzzle piece on TikTok to keep the live going. So I guess we must be doing something correct. I've never had to do that before. It's too funny. I don't have thigh surgery advice. I'm sorry, I don't do that. Yeah, Mrs. Andrade, just DMS. We'll connect you with that doctor. They do follow my protocol. Well, I have to do retesting for fat transfer. I don't know what test you did. Did you do a total talks test or are you talking about what test? All right, who else do we have any other good questions here? All right, y', all, that's it. You haven't even asked me like how much we transfer at a time. So, you know, 2-400cc is pretty normal. You always want to get a cup size change at a if at all possible smaller patients, a little bit of fat can make a big difference. So don't ever underestimate that. Casey is asking about our diet recommendations. My best advice, Casey, is to get either you can do the, like, sharp $10 mini course or just read the Sharp book. But I always advocate for high protein diets. Good, healthy fats. You know, olive oil, avocados, healthy nuts and seeds. Those are good ways to get healthy f. Eat more protein. I think most of my clients don't eat enough protein. That's a problem. Somebody says one day post op and they're dying. You certainly are not my patient. One day post op, you'd be in my office getting treatment, so that's a problem. So. So increase your protein intake to about 100 grams a day. Walk around, try to get your rest at night. Get your circadian rhythm back online as quickly as possible. All right, Well, more people are joining. All right, any other good, good stuff? Haley Jane, is it okay to go in the sauna if you have breast imp. Plants? I encourage you to go listen to the podcast I did with Lauren Bostic, the host of the Skinny Confidential, to learn about her experience with sauna and breast implants. All right, y'. All. Is that it anymore? Anymore? Going, going, going, going. All right, Megan, you can have a complimentary call with my team to see if it's appropriate for you to have a consult. So there's no charge for the complimentary call. Isaiah said I skipped his question. And he called me Rick Flair. That's interesting. Isaiah, do you want to ask your question again? Happy to answer it for you. I'm looking at four different phones on a computer, so I apologize that I missed you. Come on, Isaiah, don't be like that. Just ask the question again. Guess he's not gonna ask. Okay, see if I can go find it. Oh, megan asked me, do I know kane, linville and houston it. No, I don't. Yeah, I would not. Fat graph near the skin, under the eyes at all, so I wouldn't do that. Why are people trying to join my live? That's weird, you guys. Why would you do that? All right, all right. We're gonna shut it down. Thank you. All. Right, let me see my wife. Shiloh at the time. Now I gotta figure out how to shut all these things off. All right. Okay.