STOP Losing Breast Volume After Explant, Do This Instead

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 going to talk about fat, but in a good way. So fat grafting, fat transfers, or in Europe commonly referred to as lipo filling, has been done for over 100 years. So let's just start there. This is not a new treatment. I have this relationship with fat. It goes way back, so to speak. As a second year resident, I did a research project that looked at fats. I'd go to the research wing of the hospital where I worked and we would harvest fat cells using closed suction syringe technique. We would numb the area around the umbilicus, which is your belly button and we would use a syringe to harvest the fat. The fat that I was harvesting was being used to study leptin. Leptin is a hormone your body releases that helps it maintain your normal weight on a long term basis. The level of leptin in your blood is directly related to how much body fat you have. Leptin resistance causes you to feel hungry and eat more even though your body has enough fat stores. This is 1998 and 99. I'm doing this, then fast forward. I get done with my general surgery training. I'm in my plastic surgery residency training. And what are we doing? Remaking breasts with flaps that are composed of skin and fat, which is called the DIEP flap or deep inferior epigastric artery perforator flap. We're doing liposuction. We're taking fat out of areas where we don't want it. Our hips, love handles, inner outer thighs. We're putting it in different places. We'll think of the craze of the Brazilian butt lift. We're making butts out of fat. Why can't we take out an old implant and replace that volume holistically with your own fat? It's my holistic mommy makeover. I take your fat out of your hips, abdomen, inner, outer thighs. I improve the shape of the waist and we take out and perform an explant as we previously described. Then we put fat where it's supposed to be, back in the space where it belongs. So it's very important when we put fat back that we place it in the correct position. We don't put it where we took the implant out of because it won't survive there. There's no blood supply for it to live there. There's no matrix or Structure to it. When we transfer it back, we put it beneath the skin, but above the breast tissue. So that plane is the fatty plane that everybody has. You can look it up and see the breast conically shaped. And then there's a layer of fat breast tissue now that once it heals, which takes three to nine months, we'll say it's going to live with you and change with you. And everybody asks me, is it going to, you know, am I going to grow fat in new place as well? So think of the breast not in this standard conical or cone dimensions, but most of the breast, 2/3 to 3/4 of the breast is really above the position of the nipple, towards the collarbone. This is where the majority of the fat can be transferred. This is where you get most of your volume restoration. It has the most space versus the area below the nipple complex, which is shorter in distance, maybe 5-9 cm, average of 7 cm to the fold itself. So let me tell you why fat is such a great filler. So fat, once it heals, it's soft, it's natural, it's going to maintain itself over time, provided diet, hormones, other variables can remain as constant as possible. There's a lot of things written about fat not being a good filler. It causes necrosis or cysts. I want to explain to you that fat not only is a good filler, it's a great filler. Why and how you get it to be such a great filler Is one a technical one, how you remove it? I always remove it consistently with the same diameter cannula. That's between a 3.4 and a 4 millimeter cannula. I use a very specific collection system by Wells Johnson. I have no financial incentive to say anything about them. In full disclosure, I don't get paid by Wells Johnson. It sits there, it's sterile. We use an antibiotic solution to wash over the fat and rinse it. We have a shaker. We don't centrifuge the fat, which I get asked a lot about why I don't centrifuge fat. Then we place it back. We place it back with the same diameter tube that I took it out with. So the cannula to put it back with is a 4 millimeter cannula. So think of fat. Fat is not like a series of skittles which are all shaped the same. Fat is more like unevenly cooked popcorn or the popcorn you get in the tin at Christmas. There's all sorts of varieties, all sorts of sizes and shapes. When it goes back through those tubes that you took it out with. If it's the same diameter, you cause the least amount of injury, you're not creating a pressure that's going to damage the fat. Now, most, if everybody won't know this, but I was in a sarcoma group for a really long time. At my previous academic position, I studied adipose derived stem cells. It was my research project how they affect and translate with fat transfers and do they cause cancer and all these things? There's lots of things when you break down the components of a fat transfer. But I'll tell you, the quintessential thing that I try not to do is injure the fat that I took out so carefully when I put it back. I tried to put it back in a very careful and holistic manner in the proper position, which is below the skin but above the breast tissue in the fatty plane, it occupies the 2/3 of the breast from the collarbone down to the nipple complex, because that's where you put the most. And I don't put a ton on the bottom because it's just there's not enough space. And with or without a lift, I do those things as well. But think of it this way, it's very, very psychosocial and important for a woman to have made this complicated decision and have on the other side a way to look and feel as good as she can about the appearance of her breast. And so whatever the situation, I can get to an endpoint to restore volume, reduce skin laxity or sagging, improve shape, lengthen the torso and appearance, narrow the waist, improve the thigh gap, reduce the saddlebag, take away the love handle, and that's a holistic mommy makeover. How much fat will be there when you're done, Dr. Whitfield? And so there's lots of factors that I think that you need to address before you completely commit to that one. Everybody who's a client of mine, I try to get their diet organized. If you're going to do body contouring, whether you're doing a liposuction for aesthetic purposes or you're doing a fat transfer for a butt lift or a breast lift, or explanted a fat transfer, you need to know that your food is the fuel that gets you through the process. And I do food sensitivity testing now in my clinic. And the point is, if you don't know what you don't know, I can't help you recover to the best of your ability. And then you won't be able to maintain your results. The best Year. So, for instance, I'm allergic to eggs, basically. So I've cut eggs out of my diet and lost about 12 pounds. Now, I didn't lose 12 pounds of fat. I lost 12 pounds of fl. So if I took every one of my clients, 96% of a female between the age 33 and 55, if I told them they lose 10 pounds with a blood test, how many people would do it? Raise your hands. I work with this great company called rupa. RUPA will send you the blood test because I have clients all over the United States and they'll help you get drawn in your area. Or obviously, if you're local to me, you just bring it with you to your next appointment and we'll draw it for you for free. Everybody's heard of an elimination diet or an autoimmune protocol diet. So this blood test gives you the answers to an elimination diet. Right. It's like taking the test with the answers. You already know what you're going to react to. So if you remove the severe and moderate columns, which are the ones that are most stimulating to your immune system, you'll reduce your overall inflammation. So how does that help in reality? When I examine somebody, I'm looking very carefully and I can touch tissue and tell whether it's got too much fluid or is it fatty. Use the analogy of the sponge. On the kitchen, there's a dry disc sponge. You know how that looks? As this sponge collects fluid, it expands. Now, in somebody who's really inflamed, there will be even more fluid in the sponge. Now, when I perform a fat transfer or liposuction, I have to put fluid in in order to take the fat out, because that's called tumescent anesthesia. That's what we do. Now think of that sponge full of even more fluid. Now, I'm a really experienced plastic surgeon in liposuction. I rarely, if ever, have a contour problem after liposuction because I can feel exactly what I did afterwards. That's how I was taught. Liposuction is a removal and tactile response to the area with which you just treat it. You compare it to other areas to get your thickness, and so rarely should there be an issue. But when you're swollen or inflamed, let's just say you can imagine how that would be more complicated for me to do the procedure for you. So if we remove inflammation by reducing the foods in your diet that promote inflammation, your gut, swelling, fluid retention in your abdomen, your hip love handle area, your Thighs even will go down. So that is part of the process. And I've felt so strongly about it, I've adopted it into basically my preoperative testing for each of my clients. Because that coupled with the next things we need to talk about are your hormones. So we'll just say I'm taking care of a client who's had two children. She's got implants, and she wants an explant. She wants a fat transfer as well. Women who've had children a lot of times are deficient in copper. It's a micronutrient that's very, very important in cellular processes. You're also typically, I find patients who have autoimmune thyroiditis or called Hashimoto's, and that's a common problem. So if you're suffering for thyroid dysfunction and alternatively you have diminishing levels of estrogen, progesterone and testosterone, we'll have to look at that as well. Because to maintain lean body mass, have healthy fat, we'll say you need balanced hormones. And so you may need replacement. Not so much of estrogen, but probably testosterone. Lack of energy, decreased libido, hair and nail loss. I'm sorry, Decreased hair and nail growth, cognitive dysfunction, hormones all play a role in this. So when you balance these out and when you look at food as the fuel, coupled to my already very, very, I feel very strong. Programs for managing nausea, swelling around the time of surgery, nerve pain, localized pain in the area of operation at the time with nerve blocks with lactozoma, bupivacaine or exparel. And then, of course, everybody wants to know about recovery. We've kind of went over it. But liposuction recovery is always benchmarked at six weeks and use compression. In our office, we have a certified lymphatic therapist to help further diminish this recovery period. We also have a lymphatic massage device, the Balancer Pro, to help diminish the swelling that exists after liposuction. Whether or not we're doing a fat transfer is beside the point. We want to reduce the swelling in the areas where the fat was taken from. And we put you in compression. And at a week, I see everybody and we decrease the size of the compression garment because we want to get more of that fluid out. We use these other techniques like lymphatic massage, the lymphatic assist device, the Balancer Pro. We want to get that fluid out as quickly as possible to further increase and enhance recovery. Obviously, there's no guarantees in life, but if you Follow along with what I just said, that will decrease your recovery, right? If the food you eat is a fuel for recovery and you eat the foods that don't stimulate inflammation and you do the things in the program to reduce inflammation and you use compression and ice and anti inflammatories, all of it collectively will work in your favor to get you recover more quickly. So fat retention, the best study is a breast augmentation study and it showed there was 50% fat retention at a year. Now breast augmentation studies are, you have to be careful on how you interpret the result of breast augmentation study. So that's a patient with a lower BMI who has, we'll just say smaller breast because that's why they want augmentation. So typically those are patients I wouldn't be able to do a fat transfer on. So when an explant patient, there's already space because there was an implant, it's already been stretched. So the skin has been stretched out. Typically there are higher BMI because they're typically older in age. And we usually gain weight as we age. We don't lose or maintain. Typically you'll have fat, which is what you need is the filler. You'll have space created by time, which is laxity, weight loss, weight gain, expansion through pregnancies. When you go and then place this. In my experience, the take rate should be between 70 and 80%. How long does it take for final results to appear? I like to evaluate fat transfer, fat grafting, lipofilling results on a quarterly basis. So I look at my patients at three months and six months and nine months and a year. And usually between that nine and 12 months, you'll have a very clear indication of what the fat transfer has delivered for this patient. Sometimes as early as six months, but you can still have swelling at those times. So I would tend to be patient and take a long term approach to those results. What are the risks of transferring fat to breast? So fat transfers should not promote risk to the breast if placed in the proper position. The question has always been asked, does fat transfer increase the risk of breast cancer? The answer is no. Breast cancer is an epithelial cancer. Fat is from mesenchymal stem cells. It can't form an epithelial cancer. What it can form is a sarcoma. And there's been no evidence that that will form. So the answer is no, it's not going to lead to risk. Now the other risks that people ask about are fat necrosis, oil cyst formation, and typically to me, that concern pertains to how it was transferred. So once again we go back to how we technically do it. We use the same size tube or liposuction cannula, a 4 millimeter and we put it back with a 4 millimeter. The way we put it back is not a syringe method, but it's on a roller pump, so it's consistently being pumped at the same speed. That allows for even distribution of the fat as it's coming out of the cannula back and forth. I get asked, will my fat transfer affect interpretation of my mammograms? And the answer is no, because the fat belongs in the plane under the skin. If you put fat inside of a breast, you will create a mammogram abnormality. Mammograms specifically what they're looking for are micro calcifications as it relates to cancer. Fat should not cause that. It should not mask it if it's not in the breast. So if you don't put fats in the wrong place, it shouldn't compromise your mammograms at all. Fat belongs in the layer between the skin and the fatty layer. On our next episode we'll talk about post op and recovery. We do some unique and special things to make recovery as smooth as possible for our patients. It's taken me five years, over 500 explants to give you the answers I couldn't give you before. I now do it through food sensitivity testing, hormone balancing and genetic testing using artificial intelligence. To learn more, schedule a free discovery call with me.

Dr. Robert Whitfield is a boy certified plastic surgeon located in Austin, Texas near 360 and Walsh Tarleton in Westlake. To learn more go to drrobertwitfield.com or follow Dr. Rob on Instagram at drrobertwitfield 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 I O.