The Truth About Fat Transfer & Chronic Inflammation with Dr. Robert Whitfield and Dr. Fab Mancini

Robert Whitfield MD, he's a board-certified plastic surgeon based in Austin, Texas, and one of the most recognized experts in the world of breast implant illness and explant surgery. He has performed thousands of en bloc capsulectomies and published the largest PCR-tested explant capsule series in the world. Revealing that 29% of implant capsules contain bacterial contamination undetectable by standard culture methods. Dr. Whitfield MD is the creator of the SHARP method, Strategic Holistic Accelerated Recovery program, a 3-phase protocol that combines advanced genetic and toxicity testing, precision surgical technique, and engineer post-operative recovery to address the root causes of breast implant illness, not just the implant themselves. He's the author of Breast Implants Explained Surgery and Breast Implant Illness, host of the Top Rank podcast with over 160 episodes, and has amazed more than 30 million YouTube views educating patients and practitioners on the, uh, fat transfer and holistic surgery recovery. His work sits in the intersection of plastic surgery, functional medicine, and genetic science. Well, that's a tremendous introduction, but Robert, I wanted to give you the honor of being able to share because I am so impressed with you since the first time we met. Your work speaks for itself. Your reputation is impeccable in the field, not only among all the doctors, but also the consumers. But thank you so much for making the time to be with us.

Thank you so much for having me. I really appreciate the opportunity to share our work with your audience.

Well, you know, it's interesting because this is a topic that is a very popular topic, but maybe one that I don't know if a lot of people necessarily discuss with other people, maybe with their intimate friends or maybe with family. So I have a couple of questions, but feel free to interject anything. Let's talk a little bit about this 29% contamination discovery. I mean, that's one thing that really captivated my curiosity because it's the one thing that you rarely hear people talk about. I hear people many times considering an explant. I hear people talk about that perhaps they feel like their implants are causing some of their health issues, but your PCR testing revealed 29%. What do you believe is the most underreported implication of that finding for the broader medical community, and how has it changed your pre-surgical conversations with your patients?

Yeah, it's fascinating. I had a patient in 2016 who was a breast cancer survivor, and she wanted to have her breast reconstruction removed. It was implant-based. She wanted to have a flat closure, which of course is becoming more and more common. And I did her preoperative workup as I always do, and I did her consult, her exam, reviewed all of her laboratory findings, all examinations, And, um, we did her procedure where we did a total capsulectomy. We removed all the implant material. Now remember, she has breast cancer, so you never ever want to not send that material off for evaluation for microbiology to make sure there's no peri-prosthetic, or in the capsule, infection. And you also want to make sure that you send off the scar and all the capsule tissue to make sure there's no recurrent cancer that could harm that patient. So at a week, which is always my routine to meet the patients after the surgery, of course, go over the results. The pathology was negative, which is paramount to someone's long-term survival with cancer. So that was great. But what she had, what I had missed, what every provider had missed before me was a silent indolent E. coli infection. So 10 to the 6 bacteria were found in the specimen, which at that point in my career was a simple culture swab, which we all did going through training. Sent off to lab, it's incubated. Technique hasn't changed in over 50 years. And it came back E. coli. And so, Dr. Mancini, I felt terrible. My sister passed away from breast cancer, and had someone missed an infection on her, I would have been extremely disappointed. And so I went back through all of my notes, and tried to figure out how I'd missed this, and there was nothing obvious. This patient, um, didn't have any laboratory changes, no white blood cell elevation, no physical findings. Went back through the pictures, bagged them all up to see if I'd missed something, um, and I hadn't. Her one physical symptom that she told us she had was fatigue, but many patients who've been treated with chemotherapy have bone marrow suppression, ultimately have a problem with fatigue. But when we treated her with oral antibiotics based on the culture and sensitivities of the E. coli, all of the fatigue went away. So yeah, for everybody listening, that patient had an infection that was causing just really fatigue for an indeterminate amount of time. And so I believe she, um, put me through a private Facebook group that said I would do explant surgery and flat closures, and all of a sudden I had people start calling my office wanting that procedure in 2016, which is a little confusing to my staff because I was doing a breast cancer reconstruction predominantly at that point. But over the course of time, more and more of those patients self-referred to me. And then in 2018, I was doing a case similarly. I did the capsulectomy and the implant removal, and I— after it was all done and the patient was closed and, and we were done in the operating room I examined the material on the back table and found a very, very slimy feeling implant after I removed the scar tissue. Remember, the scar tissue is just a collagen sac that exists around the implant, whether it's hip, knee, breast, dental, cardiac. And after I wiped all this off, the implant seemed to be intact. There was no rupture, no leak. And so, like you would suspect, I thought that was an infection, a biofilm or, or something. And so I sent it all off. I went out to, uh, lobby and told her spouse, I think "this is infected, I think within a week we'll understand what it is, and I'll be able to help, you know, guide therapy." This was an ICU nurse, in fact. At a week, Dr. Fabb, everything came back and it said it was normal flora. For everybody listening, that is a term that's established when not enough bacteria can grow in the specimen, and then you don't get the answer. So I found that to be extremely frustrating, I knew that was incorrect, and that wasn't going to help these patients. So at that point, we already knew that breast implant-associated anaplastic large cell lymphoma had, uh, become a problem, and we were learning more and more about it. And early studies had been done at MicrogenDX, a laboratory in Lubbock, Texas, using PCR analysis. So I reached out to them, and in Q1, approximately February of 2019, I started doing PCR analysis of all the specimens. So in, um, September '24, we published the largest series of consecutive specimens, 694, which show that 29% have bacterial contamination on analysis. And those predominant bacteria are Staph epidermidis and Cubacterium acnes, formerly known as Propionibacterium. Those readily form biofilm. And think of biofilm, for everybody listening, the original biofilm is plaque on your teeth. So that's a real problem. And once again, the scar tissue that sits around the implant— I have a little implant here with a white towel around it. You can't see it, but everybody thinks this collagen bag is impervious. Dr. Fab, it's not. It's more like a woven sack. It allows for signaling between the bacteria and the breast tissue, and when that happens, it creates an oxidative reaction. It oxidizes the lipid in the breast, specifically oleic acid, that leads to oxylipin tin home, that leads downstream to TBET activation, and notably macrophage polarization, which leads to what all the patients come in with, symptoms of chronic inflammation. And so that's a cause and effect. We've established a rate, an incidence, and a large enough sample size that I always feel comfortable communicating with patients and providers about what we found. And more and more information is finally coming out about this from a scientific level through study of studies done by Mathun Sina and others. And I'll pause there if you have any questions about how we arrived at that.

Well, you know, one of the things that I'm extremely impressed with is your ability to take your conventional training but not stop there. You know, ask the questions that we have been trained for years on the root cause and going deeper from a functional perspective. You know, the growth of functional medicine has been explosive over the last 25, 40 years. But I love the way that you have related it to this particular topic because now you're able to educate people so they understand that there may be more to the story than they're being told. But you also talk about the difference between en bloc and total capsulectomy, and I know that there's differences of opinion there, but how would you respond to a surgeon who claims that total capsulectomy achieves equivalent, equivalent outcomes? And where do you draw the line in your practice when it comes to making that decision?

Yeah, so ever since the patient, uh, I discussed from 2016, it goes back to my training when we were always taking down a reconstruction. We were always removing the scar tissue because we felt from a biomaterial standpoint the debris off the shell could be embedded in the scar tissue. And that is what's been shown recently in a study done out of Denmark And so I always advocate for complete capsulectomy. It's very difficult in cases where it's super thin, but super simple in cases where it's very, very thickened. And there's no danger to the patient in terms of pneumothorax or problems with the chest wall. That's really, uh, extremely low incidence and should not happen. So let's talk about the paper out of Denmark. So everybody knows and has had a splinter gets stuck in their hand or foot and it creates a red bump, and that's basically your body reacting to a foreign body. That's a foreign body reaction. Everybody understands that. That's gonna, on— under a microscope, look like histiocytes and giant cells ultimately over time. Those are just types of cells. But what's really happening at the level of somebody's scar tissue, that capsule that's thickened, firm, or tight, a capsule contracture if you will, is they're having more of an organ rejection response. And we know in our patients, 83% on audit have genetic mutations in multiple detoxification pathways like their vitamin D pathway, their antioxidant pathway, their methylation pathway, their glucuronidation pathway. Many have hormone metabolism issues giving them hyperstates of estrogen, high, high levels. So Just think of all that. You have a, a bad genetic setup combined with maybe multiple environmental exposures, a mold exposure, heavy metal exposure, plus a device that your body is chronically bothered by, and you're trying to get it out. You're, you're actively rejecting it by increasing T-cell activation, B-cell activation, plasma cell activation. That's called organ rejection. And in the transplant world, you have to give patients medication So if I were to give you a kidney, you would have to take steroids and other medications to block their response. If, if we happen to be non-identical twins, you would need less medication. If we were identical twins, you would need no medication because you'd have the exact same genetics. So it's very, very simple. Our body is incredibly bright and elegant but extremely simple. It recognizes itself and everything else is for it.

When you created the Sharps method, uh, tell me a little bit about how did that come about and, and what is it that made you recognize that what most surgeons were doing, especially when it comes to explant, may not be enough?

Yeah, it was fascinating. So we took care of these patients and more and more of the patients kept coming and we'll say a third of them got well relatively quickly after surgery. So those are the patients you would assume who had infections or ruptures or capture contractures with leakage or whatever the series of problems were. But then, uh, you know, a third would take, you know, we'll say 6 to 12 months to get better. And then you had a third that really didn't get better, Dr. Fab, and that was a very, very difficult group to manage because they went through the surgery, they want to get better. So then we started digging deeper, and we already understood there were methylation issues. And, you know, we had early things like 23andMe, and we'd look at FUT2 and COMT and MTHFR. And now you can basically get the entire genome done, um, you know, for a relatively inexpensive amount. And Then we used more and more toxicity testing. First it was the, you know, Great Plains Mycotoxin Test, and then ultimately we established that we better be looking at all the toxins, heavy metals, environmental toxins, forever toxins, you know, PFAS. And the number one toxin in 500 consecutive tests in my patients is BPA. Number 2 is glyphosate. Number 3 is aflatoxin. And so if you don't pick your parents right, if you don't genetically detox well and you have a high, high burden, all you need then is an event, right? Death in the family, a reno of a home, a stressful something, an illness, viral illness, Lyme disease, whatever the thing is. And then it all bubbles over, as you know.

Well, you know, it's interesting because we're talking a little bit about some of the discoveries that you've had, especially when somebody shows up in your office and already may be experiencing symptoms, is concerned, is trying to do the explants. But there's a tremendous amount of people still doing implants today. —Right. So tell me a little bit about what is it that individuals need to take into consideration, or perhaps what are some of the things that you wish people would know before they did an implant that they understood the whole process, not only from the beginning and how great it may feel or even look and get into that mode, but instead maybe taking a longer-term look at whatever I do today may have an effect, you know, 10 years from now, 20 years from now. What, what would you say to somebody that's considering right now having a breast implant?

So that's, that's why we wrote the second book. We wanted to write the second book to help offer a way to educate people who are looking at that and making that decision, because the number one thing I get told, Dr. Fab, is like, it wasn't explained well enough to them. They didn't understand it. They didn't need— they didn't know the device would have to be changed out over time. They didn't know there could be downstream ramifications like you're alluding to. And so there's two big peaks of this. There's the young, young person who gets out of high school, university, and goes out and cobbles together the money to have an augmentation. That's one big peak, so that's early. Then there's the, the second big peak is around the time after someone's done having children and they're more in a, a state of looking for some kind of rejuvenative type procedure because they've went up and down in weight, up and down in breast size. There may be excess skin or sagging or something that's just— they're unhappy about. And so That first group is very difficult, Dr. Fabb. Young people, I have two young children in that age group and they don't listen to me. So, and one of them is a Leo like me and you can't tell a Leo anything, right? So I think we all need to just, I give them grace and I say, hey, here's the information, that's why I wrote the book. We have, as you mentioned, like 30 million views on YouTube when they used to show my videos. They don't really like showing them anymore. I have 4,000 of them and 160 podcasts. So the information is there if you choose to go find it. Now, when you're older with more life experience, I'm gonna be a little bit more critical of that group because you should take time to understand what Dr. Fabb is saying. There are always long-term ramifications. And if you've already been having children, you should be worried about both their health, but more importantly, your health. Because ultimately, those kids never go away. They just develop new and, and, and, uh, creative problems for you to help take care of. So you have to be around, you have to be healthy. And if somebody just wants to go up a cup size and have a tighter lifted breast, well, that's a breast lift and a fat transfer. And we'll talk about fat transfers because those have been bastardized throughout the the media and the, the world of the internet, which is undefeated. Now, if someone wants to go up a couple cup sizes, that's very different. So that's typically only going to be accomplished in one setting with an implant. So then you have to understand the ramifications of having a device. And I think it would be better, Dr. Fab, if people really understood their genetics from inheritance through their parents, their toxicity burden their gut health, their food sensitivities, their hormonal balance before they make these decisions. Right. There's nothing compelling about that decision without information. There's only regret on the back end.

You know, and I've seen that. I've seen that with not only patients, family members, people that I have known over the years, friends and family. And coworkers. And it's one of those things that many times we don't choose to make decisions with that level of understanding or research. We're just looking for that short-term gain, you know. This is what I want and it doesn't matter the cost of it. I'll worry about that then. Well, that's the interesting thing because you're one of those four leaders, I mean, one of those, forward thinkers and leaders in this space that is disrupting the whole space. I mean, you have been able to support people when there have been no other answers, when they were just pretty much giving up because there was nobody else that would say, let me see if we can understand what is causing you some of these things. Maybe let me see what is it related to. But Let's talk a little bit about breast implant illness and also the idea that what is the psychological component when patients come to you? I mean, making that decision to have an explant is not an easy decision, right? And I can't even imagine thinking it, but I've seen it close, up close with family members, and it's a very personal decision, but also one that— what are some of the things that you feel patients express to you as their challenges, their concerns? And what are some of the answers that you can give them to make them understand that maybe this is not as challenging or difficult as they may think initially?

I think the quiet part that's not said out loud that was said to me the other day by a woman in her 70s who's had implants for 40 years, was very worried about the appearance change. So 70 years old, with her daughter, her daughter with her child, so that granddaughter's there, and the 70-year-old woman is worried about her appearance. So bottom line is, even when they say they're not worried about it, Dr. Fabb, they of course are worried about it. That's my example, right? So I understand that. I give people a lot of room. It's a very safe place. You want to say everything you need to say, and I understand that. Um, everybody's worried about the amount of breast tissue they have. What's it going to look like? Is it going to be saggy with saggy skin? Is it going to be deflated? Am I going to do this and not feel better, right? Those are kind of the basic things. And, um, If somebody has had implants plus 10 years, I kind of look at them directly and say, well, we should have been having discussions about exchange, removal, because that would be the standard of care, because the rupture rate in a silicone device or saline device increases 0.5% per year annually after 8 to 10 years. It's already, um, past its prime at that point, right? That's old tech. And I usually just look at them like I did the lady with 40-year-old implants and I say, do you drive a 40-year-old car? She goes, no, I drive a brand new Range Rover. I was like, oh, that's fair. But you're carrying around a 40-year-old device, right? So I think from a safety standpoint, we can all agree that the tech 40 years ago was not great. What I tell all those patients is, you know, we've published this data that shows basically 1 out of 3 have a bacterial contamination problem contributing to symptoms. Now, the data I, I quoted out of Denmark last year is the most fascinating paper, first paper ever published about an enhanced immune system activation at the actual scar tissue level. So for everybody listening, and I can— I'll nerd out for a moment on this, If I have the ability to send that off for commercial examination, I would squash everything that I get bothered about on a daily basis because I could and then would know forensically everything I want to know. I would know, is there a biofilm there on the DNA test? That's the PCR test. And then examination of T-cell, B-cell, and plasma cell activity would be determined by RNA analysis. And protein formation. So the molecular science, the real things that we need, are catching up finally to answer the questions. Now, I feel like I can help everybody get better. Now, the time frame it will take will vary depending on how they start. If they've had symptoms for this 40-year-old set of implants, I'm not going to solve that in a week. Now, if you prepare yourself properly, improve your sleep hygiene, number one, improve your diet by increasing your quality of an intake of grams of protein per day, drink filtered water, not garbage, breathe quality air. And that's what I said, quality air, air that's been filtered at a high level, Swiss IQ Air, Jasper, things like this. Take everything that you put on your body and look at it critically. Because I just told you the number one thing I find is BPAs, and that's been in feminine products for over 70 years probably, and glyphosate, which is on food. So the quality of the fluid you use in your body, the quality of the air you breathe, the quality of the food you eat, and the quality and depth of the sleep you get, those determine much of what we're talking about, and they cost nothing to actually really implement. They're just habit changes. Now, I have all the elaborate testing you can get at any clinic. I have a nurse practitioner, I have a 3-person functional detox team. I have a full concierge staff that, you know, run my pre-op and post-op programs at my clinic. I have a brand new surgery center coming online. In my clinic, you spend about a week here and, you know, we work really, really hard on the front end to avoid problems on the back end, Dr. Fapp. I was taught a certain way, maybe go write a prescription for a narcotic and drop it off at the patient's bedside on the way out after surgery. So we don't do anything like that. We work really hard on the things we just said, sleep hygiene, food, air, fluid, proper supplementation to support genetic pathway detoxification, all liquid liposomal because my patients have so many gut problems. We don't even need to go into that. They take, years to sort out. And then by the time they get here, because they've done those things, they've already lowered their inflammation, makes the surgery simpler. They've also set themselves up so that everybody understands there's no one on this call unless you're a surgeon who causes more cortisol release than I do. So my whole job is to release cortisol in patients because I operate for a living. My job now is to figure out ways to drop that as quickly as possible. So in the lead-up, we do all this work. Then the night before, we use an ERAS, enhanced recovery after surgery protocol. So we start something for nerve pain, inflammation, and nausea the night before. In the pre-op area, I mark everybody, Dr. Fab, so they all see me. We always, you know, go over everything again. And then my anesthesia team does an ultrasound-guided nerve block with long-acting liposomal bupivacaine, or Expro. And so before my patient goes back, they've spent weeks to months preparing with the proper food, sleep, supplementation. I don't stop supplements for surgery either. I don't. They have an ERAS, they have an ultrasound-guided nerve block that helps diminish the signal from the tissues to your brain because that doesn't stop with general anesthesia. But with local anesthesia, you can curb it. And then when I do the surgery, we're talking about doing capsulectomies. I always do a capsulectomy. I try to do them all intact. In block is just a pathology term where you're taking a margin around it for cancer, but we try to take them out intact with very little in terms of excess tissue. No breast tissue ever, really. We don't want to take breast tissue in these patients. And then I do my own nerve block on the tissues when I visualize them. So we've done all that work pre-op. We, we've got our anesthesia team working hard and they're great. And then I add a block. So in recovery, my patients don't need fentanyl, they don't need Dilaudid. They need a pain pill, if anything, and a ride home. And that's why the caregiver can pick them up, take them. Now the night of surgery or the day of surgery, I try to tell everybody, you gotta get your circadian rhythm going correctly. So don't go home and sleep, stay awake. Try to get a good night's sleep 'cause you're gonna come to my office under your own power, not in a wheelchair, not on crutches. You're gonna walk in and you're gonna do a Human Regenerator treatment. When I bought my Human Regenerator a few years ago, I was the third clinic in the United States. So the Human Regenerator is like an ion shower that helps really lower sympathetic activation and get you into more parasympathetic state. It's like the feel-good machine, right? Yeah, then they do a lymphatic massage with a device from New Zealand called Flopresso combined with NanoV. So we do that simultaneously. It's a great treatment. You really have to improve filtration because I don't use drains in patients, and we can talk about that. I don't use any at all. There's no chance you get a surgical drain site infection because I don't use them. And then they do a vertical hyperbaric chamber treatment and a red light treatment with you before they leave. And so the whole point is, I hope everybody understands this, if you prepare properly, if you run a tight ship and you have a really dedicated staff like we have, your patients are going to do really, really well. And they're going to be, you know, I always like to say, Dr. Fab, if you get off on the right foot, you're more apt to have success. If you have problems in the beginning, it's always going to be tough.

Well, you know, And I love the way that you explain it because for anybody that may be watching or listening to this, they can kind of visualize the whole process. And I love the fact that you do spend quality time on that pre-surgery routine or ritual because we do know in functional medicine, holistic medicine, the importance of that. Anytime you're about to do any type of surgery, And also your recovery is much faster, like you mentioned. Let's talk a little bit about misconceptions out there in the space, because we've been discussing a very advanced way of dealing with implants, you know, X-Plast and some of the illnesses that we're finding. I know that the industry still is trying to contain the same philosophies that they've had for years. Yeah. And it's a business. I mean, I've always said that healthcare, the biggest thing that I tell doctors, and I've trained a lot of doctors in my life, I always said your biggest surprise as you enter the healthcare field, that the healthcare field is not really about health, it's more about economics. And the economics drive most of the decisions in healthcare. And as long as you understand that as a doctor, you will never be disappointed. Now, what you can do is you can choose to follow your own values, and you've chosen to do that. You've chosen to expand your training in order to better support your patients and better educate them. You're one of the top educators in this field, uh, worldwide, and that's why you have so many millions of views, is because you have been training people and educating them for a long time. But When it comes to misconceptions, what would you say are the top misconceptions about having implants? Maybe the top misconceptions about explants, or maybe perhaps breast implant illness. What would be the top misconception of each one of them that you have seen out there in the marketplace where again and again people keep coming to you with those type of scenarios, or perhaps when they message you, text you, follow you, or listen to one of your many lectures out there?

Yeah, first and foremost, it's still the misconception about maintenance of a device. So instead of, you know, being told that this needs to be changed on an interval or surveilled over time, it's this one-and-done type, you know, um, feedback I get, which is not a, um, it borders on just an ethic issue that I have. You know, when you're communicating, you should always say any device you put in can become infected and need to be removed. So that's whether it's a defibrillator, pacemaker, neurologic implant, mesh for whatever reason, hip implant, knee implant, dental implant, breast implant. They're all foreign and they can all become infected. And nothing is forever. I don't, I don't know where this conception, you know, developed, but, you know, they used to be very, very leery, if you remember, to put knee implants in young patients because they knew they would have to change that out. And every revision surgery is got a higher complication rate. Every revision surgery is more prone to, you know, another problem. And I always tell everybody, Dr. Fab, you know, all I do really is operate on revisions, right? I do a revision every time I go in the operating room. I don't make blood supply better. I'm not Harry Potter, for Christ's sake, you know. I, I'm, I, I'm not a magician. So I try to tell everybody, very honest with them, you have to be very respectful of tissues and what you can do. And patients, you know, whether you have blinders on or you're not listening, you sign a consent form that's very well thought out by a lawyer who happens to be a plastic surgeon. All of it's in there. And when you say it wasn't told to you, I understand that, but it's really inauthentic for you not to sit and read it. If you're putting a device in your body. So we, we all know the Type A shopper, and we just want to get it done and, and move on. That's, that's one. Like, a device can fail, will fail, will need to be exchanged over time. That's fallacy, you know, number one. The next one is this misconception, misguidance, disinformation about capsulectomy. So I published a paper to show that if you don't do that, you're essentially leaving infected biomaterial in a patient. And so I find it to be almost asinine for someone to question that because it's very plain, right? You have biofilm, you have debris from the device shell which is cured from heavy metals, Every shell of silicone elastomer, you have debris, your T-cell receptors will look at that and know it's not you. You'll have ongoing signaling. So when patients go to doctors under local, Dr. Fab in the office, they will numb it, incise it, and pull the implant out. I had this done on a patient who had a ruptured silicone gel implant. They were peeling ruptured silicone gel out of somebody awake. Now, you know, you can never ever get that out. Think of like reaching inside someone's chest and trying to pull out a whole thing of jelly. It's impossible to do, and you are being dishonest and to me really unsafe by saying that you can do that for a patient and have an outcome that's you feel comfortable with? How can you sit back as a provider, knowing what you know, training how you've trained, and say that? That patient went and had ongoing symptoms because of everything we've talked about. So I did her revision capsulectomy, and all of that went away. Yeah. And then, you know, the final thing about breast implant illness, I testified at the FDA hearings in 2019. Everybody can go and watch it. It's on my website. I said, as the president-elect of a research foundation, we'd fund research to help better understand it, 'cause we just didn't have a good understanding. And I'm no longer a member of that society, but I did get funding for those projects. And since that time, I think 200+ papers have been written about breast implant illness. So it did help get the conversation started. Um, but for somebody to be a denier that there's a problem, or questioning whether or not a device can have biofilm contamination or bacterial infection, I find that to be really disingenuous as a position to take as a provider, especially someone who understands and should be able to explain those things, you know, to patients. Those are not difficult concepts. So those are the things that I, I find very bothersome. The other thing that really bothers me is there's not an even discussion given to fat transfer. Fat transfer is something that, although I don't want to write another book, Dr. Febb, I have to probably pen one about fat transfer because it has not been given appropriate discussion. It is not discussed with patients as an option. And I'll leave everybody with this, and then I'll let Dr. Fab take it again. I finished training after 6 years of general, 2 years of plastics, and a year of oncologic microsurgical reconstructive training. I started practice in '05, and I took almost exclusively care of cancer patients and trauma patients. But because breast cancer is so prevalent, that's what I, I did predominantly. And everybody who has a mastectomy ends up getting typically a second operation that is a contouring type operation with a fat transfer. So every year for my first 15 years in practice, I did about 100 fat transfers to 150 a year. Now, if you graduated and finished, we'll say, at the same time I did and went into private practice and were an aesthetic cosmetic surgeon and maybe doing a little bit of this and a little bit of that, there's no way in hell you can ever match the experience I have about fat transfer. So when people talk about it, I always tell patients the same thing, and I'll tell you this: you don't take a Ferrari to a Volkswagen mechanic. If you don't know what you're doing, just say you don't know what you're doing. You don't have enough experience to talk about it, to give it its due. If you can't have a balanced discussion about it, just say, hey, why don't you go see someone like Rob? 'Cause he can talk to you about it. I can't, I haven't done enough. But to say it doesn't work, it doesn't last, and it's basically a coin flip, I mean, who the hell wants surgery like that? That's crazy. Nobody should do that.

For those of the people that may be listening or viewing this and they may have never heard of fat transfer before, can you briefly explain what exactly it is? I mean, I know what it is, but I think it's important because you explain it so well. Yeah, but I want to make sure that they understand what the actual ask, you know, to you is. Would you do a fat transfer after the X-Frame?

And everybody can look up— I wrote a safety paper about fat transfer to the buttocks when people in Miami and Los Angeles were dying from fat transfers to the buttocks, which is called the Brazilian butt lift. So fat transfers are not new, they've been around over 100 years now. The way which we harvest the fat has changed, the way in which we process the fat or contain the fat has changed, and the way we deliver it back to the recipient site has changed. The predominant Places we take fat from in my practice are from the inner and outer thigh area, the love handle or flank area, and of course abdomens. Those are special instances. And then when we put it back, Dr. Fab— so we acquired with a certain system, we use Wells Johnson, which is specifically designed to harvest fat. It's contained sterilely, it's never exposed to the air in the room It's never somehow contaminated or anything like that. And then after processing, we have a special vibration plate to separate it because water is denser, blood is denser, and then the fat will go to the top because it's the lightest. And I think it's an exceptional tool. I've used it for cancer reconstructions for, like I said, over 20 years. And in the setting of aesthetics, Everybody needs to understand, when you put it back in somebody, that is really not that complicated. What is complicated is what we talked about on the front end, which is preparing the patient, lowering their toxic burden. I also get a DEXA scan, Dr. Feb, on every single patient I do a fat transfer on, because I do a lot of low body fat transfer, low body weight fat transfers, low BMI fat transfers, because they've been shunned by other surgeons and told point-blank, oh, you can't have a fat transfer. You don't have enough, enough fat because on physical exam they couldn't figure it out. But I think in 2026, even using an old technology like a DEXA scan, which is my preference because they're ubiquitous in this country, it's easy for me to talk to someone in Dallas where you are and say, hey, just get a DEXA scan, I'll look at it. So I get all those things up front, we lower their mycotoxin burden, specific protocols, itraconazole, cholestyramine, hyperbaric pre-op for that. If we have too much PFAS, organophosphates, glyphosate, BPA, we'll delay it. If it's within our ability, you know, to treat them and do the work, then we'll say, all right, Rob acquires the fat and now he's gonna put it back. Where does it go? Right? So fat, and we'll say for the chest, I guess we can describe two different real estates, all right? The buttocks is big and has a big muscle, the gluteus maximus. I wrote the safety paper and said, you know, I remember when I wrote it, Dr. Fab, I said, "We shouldn't really put fat in the muscle anymore if we're worried." And they're like, "No, you can't say that." So I said, "Okay, well, fine." We took that out. But there's this big fatty layer. And so you put it in the fatty layer. That's it, very easy. You don't point at the sciatic nerve and you don't point at the blood vessels, you just go over the sacrum and inject it. Really simple. But it goes in the fatty layer. All right, so what's the difference in the chest? Well, males and females have a pec major, they have skin and they have fat. Males and females have breast tissue, they just have varying amounts. So it doesn't belong, like we said, in the muscle., and it doesn't belong in the breast. It belongs in the fatty layer, which is beneath the skin and above the breast tissue. And so just like the pocket on the front of a shirt, that pocket will only fit so much. And so when it is full— so, so think of it like this: the expression is pot orange, like an orange peel. When the dermis is at its max of stretch, it will look like peau d'orange, or orange peel. That's your endpoint, that's your stopping point. There's this concept Dr. Fab talked about as overgrafting. I don't know if you've heard of this, and they do that because they're expected to lose volume. So when I hear that, I find that to be one of the most unethical things that could ever be said out loud to a patient, because you are telling me that you were not trained to do anything related to cancer, because you would never overgraft the cancer patient, because that would make them ultimately feel like they had cancer again because there would be an area of firmness, a cyst, calcifications requiring biopsy— all the things that no cancer patient ever wants to relive, you just set them up to have. So just by saying those things out loud, I know you don't know what you're doing and you shouldn't be doing it. It's not an ethical thing to offer a patient. It's an absurd thing to offer a patient. Right? If we're going to be, you know, stewards of this and do this properly for patients and get the right results, then prepare the patient properly, set the correct expectation, do a responsible procedure, and support them through the process— pre-op, intra-op, and post-op— so they get the best possible results. Don't set up stupid, unrealistic expectations and then create new problems.

You know, it's obvious that you've always been a man that has a mission bigger than themselves. You know, you didn't stop at your conventional training the way most doctors and surgeons have. You're still looking for better ways, and I commend that. But if we look at the Shark Method as the standard of care, especially when it comes to X-Plan, What would it need— what would need to happen in this healthcare system of ours that's so conventional, in some ways antiquated in my opinion, in order to better support the patients today and in the future?

Yeah, I've talked about this and I've tried to— and anybody listening on this call, we're open to discussions about this because I think the bridge between my Western education and genetics and we'll call it integrative care and all this emphasis on biohacking and all these things. The Sharpe Method is really the blending of all those things. It's in the middle. It's the, the, you know, the Venn diagram basically. So I feel like that's how surgical care should in fact be delivered. Now, is that going to happen I think it will only happen top-down. So the people who have the wherewithal to approach it in a very aggressive way to help patients, that'll be where it starts. And that's the people who can and are working at the top end and they're high-performing patients. They want the fastest possible recovery. They want the best possible situations. They understand it, they get it, they're switched on to those things. My problem, Dr. Fab, is there are plenty of patients like that. They have to find me because I haven't licensed or trained enough people. The problem is that the surgical side, the surgeons wanting to do that and caring that much about doing that, that is what I don't find. Because if you've heard me speak, Why wouldn't you want to try to do it a better way for your patient? Like, if you don't desire a better patient experience, then why are you even in the game, right? So that's not a, a slight to anybody, but if you say you're all about patient safety and you say you're all about patient advocacy and you say you're all about delivering the best, well You probably ought to start trying a little harder then.

You know, I've been a, I've been a doctor for over 35 years. I was an educator for over 13 and a half years. And the one thing I can tell you with certainty is we live in an evolving world. We know that technology is changing things very rapidly, but we also know that We are beginning to study things that we didn't know the answers to before. We're beginning to recognize ways to not only live longer, but live a better quality of life as we live longer. And I believe breast implants or explants are no different. This is just one area that unfortunately has not advanced as some of the other areas that we're seeing as quickly as that people have very much began to embrace. And I believe a lot of times is because as doctors, we may get comfortable with the training that we were given. I mean, you know, you go to school for over 12 years, sacrifice so much to get to that point. And if you stay within that parameter of training and you choose never to depart from it to try to identify Are there any other better ways out there that maybe I'm not being educated in my typical continuing education seminars that I attend, right? I go to all kinds of different ones, not only within my industry, but also, you know, regular medicine and functional medicine and integrative medicine. Why? Because I want to learn what other experts out there are figuring out, right? And how do I bring that into my particular profession and improve upon what has been there, if that makes any sense. But I have one last question, and that is, because I know I'm very sensitive to your time and I know you've had very long days, what would you, what would you want to say to somebody that may be listening right now after listening to everything that you've explained? And they may be sitting in a position where They're having to make some decisions. I know that before the call I asked you if it would be okay to try to set up maybe a call where somebody can have the opportunity for a few minutes to ask the question, because there's nothing like that. And because I know you personally, I know how giving you are, and you allowed us to do that. And I'm going to send you those that are watching, a special link that you can actually reserve that special time where you can directly ask the questions that are important to you. But on a general basis, based upon the years of experience that you have, what do you think that somebody— what would you like for them to take away from this time that we've had together where you have explained so many things that I bet you anything the comments are like most people have never heard of or they've only heard very limited versions of what you explained very thoroughly at this session. And I'm so glad that I'm recording it because for those of you that are watching, I'm going to send you a recording so that way you can actually view it again and maybe share it, share it with somebody that actually may be going through something difficult. So what would that be, Dr. Whitfield MD?

So I, I really appreciate this. And when we talked, we were at a book signing together, uh, and it's taken a while to get this organized, but In that time, over that period about 9 months, I've become, I think, the most censored person talking about this. I've been taken down from YouTube, essentially. You can't even find our videos anymore. So I think what I would like people to understand is the symptoms, the, the problems, or the The frustration you've experienced from providers is, I would say, not uncommon. I think Dr. Fab and I have talked at a very high level. Now, most providers are not going to be able to sit across from you and have that discussion because they don't understand it. They haven't seen enough of it. Surgery, Dr. Fab, is a sport of repetition. You get better with time. And I don't listen to people to make a diagnosis to give them a prescription. I listen to people to understand their exposures through their travel history, work history, living history, diet. Through that, you can listen and understand their genetics, patterns of inheritance of certain genes. So I want everybody to understand you're not crazy, you're not losing your mind. You may in fact have a very specific problem of chronic inflammation that a breast implant is playing a role in. It's not the only thing, but it is playing a role. So like Dr. Fab said, I gave him a link to have a free discovery call with my team. Now, once again, I have put out 160 shows, 4,000 videos 3 courses, 2 books, A Partridge in a Pear Tree. There's enough education out there, you just gotta go find it. Now I do have a private community and once we're done, I can go hop on there. It's drrobcircle.com because I have been censored on YouTube, Google, Facebook, and Instagram predominantly. So they've made it very hard to find me and you know who's capable of doing that. In this period of time that we're talking. The implant companies are owned by two very large pharma companies. One is J&J and the other is AbbVie. That's all you need to know.

Well, I just want to say thank you so much for your time, uh, and also for your life work.

Thank you so much for having me.

Can you repeat the— can you repeat the website again so they can —join you from here to there.

D-R-R-O-B-S circle.com. DrRobbscircle.com. Perfect. Thanks, everybody.

I will see you next time. Bye-bye. Bye-bye.

All right, we're gonna answer questions after the webinar I did with Dr. Fab. That was incredible. He's an incredible host. I really appreciate him having me. Um, I hope you all got to hear the webinar. Let me know what you thought. I mean, he is an incredible surgical— I'm sorry, from an educator standpoint, he's been incredible. I've done signings with him for his books. He's done tons of programming, and it was a pleasure to share our surgical education with his audience. I hope you all enjoyed it. So I'm free to take any questions and Let me know what's on your mind. All right, Leah and Danielle, you have the floor. Awesome, I'm glad you got to— So we were at a book signing together and just like he said, I was introduced to him and we started chatting. He knew somebody personally in his circle that had had an explant, understood how important it was. But because of his schedule and his book tour and everything that I normally do, it was not easy to get our schedules aligned. And he just got back from Italy this morning, I believe, or this afternoon, and came and did this. So it was amazing that he did that for us. And I was supposed to be in Cannes today for a film festival to, be part of the premiere of SHIELD, the documentary I'm in with a lot of other people. So although it was disappointing to miss that, I saw the pictures today and the video today, and that's pretty, uh, um, exciting, like a once-in-a-lifetime opportunity to be there in Cannes for the premiere of that. But Hey, everything for a reason. Hopefully this really helped, you know, people listening or stimulated them. I'm still, like I mentioned, getting heavily censored online, both on Instagram, Facebook, YouTube, Google. I don't know if TikTok actually gives a rat's ass about me, but it doesn't surprise me if they censor me as well. Oh my gosh, I had Miss Hannah on today. I have Leah tomorrow on the podcast. So it's, I did 3 podcasts today and this webinar and now live Q&A. So we've had a big day of broadcasting. Then tomorrow I have Leah and yeah. We are located in Austin, Texas, and, um, whether you're coming from London, Singapore, Sydney, LA, New York, Denver, Seattle, Phoenix, Atlanta, anywhere in Florida, uh, Mississippi, Alabama, The Dakotas, Montana. Lovely Hannah is in actually the beautiful state of Montana. And yeah, we take care of everybody. We've got a really awesome set of folks who help with Airbnbs, or if you have a great hotel relationship. Yeah, all the things are here. Austin's a fun place to visit. We have the hookup for all the great places to eat at and to DoorDash from, like Eat Well ATX, gluten-free, dairy-free, seed oil-free restaurants that we're super close with. If you're plant-based, we have a really, um, great group, uh, folks who do the Conscious Kitchen and kind of everything in between, honestly. Um, Yeah, yeah, I just made a new travel page and it highlights all the countries and places that patients have come from, and we just put it up, so it's, it's a new build-out for us. In addition to our scientific research page, which highlights our study, so we have thanks to the hard and diligent work of everybody on the team, a section that's called Answers. So the LLMs, or the large language models that everybody's using, all answer questions. And here is the answer section from our 160 podcasts. And then we have an entire blog section. That has been revamped, and we have 138 blogs. So yeah, so we can just keep, uh, you know, letting everybody know. If you guys would share that information, that would be great. Um, the team has done a ton of work since February 19th when we launched, launched a new website. Um, Yeah, I mean, we've put, I can't tell you how many hours into this thing. But those are just samples of the blog, the answer page, the travel page, of course. And all the things about SHARP and surgical services are there as well. You're already in the circle. These things are all linked within the circle, but I'll just put those new pages up so everybody can see them. Where are you at, Lucrecia? I know Dr. Fabs in Dallas. Are you in Dallas? LA. Okay, awesome. Yeah, I have good folks, um, in LA. If you want to run our system, um, you know, I'll be biased and say I have the best system in this country. I think it's hard if I say the world because I know some folks running some things in Europe that are pretty unique. But our staff is not— I think our staff is unparalleled because I've done an explant on my nurse practitioner who runs our surgical follow-up program. I've done explants on 2 out of the 3 functional detox practitioners that run our functional medicine detox program. In the office, we have this incredible team that takes care of everybody and helps with the Human Regenerator, helps with the hyperbaric, helps with the lymphatic massage with Lopresso and the red light. So it's really unique and, um, very proud of the group that we have. Very proud. Super happy. Are there any questions I can answer? Did something, uh Did everything, I hope, resonate and make sense? Awesome, all right. Well, we look forward to having you here, Lucrecia. We're just now gonna assume that you're coming. We just have to figure out the timing of it. And then you can come visit and hang out with us. All right, if there are no more pressing questions, I am gonna call it a day, 'cause it's 8:18 Central. I'm a bit tired, it's been a bit of a long day, so, all right. Have a great night, everybody.