A recorded conversation (YouTube video) between Robert Whitfield MD and Michael about safe breast reconstruction practices, focusing on the en bloc explant/removal technique. Dr. Whitfield states he has performed 1,500+ related procedures and reports pneumothorax and hematoma rates under 1% in his practice. He explains reasons for complete implant/tissue removal (infection risk, cancer surveillance) and cites emerging implant-associated cancers (squamous cell carcinoma and lymphomas). He describes a training program to teach the technique and emphasizes that outcomes are procedure- and operator-dependent.
Questions this video answers
1,500+
Less than 1%
Less than 1%
Chapters
The funny thing is there's a lot of pushback, right? Oh, it's dangerous. Right. You'll hear this a lot. So everybody can. For your audience to know. I've done 1500 plus and I have a less than 1% pneumothorax rate, which is entering the chest, and a less than 1% hematoma. Right. It's, you know, relatively speaking, it's a very, very low risk procedure in the hands of somebody who's experienced. But I didn't get that experience in the traditional fashion from cosmetic surgery, because I did cancer surgery for so long. So when I would take down a reconstruction to make someone flat, which is perfectly fine in terms of reconstructions, if that is what they wanted, whether they began that way or they wanted their implants taken out and become flat, you would take all that material out anyway. For a couple reasons. One, they could have an infection because they had an implant. Everybody knows anytime you had an implant, you could always have an infection because it's not your tissue. The two is, the more important is cancer surveillance. You want to make sure that nobody has a recurrent cancer. So predominantly this has been done in breast. And that's what my basic career was about. And I, in 2016, was asked by a patient who wanted to go flat, which, would you just do this en bloc technique? And I'm like, kind of weird for a patient to ask me that, but I know what it is because it's just a pathology term we use. But basically you want to take out everything intact entirely, and not in every instance can you do that. But you can certainly put yourself in a better position to take care of your client if you're trying to do that. Because more and more cancers are being found all the time now. There's breast implant associated squamous cell carcinoma. There's breast implant associated lymphomas. So there's no, you know, if you're looking at it from a provider and you're trying to be safe, then, you know, we created a training program to help people, you know, observe what I do to make it easier for them to execute for practices. We created a training program so that they could take care of the patients better, understanding how we take care of them. But it is a very safe and executable operation in experienced hands.
I want to discuss and walk the audience through the procedure.
Okay.
Okay. So first, tell us what happens the day of the morning of. And I can chime in with my experience, but.
Or maybe even go back a little bit more. And talk about what you do before you.
Right. Because you do do pre stuff. That's good, Michael.
Yeah. So our, our program is predicated on avoiding what can be poor outcomes afterwards in terms of recovery. Because for the audience, you have to figure out what are the sources or drivers of inflammation in order to, on the back end of this, feel as good as Lauren Ory does, because not everybody's going to react like she did to surgery.
