Why Fat Transfer Results Vary After Breast Implant Removal (Explained)

Let's get rolling. Welcome everybody. So there's a question I get more than any other, and it's almost never the first thing that a woman says to me. It's usually at the end of a consult, um, kind of there's been time, it's quieter probably by that time. She's listened to and trusts what we're saying. Typically she'll look down or look away and be very concerned and say, what am I actually going to look like? Not actually will I be healthy again, not will the fatigue go away, but what will I look like? It's a very fair question. I get asked a lot. People very concerned about it, and I want to speak to it directly tonight because that one question, the one most women are most embarrassed to ask out loud, is the single biggest reason women stay in this kind of chronic state of inflammation with their implants. They already know they're actually a source of chronic inflammation. So many of you hopefully have heard some of our videos or shows. I'm Dr. Robert Whitfield MD, I'm a board-certified plastic surgeon. I'm in Austin, Texas. I spent almost the last 10 years working on explant as a problem, testified at the FDA hearings in 2019, and devoted research dollars to BII as a past president of ACER. And so here is what I want to do for the next 30 minutes. I'm not going to be selling anything. We're just going to talk about what we found. We're going to include parts that, you know, other, other people probably won't discuss. And just, we want you to stay with us on this. And at the very end, we're going to tell you one thing that matters more than how much fat you have, more than your surgeon, more than the technique, more than than any of those things, it's the one thing that actually determines whether you're going to be happy with your results, either 6 months later, a year later, or 5 years later. And most people never have heard of this, and we'll get there. So let's get started. Remember, we're gonna go live after I give this talk in my private community, drrobcircle.com. It is free to sign up. Go to drrobcircle.com/ www.drrobertwhitfieldmd.com/signup. The first thing I want to say is, if you're afraid of what you'll look like, you're not vain, you are not shallow, and you're not alone. I've had women in my office who are genuinely sick— fatigue that doesn't lift, brain fog, joint pain, rashes, chronic problems with constipation, chronic UTIs, chronic bacterial vaginosis— women who know that the implants are part of it, and they still wait. Another year, 2 years, getting sicker. And why do they do that? Because somewhere along the way, someone made them feel that wanting to look like themselves is a character flaw, that if you're really sick, you shouldn't care about your body. And that's complete nonsense. Your body is yours. You get to want your health and want to feel like yourself in the mirror. Those 2 things were never in competition, and anyone who told you otherwise had done a disservice to you. So the fear is rational. It deserves a real answer, and we're going to get to that. Here's the crux of the problem. Most of the time when a woman finally asks that question, the answer she gets is a scare or a shrug. You'll be flat, or we'll just put a smaller implant back in, or the worst one, silence and a subject change, or it's not a thing, it's in your head. Tonight you get the real answer, and it starts with dismantling one assumption that almost everyone in this position is carrying without realizing it. That assumption is the first loop I'm going to open, so hang on to it. Once again, afterwards we're going to do a private Q&A, so hang in there. The assumption is that an implant is the real result and anything else is what you settle for. Now think about that. No one starts out with implants. Think about how deep that runs. When a woman says, what will I look like, what she's really picturing is with the implant versus without it, as if the implant is the baseline, as if that's what's normal and that's what normal looks like, and taking it out is subtracting from normal. So we want to change that around tonight carefully. An implant is a device, and I'm not here to demonize the device. I've placed them for cosmetic surgery, for cancer reconstruction. They have a role, and I'm not going to stay in here until you that every implant is a problem. That's not honest either. But let's be clear about what a device is. It has a lifespan. Your body builds a capsule around it that walls it off because your body knows it's foreign. It doesn't belong there. It can rupture. Obviously, it needs to be monitored. And at some point, whether it's an 8 to 10, whatever window we're looking at, it's going to need to be exchanged or removed. And that's not a scare tactic. That is what comes along with having a device— hip, knee, breast, dental implant. They're all similar in nature. So here's the reframe: an implant was never your baseline. Your baseline is you, your own tissue. And that changes the entire question. It's not, what will I lose when the implant comes out? It's, what can we restore using actually what your own tissue sources? That's not a consolation prize. That's actually a different starting point entirely. Now, I told you I'd tell you the truth, including the hard parts. So let me open a second loop. And this one's going to sting a little for some of you. So if a surgeon has told you that a fat transfer won't work for you, that you're not a candidate, I want you to consider a couple possibilities because there are two and they're both very different. The possibility is first that that's actually the case. It's true. And I'm going to be honest with you, I do probably as many low BMI fat transfers, low body weight fat transfers, as anybody around the United States. States. And so there are people I just tell no to. I go through a lot of studies and look at DEXA scans and physical examinations, um, and really try to be as data-driven as possible about it. Now, if there's not enough fat, then we can't transfer the fat. So that's reality. No source, can't have fat transfer. That's, that's just the, the nature of the body, and that's not an opinion. A good surgeon will tell you that plainly. And if someone told you that, they may have just been trying to do the right thing by you. But there's also a second possibility, and I hear this actually frequently, and it bothers me, that fat transfer is harder to do. It's a longer operation, requires harvesting the fat, processing the fat, and placing the fat with real technique. And the result depends heavily on how well Each of those steps is done. Now, placing the implant is definitely faster and easier. It's more predictable to execute. So sometimes when someone tells you you're not a candidate, it means exactly what it is, like you just don't have enough tissue to actually do the procedure. And sometimes it means this isn't an operation that the surgeon is experienced with, does, or feels is in their wheelhouse. And that's fair too. They just need to tell you that. Both are legitimate positions for a surgeon to hold. Nobody has to be, uh, the villain in either of those stories, but you deserve to know which answer you actually got because they lead to completely different outcomes. I can't resolve that obviously from the outside, but inside the Q&A tonight, if that's your situation, that's exactly the kind of thing I will help you go through. We can dig deeper in that if you want certain specifics, other things that we look at carefully. So, like, hold that thought. Let me show you what fat transfer actually is, because I think most people picture it having probably the wrong types of frames. So I'll give you the version of this that most surgeons don't take the time to explain. So fat is a living tissue, right? Underneath your skin, there's a fatty layer all over the body. And that's the whole key to everything I'm about to say. It's not a filler, it's not a product, it's living tissue. It has cells that need oxygen, it has a blood supply, and it needs to be placed in the appropriate area to survive. So when we do fat transfers, we're not injecting a substance into a space. Think of like you get a filler placed in your cheek to expand the cheek, and that's a hyaluronic acid filler site. So that's very predictable. It's also something you can dissolve. When you place fat, it's a much larger molecule. It goes in the fatty space and you can't put a lot of it, especially in the face. So when we're removing fat from one area and relocating that tissue to another area to take and heal in that area, whether or not it takes depends almost entirely on the environment we place it into. And those are principles I build everything around. Fat belongs in the fatty compartment, like they call, with its fatty friends. And think about, once again, where fat naturally lives on your body. It's underneath the skin. It's in that layer. There's, there's a really nice blood supply there. And when we place transfer fat into that kind of environment, the right layer, the right plane, the right amount, the right time, it has its best opportunity to survive. It will revascularize. It'll grow blood vessels. It'll integrate and become part of that fatty layer that you already have. It'll augment that fatty layer. When the fat is placed in the wrong environment, so too much in one spot, in the wrong space, overgrafted, then the blood supply can be compromised. Its ability to heal can be compromised. And that's when you get problems. And there's all sorts of stories on— online, obviously, about things like this. And, you know, And those really aren't stories about fat transfer failing. They're stories about fat transfer done without the, like, right concepts, if you want to think of that. And essentially, this is why two patients, two women, can have the exact same amount of donor fat, the exact same procedure on paper, and get completely different results. The difference isn't the fat. It's the environment, the technique. And this is the part I'll get to. What happened in the woman's body before she ever got to the operating room. And that brings me back to what I spoke about at the very top of this. The one thing that matters more than any of this— I haven't forgotten, we're going to get there shortly. So once again, after the talk, we're going to drrobcircle.com/signup. You can sign up for free. drrobcircle.com. It's going to be a live Q&A after that. Yes, this is a discussion about subcutaneous fat, not visceral fat. Okay, let me deal with the fear head-on because I've been circling it and you deserve some more specifics about that. How much volume can you actually get back? Well, here's the honest answer. I actually have implant on my desk as usual. Um, you're never going to have an appearance like implants, so the volume issue is, is a little bit more complex because any surgeon who gives you a guaranteed number over livestream like we're doing now without examining you is not really informing you. What I can tell you is the shape that can be restored with fat is a natural appearing shape. It's not gonna be dramatic. It can't project, right? That's the issue that is really the crux of the problem with implants is the projection. Whether it's for augmenting a deep flap breast reconstruction Or if it's a post-mastectomy breast reconstruction with an implant you're augmenting, or if you're doing a, what I call a holistic mommy makeover, where you take fat and redistribute the fat from the thighs, the abdomen, the love handles, the bra fat area, and augment the breast with that, with or without a lift. Or if you just do an augmentation, I saw a patient yesterday who just wants to be augmented with their own fat instead of an implant, which is absolutely fine. But it's hardest to do in the youngest patient because they haven't experienced weight loss or weight gain, breastfeeding, changes in the breast tissue, aging. So the skin is tighter, makes it harder to augment. So let's get back to the talk. For a lot of women coming out of explant, They really just wanted a fuller breast all along, not really the augmented look. They didn't want to be dramatically larger. I get all sorts of complaints all the time about people getting implants that they felt were too big or not what they asked for when they went in for consultation prior to surgery. Like, there's all these decisions that are made while patients are asleep that I find to be Very disconcerting. Like, everything should be agreed upon and not changed without a patient's permission after the fact. So basically, um, they just want to feel like themselves again. They, they wanted to— they want to fill up their bra and be comfortable both in clothing, in the mirror, and they just want to know that's achievable. And most of the time we can do that. Not always. And here's the piece that gets missed. How much of that transferred fat survives? How much of it stays with you long term? And obviously that's not a fixed amount because you're going to change over time. It's not a number you're born with. It's influenced by things you actually change. In this case, I'm going to discuss how we change things before surgery. So that's the loop I opened at the very beginning, and let me close that now. At the top, I told you there's one thing that matters more than how much fat you have, more than your surgeon, more than the technique. And here it is: the single biggest variable in whether transferred fat survives and stays, in my opinion, the thing that almost nobody talks about, is the condition of your body when the fat is actually placed into it. So fat is a living tissue. It has to survive a move, and whether the living tissue survives a move depends on the environment it lands in. If your body is inflamed, if your circulation is compromised somehow, if your metabolic health is off, if you're nutritionally depleted, you're definitely asking the fat to take root in a more difficult or a more hostile environment. Now think of it kind of like gardening, right? You have the best seeds in the world and the most skilled gardener, but if the soil is depleted, the terrain is bad, if you will, nothing survives. It can't thrive. So if we took two identical seeds and put them two different soils, two completely different outcomes. Could happen. And so we'll just think of like your body is the soil, it's the terrain, and we want to get that optimized. And here's what that means and why it should give you hope rather than anxiety. The soil, the terrain, is the part you can influence. You can change how skilled a random surgeon is. You can't change your bone structure, but your inflammatory state, your circulation, your nutritional status, your metabolic health, all can be changed going into surgery. They are not fixed. Those can be optimized deliberately in the weeks and months before you ever get to, in this case, Austin, Texas to visit me. This is the part that almost every recovery conversation skips entirely. Everyone obsesses over the operation itself, the 2 hours, the 3 hours, the 4 hours in the operating room, and ignores the months on either side of it that actually determine the results. In my opinion, I built an entire method around this, wrote a book about it. We're not going to go through the whole thing on the livestream. That's what the deeper conversation for is in Dr. Rob's Circle. So go to drrobscircle.com/signup. You can sign up for free. We'll go in there and we'll answer all the questions everybody has. Danielle is already in the circle, so she gets to go first. But what I want to leave you with tonight— oh, interesting. I just got restricted on TikTok. How funny. Operation is just a moment in time. There's always a process, and a huge piece of that process is in your hands before you ever come to the operating room. All right, so one more loop, and then I'm going to bring it all together. So there's a timing question around explant fat transfer that most women never get told about, and getting it wrong costs people, um, quite a bit of, of obviously time and expense. So the question is, do you do the fat transfer at the same time as the explant, or do you wait and do it later? So we have a program to work people up and stratify them into candidacy. So that's how I accomplish that and vet people. And so it's hard to give a blanket answer. Each person is bio-individual. So we work each person up, and then we decide in conjunction with them what we think their best options can be. And I will delay people if they're not in a good enough state of health, if I think the terrain is not good enough. So sometimes combining them is the right thing to do, and sometimes staging them is better for the patient. And the wrong move is just doing that and rushing into it without further analysis of the patient. So what I'll tell you is this: the women who, uh, I have who feel the best about their outcomes are most always the ones who understood all their options before they were ever on the schedule. Not the ones who found out their choices abruptly, made quick decisions, and did not have time to prepare. And that's the reason, you know, we've done these talks. I know many of you know since March I've done 3 a week, and we decided to do, uh, 1 a week moving forward at 6 PM, uh, Central is a good time slot for us, 7 PM Eastern. And we just want to share what we've learned to help patients make better informed decisions. We don't want you to rush. We want you to make a very informed decision. We want everybody to understand which path fits in their situation, and that's what tonight's conversation is about. So we're going to open up a live Q&A in drrobcircle.com/signup. You can go there, sign up for free, totally, uh, free to do. We'll answer all the questions Hello, perfect. Now you're live with me. Okay, welcome, Miss Jessica Brassiton. Um, so everybody, we finished the, the live stream on all the channels, and now we're just inside our private community, Dr. Rob's Circle, which we created due to my level of censorship about this topic. So I appreciate everybody being on. We have Jessica Brassiton, who's actually I don't know if I can give you like all the things she does because she has a very large number of missions that she's on. As, as it pertains to us, she's super special to us. She came and chose us to have her explant and fat transfer with us. So she's, um, I think done great too from surgery. I always know when patients are doing extremely well is I just don't hear much out of them. So thanks for coming on tonight. We already have some really good questions. So what I wanted to do is, after giving the talk, give folks a chance to obviously ask me questions directly. And I wanted to bring on one of my patients who had had a fat transfer and can speak to some of the very specific issues that I think are just not really talked about very much. And I I know they're top of mind in our patients and what they'll look like afterwards. And maybe they never got a discussion about the option of a fat transfer. And Jessica can talk about her experience as well with that. But we have, I think, uh, how many questions do I have? Um, I have a member question that says, 2 years post-explant, saline implants for 11 years. Symptoms that still remain: chronic fatigue, dry eyes and mouth. And give me some labs. Recommendation— recommendations to continue healing to have energy again. Uh, doesn't sound like one of my patients. Um, what I would say is looking at your genetics and your toxicity burden, your gut health and food sensitivities, always helps us figure out ways to help lower inflammation. And we have a curated set of supplements that that I know helps lower inflammation. So that's how I would start, um, in that situation. And then, um, Danielle's on, and I, I did her surgery. She's done 3 phases of Cellcore, and she wants to know what does she need to do to get ready for fat transfer, and how long is the procedure, and is it done in the office? How long do I need to remain in Texas afterwards? Yeah, I, I think those are all really— so she had explant and then she's doing a fat transfer later, which is totally fine to do. And, uh, I'll kind of speak to how we do those. So I've done fat transfers just like facelifts and all sorts of other surgical treatments that are able to be done under local in the office with the aid of something called Pronox, which is just a mixture of nitrous and oxygen. And so that's totally fine to do. There are limitations based on how much local anesthesia you can do in an office setting, so that's the real limitation. It's not whether or not you can do it. And then if we are going to be concerned about how much local anesthesia someone will get, we will move this to our brand new surgery center, the Sharp Surgery Center, which opens on June 23rd. After many, many months of delays. And then it's just done with a little bit of IV sedation and we don't need as much lidocaine. And the— I think the primary areas, just so we get them out of the way, is we talk about using posterior inner and outer thigh fat, the waist, and the abdomen, of course. Sources that I don't try to do a lot of are, or for that matter, anytime, are arms because you can make arms looser and nobody wants a looser arm. Other sources I get asked about, like calves and knees, usually not great sources of fat. I have, I have a question about where in the breast area is the fat transferred, and I think probably we'll just talk with Jessica about like her fat transfer. Maybe that will help highlight some of the things about fat transfer and I think, Jessica, uh, I remember kind of in our preliminary discussions, you're like, well, if I'm gonna have an explant, why don't I have a fat transfer? And it was, it was something you had already thought about.

Yes. So I initially, of course, when I had my implants, I didn't even know that was an option. But after looking up, you know, the explant and then seeing you recommended by two people that I knew personally I had already started thinking about having the fat transfer, and I'm really glad that I did. And for me, in my situation, I'm very happy with the results. And I know a concern of mine, or a lot of people that I saw anyway that were looking into them, was, well, it doesn't stick, you know, it doesn't stay. It kind of— and I believe, you know, I don't want to misquote you, but I thought you said, you know, you can have a little bit of a reduction, maybe like 30% or something, but you were very, um, specific in what to avoid and what not to do. And so I pretty much just did everything y'all told me to do and avoided what you told me not to do. So, um, here I am right at 13 months, um, and it's— they, they still— I don't— I didn't lose the fat, um, in my breast, and I'm just really happy with this just a very natural— it's different, right? Because there's not a round, rounded kind of device in my chest anymore. But it, it looks great. I'm very happy with it.

I think that's the thing, right? So it's a different change. And augment appearance— and that was the point of the talk. I mean, that started really obviously in 1962 with Cronin and Giroux in Houston, Texas, and they were doing the submammary or right behind the breast augmentation. So if you did that with a much larger implant, you would get a really pronounced appearance. And, you know, as time has gone on and, you know, styles change and things, you know, you know, there's always this kind of cyclical change in appearances and what's quote unquote desirable or not. It doesn't really, you know, for all intents and purposes, that's— that augmented look is never going to be a natural look. And somebody who's like 100 pounds and has a D, that's, uh, way out of balance of what, you know, was intended, obviously. And when we undo some of those results and then do a fat transfer like we did for you and get a reshaping procedure and a breast, you know, rejuvenation procedure, if you will, whether without a lift— we didn't do a lift for you— but like, those are things that could have been done in the first place had people had like a balanced discussion and been able to make a decision. But there's a lot of fearmongering about, like you said, you're gonna lose a bunch of the fat, it's not gonna work, you're gonna have problems getting breast exams or mammograms or ultrasounds, it's gonna confuse you with, or it's gonna be confused with cancer, which is not the case. And there's just all this nonsense about an operation that I did for cancer patients predominantly from the time I started practice in '05 until the time I wound down my reconstructive practice in 2019. So basically, for 15 years, I did 100 to 150 fat transfers just for cancer patients every year. And of course, that's the most sensitive group to work with. They have the least amount of tissue, they have the most concern over any abnormalities because anything that's abnormal feeling feels like they have cancer again. So you can't really, and that's why I don't ever subscribe to that overgrafting thought process. Like, oh, we'll just put some more in here in case some of it resorbs. And that's just, that's flawed logic in, in general. So we want to have the patients in good health. So we worked with Jessica and made sure and looked at her genetics and toxicity burn and gut health and food sensitivities and hormonal balance. And although that's not the— when I say it now, it doesn't sound like we do a lot, but that's a lot relative to what's being done traditionally, of course. And then, you know, knowing that we can definitely, through proper sleep, like everybody listening Every single time I talk, I talk about this. If you don't sleep and get enough, you know, a duration, enough time asleep or enough depth of sleep, then the hormones that get released that really help you recover and all the lymphatic drainage that happens at night is disrupted and you don't really ever— you don't get into recovery. Like, we've been watching the World Cup and you're talking about people that get paid Millions and millions and millions of dollars to chase a ball. Those people are followed around like lab experiments in terms of their hydration, their nutrition, their rest, their recovery. Do you see all of them wearing Whoops, Jessica? Do you see all those guys wearing Whoops? Yeah. Yeah. Because they used to have to, um, take blood out of their ear and check their lactate levels all the time. And that's how they knew if they were getting, you know, uh, like say overtrained. So now they can look at an HRV and know that, hey, this person needs to recover more. Okay, this guy is okay to go and he can go the whole game versus somebody who's like definitely not up for it.

So it was just interesting that obviously this is still going on, but Another thing too, people, this is just some things I saw that people are asking me, is that they'll form like nodules or lumps. Me personally, I have not had any of that. And then also, I think it's important to think about this surgery is not in a silo. It's not. I think it's easy for us to say just kind of probably like a lot of us thought we're getting an implant. It's not just in a silo of you're just getting the explant. Plant, then everything's going to be great. It is like you said, there's so many factors and layers to it. So I really wanted to go into the surgery with as good of a chance of a great recovery as possible. And I haven't even shared this with you yet, but I actually had my blood work done. Um, and I went in yesterday and the levels are so different. They've improved so much since when I and show you the blood work. My liver levels, um, I don't even consume alcohol at all, and, um, before they were really concerned about it. And even my hormone levels have changed. So, you know, I think it's all— it's all of these things. Like you said, it's lifestyle on top of it.

You have to do all the different things. I just had this patient come back from Oklahoma who we took care of, who has a low BMI fat transfer. So one of the questions is Where is it? She said, explanted 6 weeks ago, feeling amazing. I'm now flat, less than a double A cup. I understand what you said about making sure that the body is healthy before doing fat transfer, but can I still hope that fat transfer could be effective with such little breast tissue? Okay, so fat transfer has nothing to do with the amount of breast tissue you have. Fat transfer is a layering operation. So the, the breast tissue itself— males and females have breast tissue, the amounts vary. What we're talking about is the fatty layer just beneath the skin. So what we did for Jessica was augment that fatty layer. So it gives you, I think, and Jessica is probably, before she had surgery, looked at or thought about or talked about it with others about this hollowed-out appearance that happens in the upper 2/3 of the chest after removing implant because it's really occupying this, this space. It's pushing the muscle up, and when I take it out, that's what's the most noticeable. And so if you can augment that upper 2/3 between the collarbone, the clavicle, and the nipple complex, that helps take away a lot of that visual change in the upper 2/3. That's really— I think people That's very shocking after being full in a, in a position like that for so many years and everything just abruptly changed.

I know for me, I'm 49 and I had my implants for 15 years, and so I really didn't know what a natural breast would look like at that age or of, you know, at that progression. So that was really just scary to me, just the unknown. And so, uh, once again, it's not going to look like that because you don't have a device in there, that implant. But I, I'm just thinking that was one of my fears, just, and, and really just the unknown, because I didn't really know what a 40-plus-year-old breast even looked like, you know, naturally. And I know everyone's different, but I'm just kind of sharing that was something that was in my mind and, um, why I chose the, the fat transfer. Um, so I can only speak to what I, I went through, but I think that's going through a lot of women's minds is we just really don't even know at that point unless you've seen, you know. And crazy thinking about now, but a lot of my friends had implants and mine were not large, they were 250cc. I just wanted back similar to what I had, some volume that I lost after nursing 3 of my daughters. But that might just be going through some some people's minds as well, is like, what is it— what is a 30-something or 40-something natural breast actually look like? Because it's more of, I guess they call it like the teardrop, not the ball just stuck on there.

Well, that's what, uh, Leora Light is asking in the chat. I've had saline implants many, many years, and I've had 4 kids, um, I've gained weight, and now I have a much larger breast What can I expect to look like after an explant with a fat transfer? And she says she has, you know, body fat to use. Well, that's kind of the easier, um, case, right? So that's somebody who's already got more tissue. They've probably gained a little bit more weight over time. The breast is fuller, and that's more of a just a removal and reshaping procedure with a, a bit of augmentation with fat for the upper pole, which is what we're describing. And that's kind of, to me, like, oh, if, if you could go back and ask a bunch of patients what they would prefer to have after breastfeeding or having their kids and they're done, I get a lot of people saying they just wish they had a lift and a little bit of upper pole augmentation. And if I could do it with their own fat, they'd be like, oh, that sounds great. And so I don't think that's really talked about. It's not quote unquote a offering a lot because of the experience factor or the equipment factor or the, you know, options of surgery centers of where to go do this or, or whatever. There's a lot of factors that go into what a surgeon can offer a patient through experience and where they work and training. So, um, will working out or Retruder Tide burn off fat? Yes. It will. And Retruditide, I mean, to me, all these are going to get better, Jessica. All these GLP-1s are just going to get more efficient at burning fat. So I think what people need to realize, the days of people having, um, a lot of visceral fat are going to go by the wayside. I think that's going to be gone. Because these medications, they're not— they're going to get really efficient at burning more and more visceral fat. And if you don't, like, understand or can't get on board with a better diet, a more nutritionally dense diet with proteins and healthy fats, you're going to suffer the consequences of osteopenia and loss of muscle mass because you're not really doing what you need to do to take care of it. You said you did all the things we asked you to both before and after. And compliance or building small habits that then compound and make success are the hardest things to do. And maybe, yeah, I think like when I hear that out of you, it reinforces everything we talk about internally because we know the system works. We need a lot of buy-in for the system to work the best.

I actually, when you did that, when I did the testing before, I actually was pretty shocked at the amount of— I didn't have mold or anything like that, but the pesticides and the microplastic, those kind of things. I just, I think that helped me as well going through that process to see, oh, even though I do live a fairly clean life, I am exposed to a lot of things in our environment. And that on top of now knowing post-surgery that I did have a gel bleed, I think that contributed to a lot of my symptoms. And then just really my body, just my immune system just saying, danger, danger, like there's these things, there's something entering your body, and then overtaxing my liver, what have you. But I think that was good too. It's a process, right? It's a whole process. And that's why I chose to go with you, because of how you approach it holistically, not just get in, let's take them out and treat it as a one-time event. And, you know, that's how we get sustainable change, because we didn't get there overnight. So it's not gonna be gone overnight, right?

Right.

Just by removing the offensive thing.

Yeah, I can't solve 20 years of chronic inflammation in 2 hours of surgery. So, you know, we can do weeks to months of prep. And Leora Light is asking really good questions. She's seen on the internet, of course, that there are drain tubes, um, and that she's concerned about cutting out coffee. Well, Leora Light, Uh, my office embraces the use of coffee quite a bit. Everybody should know this about me. It has to be mold-free. We use Lifeboost. I don't get anything from them. They're, they're wonderful people, but they're good coffee. Uh, Danger Coffee is good. There's a whole bunch of— Keon's good. Um, so you can have your coffee. We don't use drains. Jessica didn't have drains, and I did explant and fat transfer for her.

So that is another— I forgot about that, but I shared this on my highlights because I was mortified. Um, I didn't have them, you know, I've never had them in my implants or anything. And so when you said, you know, I think just very extreme cases, or if there's certain things you can, you can put the doctor speak on that, but that was huge for me because that was such a— for some reason I just never had it. And so once I was able to say, okay, most likely I won't need them that just took— I was able just to not even worry about that part again. But that was really huge in the decision as well, the fact that you don't use drains unless it's absolutely necessary.

Yeah, I think it's funny, like, I remember rolling into this meeting back in like 2000, and I guess it was, uh, 2005, is that right? No, 2004. It was in, uh, there's a big plastic surgery meeting, and I got an opportunity to go when I was finishing training. And the most famous plastic surgeons who did breast surgery in the entire world were speaking, like, in a, this, in a, in a, in a row, you know. It was all about breast, it was all about breast reductions, it was all about technique using the vertical technique, which is the lollipop type scar. And one of them went so far as to say you should never do the inverted T scar on a woman, and you should never use drains. And I didn't even know how to do a vertical lift at that point. I hadn't learned it in training, and we always use drains, Jessica, on every single patient. So I was like, I don't know anything. What's going on here? But, um, that being said, it makes perfect sense. Your body is an amazing, uh, it's amazing what it can do if you just give it the resources. So if you get enough rest— and I'm going to qualify it this way, I have sleep apnea pretty bad. I've had to have some restorative kind of dental work from grinding down my teeth from doing microsurgery for, you know, those— oh gosh, whatever— over 15 years, concentrating too much, clenching too much, doing that at night, all those things. So I'd have my teeth redone, but I still have sleep apnea pretty bad, so I have to wear a CPAP mask. But the reason you want to do that, Jessica, is you want to preserve your brain. The reason people wake up, you know, gasping, is your brain was waking you up because you're gonna die. Your brain can only live without oxygen for 4 minutes, and then when it gets critically low, it's going to wake you up. That's the whole reason people wake up. Who have sleep apnea. They're dying and their brain is like, oh, dumbass, you need to wake up before we die. So that's really the point of when I say rest and quality and all these things. There's other factors that have to go into it. And I don't remember if I made a big deal of it with you, but I try to talk about it all the time with women because women usually recognize that their partner, their spouse, if they have one, snores. Like my wife said, I started snoring. I had never snored. We'd been, you know, married for many, many years. And all of a sudden she's like, you're snoring, you're snoring. I'm like, I don't snore. And then she's like, oh yeah, you do. And I was like, oh. So I got a sleep apnea test and I had moderately to severe sleep apnea. And I was like, well, what the heck happened here? And then, uh, one thing led to another. I went and got the whole dental thing checked and I had just like ground down my teeth multiple millimeters over that, you know, almost 2 decades of surgery. So all that stuff makes sense. Um, getting checked for sleep apnea for your own health. Women are at entirely different risk stratification for sleep apnea because they don't snore. They have what's called like central sleep apnea. So you'll wake up gasping, or you won't feel good when you wake up in the morning. Even though you slept enough, like the, the time. Um, and then when you get up, there's some practices, right? Uh, I'm guilty of this. I will go and drink a bucket of coffee before I do a good job with water or electrolytes, which you should do, and then some grounding and, you know, going outside and getting some sunlight. But I'm a very, uh, Jessica knows this about me, I work a lot, so I'm always like doing something at the admin level or something like that. So, um, and then the supplements we've curated can be taken in the morning simply, you know, with or without water. They're mostly liquids, as Jessica, uh, can ascribe to be, because the point is I need compliance. I need to do all those things that are boring little things to do, but they're super important and compound over time.

I know for me, I have a very busy and full life, and I do whatever I can to have it stack. And so I tend to need to see things, and I just put it where I was during the day and would work it in there anywhere that I could. So I know that that helped me because I'm sure most people are already busy, but I just made it a priority and I decided like, this has to be something that I need to get into my life. And it really helped, but I visually had to see it and I just put it along my day wherever I was. Just to make it as easy as I could to implement it. So that helps a lot.

Yeah, I think, you know, it's— we tried to put all the information out either on books or videos. And at some point, Jessica, I think I have too much information out at times because there's so much to then navigate. Claudia has a consult with me on Monday. Claudia, if you haven't listened to or read our Sharp book, that would help you the most understand our process because surgery is not mostly what we're discussing. It's like everything we're talking about is the preparation and the diligence and the, the habits you have to form in order to have a good— it's not just a good experience or a good recovery, but just improve your health. You want to— they talk about leveling up. I guess, you know, if you want to think of it that way, I think that's Um, that's how I think of it. I— if you can do those, and there's a lot of things we ask you to do, and I can definitely tell you the people like Jessica who do— I had this lady Jessica, she was a hot mess before surgery, and she came in, we did her surgery, we got her all prepped, did her surgery, low BMI fat transfer, and she was as, as some people get, as you know, very emotional afterwards. Very, you know, it's very disconcerted. Appearance change, swelling, all the areas, all the things, right? All the stuff, like, all at one time happening. And, you know, Jessica can speak to this. Um, I have a nurse practitioner who I did her explant, and she leads the surgical team. I have 2 of our 3 detox practitioners who run our SHARP program. I did their explants, and they are fully invested in helping, supporting, taking care of everybody, answering questions that I have no business answering or can't answer because that's just— I'm the surgeon doing the work, and they really support the patients at such a level. I think it's unprecedented. You know, if I have to think back in my history, I mean, you can have a breast cancer survivor who's a navigator or something in a clinic, And that's super valuable. I don't know that I can remember having 3 involved in one surgeon's, like, team. I don't ever remember that in all my years of multidisciplinary care. And maybe, so I think my team obviously does a great job and they are great because of their experiences collectively, individually. And they helped get this lady over the hump. She came in for her 3-month appointment in person. And she has such a good 3-month result for a fat transfer in a low BMI patient. It's, it's great. But she's like, I do every single thing that I'm told. And I do all the, the dietary part is very hard if you're not used to taking in a lot of protein, eating healthy fats. Um, women overtrain. Way more often than, than men do. And that is just— the balance issue is incredibly important. Like, you have to— as you feel better, Jessica, you can speak to this too. Like, you can do more, and it's easy to then do too much without, um, taking enough calories or enough protein. Or you have a very busy travel schedule, you're constantly on the go. And we've talked about this a little bit before, but it's hard to stay on track.

I was going to say before you said that is a lot of times, and I saw this when I used to, you know, coach women years ago, is it's usually we under-eat the right amount. And so that was something, too, that I had not— other surgeons I talked to hadn't even— didn't even bring up, honestly, all these components and factors. So it also helped me as a reminder to say, Okay, go in this way, but then also bringing in enough of the foods and the right foods to not then undereat. So that tends to be what a lot of women, we, like you said, we want to like, well, if this works, I'll do it 5 times that and it'll be great. It's like, go in, you know, we don't need to overdo that. And I wanted to say something too, because some, some people going through it might, you know, maybe this can help. And you talk about this a lot, and I appreciate that, is the mental and emotional, because for me, then it really caused me to self-reflect of why did I get them in the first place? You know, and obviously we could say, well, I, you know, I nursed all my kids and I just wanted, you know, this back. But then it's— there's a lot of layers to it. And so I like that you really are upfront saying your body needs to be ready, your mindset needs to be ready instead of just pushing for that? Because it doesn't mean it, you know, that it can't be overcome. But what support do you have? What are you doing for yourself? And then taking that time to really reflect and do those things because it is a journey. It's a beautiful one on the other side, I can tell you. But it really does bring in all of these layers that maybe you just have been too busy or kind of ignored. So I really like that you talk about that because it is, it's an emotional and mental, uh, journey as well as a physical one.

I mean, we've tried— I've talked to and engaged with all sorts of people with programs to help with mindset or dealing with past trauma or trying to help with, um, self-healing, like all those different things that— and you know how what I try to do is Every time, because somebody's always approaching me with some program, Jessica, always.

I'm sure. Yeah.

And I'm like, okay, this is how this works. My team will run your program as a pilot. My team will, because they've all had the surgery. So my team will just say, nope, this is not going to work. It's too heavy on, or focuses only on, like sexual abuse as the trauma factor. Everything is linked back to that. Well, sexual abuse is unfortunately prevalent, but it's not the thing that's the main driver in my, my practice. But we always then go there and say, like, you have to find a way to do the, uh, EMDR, whatever, whatever thing that you can do to help yourself. And a lot of people just don't even want to engage in that.

It's easier not to. It's easier to just kind of similar to, you know, a quick fix or taking a pill versus making a lifestyle change. It's so much easier. But that's where we grow and where we have the most is when we do take the time to do it. But I agree, because it can be scary and it's a lot easier just to bypass it. But it's necessary. And you, you have— and people that I know and that I've talked to that have done the work and have taken the time as well as doing the, the detoxing and the lifestyle changes are the ones, at least that I know, that have had the best sustainable results even post after that. Because, you know, even, even if like for me, I'm very happy with my results, but that's the physical part, right? If I hadn't done— taken the steps to support my mental and emotional health and what that looked like, Really, it's kind of like someone who gets an implant maybe, and then they're still— doesn't mean your life's going to be all rainbows and unicorns, you know, because you have, you know, the breast you thought you always needed. So yeah, I, I love that you, you bring that up at the beginning because it is important, um, for whatever reason we did it.

Yeah, I, you know, there's all this you have to shift and It's a big shift, honestly. I, I get it. And there's going to be all sorts of ramifications for going back or, you know, making the move that nobody wants to make. Like, nobody wants to come here. I get it. Like, nobody wants to come see me. It's fine. Um, you know, we have millions of stalkers at this point, which is totally fine too. I, I think— and people are asking me, you know, can they learn something if they expat somewhere else? I'm like, yes. You know, we set up all the programming, and we run a group program for people who've explanted elsewhere now. Because, um, I know this has been added to the repertoire of a bunch of surgeons, and some people are doing it, I think, in a very ethical way where they're providing capsulectomy and trying to counsel the patients, but they don't have the infrastructure, they don't have the staffing, they don't have the experience, they don't have the curiosity about genetics or functional medicine that we have in our practice. So leaves patients still needing, wanting other, other, um, programming or, or help or support. And, um, I just had a meeting with our team, uh, yesterday, in fact. I, I don't get to meet with them that frequently because we're so, like, busy all the time, but they're so smart, they're so talented, and they do such a good job with patients. And do you know that Google will take down a review if you name one of my staff in it? It's ridiculous because they think people are being incentivized to get reviews, which we don't do that. I mean, there's a great deal of work that goes into this on behalf of our, you know, team. So for them not to be able to get recognized is really frustrating.

It's kind of sad when, when we get to a point in society when someone is working with a level of excellence that can bring those, those things. Out that it's brought attention, you know, like, wait, surely, you know, they're not just getting all these on their own. It's like, well, yeah, when you work with excellence and make it a priority and put your patients before just profits, that, that's what you get. Um, I noticed that too, actually, on some Facebook things, which is now that's making me wonder if there were some things that— yeah. I hadn't thought about that, but we'll have to talk about that on another offline. But yeah, it's— yeah, it was like I was truly—

I think what you'll find is that people get planted from other practices into those groups to promote surgeons. And I actually got kicked out of a group recently, and, um, I was just answering questions, and I, I did a, a interview, and you may have seen our patient Sarah Minick. Sarah's from Nebraska and she's a cancer patient and she was really treated poorly as a cancer patient, which is— my sister died of breast cancer in 2024 and I took care of breast cancer patients because that's such a prevalent cancer in the United States and around the world. And I mean, for you to be shitty with a cancer patient, you, you're a really low life form. You shouldn't be involved with care. You should not do it at all. And, uh, she told me the stories, which are just horrible. And her husband was there the whole time. Like, he's like, oh yeah, they said this. Like, they said that to her in front of you? And he's like, yeah. And I'm just like, it's just— it's hard to— I can't fathom the stuff. And so, you know, I have a lot more cancer patients showing up wanting to go flat or wanting me to do an explant and a fat transfer because I have lot of experience doing that. And I don't do the deep flap surgery anymore, which is what I, I did predominantly, you know, for, for patients with implant problems from breast reconstructions, as well as people who needed, you know, total, uh, total breast reconstruction after mastectomy. And so I did her initial fat transfer at the time I did her explant. And those are very hard cases because they're always very asymmetric. When they, when they do the mastectomies, and then when they do like expanders and all this stuff. And I knew, I told her, I was like, hey, this is going to be the first step of a 2 to 3 step process easily. And so she said, I don't care, I just want to feel better. And she had an implant infection, the whole nine yards, all the things. So I did her surgery, and she waited a year, got, you know, feeling a lot better, and came back and wanted to have another fat transfer. So she came back, and there are super nice people, like her in-laws came with her, who are like in their 70s or 80s, and like, they're just like sweet people. And I do her case, and, um, she's very emotional afterwards because I, I told her I would do on the second one, I'd be able to do a lot more. And I got a really nice, you know, on-table operating room change for her that was very visible after surgery. And for a cancer patient, that's such a big, you know, change for them. And so, and she told me I was the only person who she had talked to that would preserve her nipple reconstruction and nipple tattoo, which is a big deal for her. And so I said, yeah, of course, you know, I did this my whole career. So So I did a podcast with her and she's such, she's super nervous to do it as you would expect. And she did it and we got done. I was like, that is literally like one of the best podcasts I could ever do. 'Cause everything was, she's so authentic and just sharing her story. And I said, you know, I think we should put this up, you know, this week. And so I had the team edit it you know, quickly and turn around and get it. And I made a post about it and I said, you know, I just did this amazing show with this, uh, patient, Sarah Minnick, and it's phenomenal. I made this post, they wouldn't put it up, and they took down my previous post because people, so many people were commenting on it. And so I was like, why would you do that? And so to your point, these people are going on and saying stuff about me, saying I don't take good care of patients. You know, all these derogatory things about our practice, etc. It's fine. It's all— it seems like Facebook has become like Yelp.

Yeah. And then you don't want to even go with the whole AI bots and all of those things, you know. So it's just— I think it's, it's sinister on both. It's the AI bots and then it's, it's people with ill intentions. And I think that's something that as someone who has testified in the Texas Senate against censorship back in 2022, Um, I'm very aware of that. So these are— this is why it's important to, if you are thinking about this, talk to real people, you know, talk to people that these surgeons are saying that have, you know, had procedures, talk to the staff, do your own research. And then the best way is to go to the source. That's how I do things. I don't read headlines or snippets, or— I go to the source. So that's what I did with you, Dr. Whitfield MD. I called your office. I did a consult. I knew two people that, uh, went to you. And so, and then I've had a lot of people when you shared my journey before the explant that found me through you, your channels, and would ask me questions. And I was just honest with them. And so I think reach out to real people, ask real life people that they've seen, or maybe go to some of your podcasts with patients and just start asking them.

Right. I, I find it kind of weird that people do the anonymous keyboard warrior thing. Like, they just want to go trash my practice and my work. And I'm like, I've been operating for 30 years and somebody said like I didn't care about my patient or I didn't listen to them. Like, I'm like, really?

Someone, now that you're saying that, like I said, this was way back when I was first looking and, in some of these other groups. And then I went back and just said, that has— that was not really— that was not my experience, right? The staff was friendly. They, they've been, you know, more than happy to answer any questions. I never felt rushed or like a number. So I just can say, all I can speak about is my experience and those that I know who have gone. Um, I even sent you, you know, some other, you know, very dear friends of mine, and and they've all had a great experience. And yeah, it's unfortunate, especially something so, um, delicate like this, right? And that's why I say go to the source, like look at the person, do your research. Um, I binged your podcast once I heard about you, and, um, and I, I just like the approach and then reached out. I thought for sure, I was like, oh, well, I'm— this is awesome, but I'm in Texas. I thought he's not going to be here. He's probably in, I don't know, LA or something. So when I heard you were in Austin, I was like, okay, I'm making the drive. And, um, but I, I have friends that have flown in to see you as well. So yeah, do your research and don't just go by, you know, you don't know who's behind these things, especially if it's anonymous. You really don't know, but they could be AI bots, like, who knows?

Well, the other thing too is like, I think this is something that I will say um, and I've never changed. Um, I'm always very direct and very honest about either what I know or what I don't know or what I see or what I don't see. The one thing you can never do is bullshit me, and a lot of people try, and that's not a good tact to take with me. And people try to lie, and you know what I'm talking about. It's not really— you know, we're extremely motivated and try to stay on course and be as, you know, the standard of care is very important in this procedure to me. Like, I feel like we've worked very hard to establish it and we want it to be very, very high. And I don't like anybody taking potshots because it ends up affecting the patients. My reputation is my reputation. That's, that's fine. But it affects patients because then they get scared to then ask questions because they read some garly comment about something. And that's, that's the kind of stuff I feel like is detrimental. Like, you can just— if you want to be nasty to me, that's fine, okay? But you're, you're harming the, uh, the, the real person who's maybe wants to ask a question, and now you've made them very afraid to ask a question. I don't like that. I, I don't think that should be the environment.

Yeah, I, I agree. And I think especially in a state like this where, you know, maybe they were like me and they were like, we kind of feel alone, or we don't know where to start, or then we're like, once we decide, wait, maybe these symptoms are, you know, from the implants and maybe I do want to go this route, then it's a whole rabbit hole, you know, that you're going down. And I think for me that was important to have someone that I I know has used, and then I could go to them. And then also even people I didn't know already, then I just, I just started looking at people who followed you and been on your podcast and would message them or take that information. And yeah, it's unfortunate, but that's why I think, you know, it's just making it harder for someone looking, looking for someone to do it. So, right.

Well, I think the chat is actually you know, quieted down and it's just us. I, I really appreciate you hopping on. Everybody needs to understand, like, I reached out to Jessica because she was coming in for a visit and, and she, uh, hopped on. I operated all day as usual and then we were doing some things, uh, and we're able to have her hop on. She's a great sport, great, uh, patient, and great, uh, friend of the practice, so we really appreciate you being on.

Thank you, thank you, Dr. Whitfield. This was great. And if anyone wants to message me, if they're still listening or see the recording or whatever it is, then just ask away. I'm an open book.

Thanks, Jessica. We'll see you soon.

Thank you. Bye-bye.

Good night. Okay, all right, y'all, I'm ending the stream here. Is there any last questions? I just want to make sure that if there are, I answer them before we hop off. I appreciate everybody being on. Hey, Danielle. Yeah, Jamie, I just would have to review everything. And if you're able to, I'm always happy to do any in-person exams to really help codify it. I mean, that's obviously one that's a little bit more challenging for sure. Oh, thank you, Leora. Yeah, and message Jessica. She's a great, uh, a resource, um, and, uh, really lovely, lovely human. She does so much work to help, um, protect children from human trafficking and all these other things. She's really inspirational. So any other questions for me, y'all? All right, I'm gonna shut down the stream. All right, good night.