My Explant, Capsulectomy, and Lift! Meet My Surgeon Dr. Ricky Brown

Today on Midlife Conversations. I can't wait for this conversation because my Instagram, especially dms, have been blowing up with questions and I didn't have the answers to all of them. I'm talking to my surgeon, Dr. Ricky Brown. He is a board certified plastic surgeon. He's who personally just did my explant and lift. And there's a lot of questions that have been coming in. I've been trying to answer them as fast as I can. I've also been blowing up him personally with my own personal questions. So selfishly, this episode is as much for you as it is for me because I've got a lot of questions too. So thanks so much for being here.

I can't wait to talk. Pleasure. Yeah, it's going to be great. I'm excited.

First, I want to start with how did I end up working with you? How did I end up going with you? A lot of people have asked that I shared. You know, it was about six or seven years ago. I had had a botched surgery and I had an amazing doctor, Dr. Kat Bagovic, fix me. She had fixed my me in L. A. And I was super happy with the results. And the first question that came in is, why did I not go to her? What. What made me switch surgeons and go. And. And the main reason I wanted to share is that I now live in Scottsdale. That's number one. And I personally just didn't want to recover in Los Angeles. I wanted to recover at home. It was important to me. And being in Scottsdale now, driving, you know, five, six hours to get to surgery and then staying there in two weeks, that was honestly my main reason. The second reason is because she's an incredible surgeon. You have done a lot of explants and capsulectomies and what I needed specifically. And you were recommended. But a little funny story behind that. First of all, those of you who don't know, Dr. Ricky Brown has 7, 8 million followers on TikTok. Like you've got a crazy amount on TikTok.

Yes, 7.7 million is 7.7 million.

And so does my friend Dr. Tony Yoon. He also has something like that. Or 10 million or something.

Yeah.

Okay, 8.3. So what happened was my friend Amy Allenbach, who I have my oxygen chamber from, she actually recommended you. And I right away went to your TikTok and I said, no way. And the reason I said no way is I thought, okay, he just has this big TikTok. He's a marketer. And right away I saw Tony Yoon, who I'm friends with, giving you a hard time and comments. Like, he would, you know, he would, you know, tag some weird cases and say, oh, you must have done this. So I thought he actually really didn't like you. So that was like. So I. So I messaged him and I said, hey, I'm getting referred to go to this doctor, but do you think he's bad? Like, what's going on? And he giggled and said, you guys are actually good friends. What's that about?

We are. We. I mean, Tony and I met at the American Society of Plastic Surgery conference years ago briefly. And then in 19, when Covid hit and all the craziness, he and I both kind of joined TikTok and we just became friends because we were taught, because he was. He's a much bigger social media personality than me, and he had a bigger YouTube at that time. But we just became friends and we started talking and we were always talking about, how do we do TikTok? Like, what do we do? What kind of content should we make? And we just became friends. And I've met him several times since then because I think you've been to the mindshare here. And Tony was in mind share. So he brought me this year. But we're friends.

Yeah, okay.

We're good friends.

He gave you the stamp of approval. And then what I personally loved about you is I had booked a bunch of different consults in Scottsdale, but you went out of your way to message me right away and say, hey, I've got you. This is what I do. I'm happy to come. You came in. I think I'm like, your day off for me. So right away I was like, okay, he cares. This is. This is awesome. And you were so thorough on my consult. And this is important to point out because I had had a number of consults, and each surgeon I talked to told me why I would hate removing my implants. And since the backup, I had an actual rupture. You also, some of you that didn't listen to my past episodes, I had an actual rupture that showed up not only on a mammogram and an ultrasound and a breast mri, but I had an actual silicone rupture. And everyone I spoke to said, you've got to replace them. You will be unhappy if you remove them. And I. When I came to you, I originally said, you know, I want to make them smaller and do a lift and replace them. And you asked me, you said, why do you want to make them smaller? And I said, because eventually I think I'll want to take them out, and I want to get used to them being smaller. And you said, natalie, if you're thinking about that now, why not just take them out now? You were the first one to say.

That to me, which blows me away. Right? I mean, and I posted on Social last week and tagged you, and I saw you reposted it. Thank you. That it's really difficult because so many plastic surgeons presume how the patient is going to feel. Right. Like, we assume that you're going to be unhappy. We're telling you you're not going to be happy. But in my opinion, we need to give the patient the respect to decide for themselves. Right. Like, if you ask me, how small am I going to be, I could tell you, yeah, you're going to be kind of flat. Like, you don't have a lot of breast tissue and your implants are kind of big. But it's not for me to determine whether you're going to be happy or not. And in our. In our talk, it was really. Also, I totally got the vibe from you that you really didn't want them. Like, you just. Everything was leading towards. I kind of don't want to be with these things anymore, you know, And.

I had my husband with me because I wanted him to hear everything. And we. Him and I had decided beforehand. My husband's been super supportive this whole time of whatever I wanted to do. But we had decided in my mind that, hey, if I just take them out, it'll be too big of a shock. All these surgeons are telling me this, you know, so I'm going to replace them. But. So we left that consult, that initial one with. With. You suggested that, but I said, you know, I think I still want to put them in. And you said, we still have time, so if you change your mind, we have plenty of time until your surgery. We had booked it, like, six weeks out, and I couldn't sleep. It was like a whole week of me not sleeping with the thought of putting them back in. And then I messaged you and said, okay, I think I want to take them out. And you were fully supportive.

Yep. And I think a big tipping point for you, too, was we talked about. You asked me the question, could I put them back in if I want to? And I said, yes. And I tell a lot of women that I even have primary breast augmentation lift patients who come in that aren't sure about implants. And I tell them, lift your breasts without implants. And See how you feel in three months. You can always put implants in later, which was the case for you, too.

Yes. And I also had asked you about the idea of a fat transfer. A lot of people want to know about fat transfer. And what I had read and heard, and you agreed with this, so I want to ask you about that, is that fat transfers could potentially work, but you should not do them at the time of doing the removal and the, the lift. Can you explain a little bit more about that?

Yeah. So let me get into that a tad. You know, when we put the implants below the pectoralis muscle or even above the musc, you form that capsule around it. And the way I describe this to patients and to people in general is imagine a medical glove on my hand. My hand is the implant. That thin latex glove is a capsule. It's collagen that surrounds the implant because it's not supposed to be there. Right. Well, in your case, we had to take out the capsules, which I'm sure we'll talk about. Talk about because of the, the, the textured implants. When you've got breast tissue and you take the capsule out, the breast tissue is usually so thin that we can't get the fat into the breast tissue. It ends up going into that space where the implant was. And that's the issue is we need the. To scar back down to the chest wall. So now we actually can get the fat to stay in the actual breast tissue. So if a patient has thicker breast tissue. Yeah, we could fat graft at the same time. But when you've got thin skin and not a lot of breast tissue, it's really hard to get the fat to stay in the actual.

And it dies over time, too. Right. Don't we lose some of it?

Yeah. I tell people, look, 50, 50, right. Like 50% dies, 50% lives. And that's even 50, 50, depending on the patient.

Yes.

Some patients just don't get any take at all, and some get great take. And it's hard to predict who that's going to be.

Now. This was my sixth breast surgery. Even you were shocked. You're like six, Natalie. Really? Like, this is my six. I see it so clearly. I'm not. I was not somebody against breast implants. In fact, I used to get annoyed I'm being real when I would hear the BII people. And I thought I looked at it like a cult, like, oh, they think everybody has bii. Like, BI stands for breast implant illness. And I was convinced, like, I don't have any issues. Like, I don't. This is not. This is. Some people get that I don't. I honestly didn't have weird symptoms which you can talk a little bit about until after I had the rupture. Up until that, I don't know of things that I had wrong. Can you give your experience a little bit about what you've seen with BII and like, what is your conversation now? Because you still put implants in too. Like, what's your conversation? And assessing like, who actually is a good candidate for this and how do I talk to people about that?

Yeah, it's is a great topic. This is a tough topic to discuss because there are so many issues surrounding the bi community being angry at physicians. Physicians being angry because they don't think that it's real. There's this whole conversation that's happening. But let's just start with how do I decide?

Yeah.

So every patient that I see, I have a full on conversation with them. And the very last thing we discuss is breast implant illness. And what I tell patients is the following. Some people come into me for explant who feel like they have brain fog, joint pain, rashes they never had before, gut issues, maybe thyroid issues, heart palpitations. They've had full workups and they can't find anything else that's related. And so people sort of default to, hey, maybe it's my implants. And I'm not here to argue whether it could or couldn't.

Right.

I obviously believe that that could be a possibility because for me, these are foreign devices that we put into patients. Just like I had a hip replacement 10 months ago and I'm fully aware that I could get metal toxicity. So the conversation that I have with Pat is here's what we know and here's what we don't know as scientists. We are all about evidence based medicine. Right. But everything can't be about evidence based medicine because it may be hard to collect the data to actually prove that there's a correlation between the two things. But we have real patients who are getting these symptoms and then they have their implants removed and most of them feel better. So what I tell people is the following. What we don't know is we don't have any studies that can. I can tell you, hey, implants are making people sick. This is what's happening. I don't have a test where I can test you and say, natalie, you're more at risk than this person because you tested positive for this. We don't have that information as of yet, what I do tell patients is I fully believe that there is a small population of women who are potentially rejecting their implants and having this chronic inflammatory response. It would be, in my opinion, ignorant for me to say that I know everything about the human body and that it is impossible for this to happen to women. So what I tell patients is, while there's a small group and we can't really quantify what that group is, there are millions of women who have implants that are totally fine. They've never had problems. Some of those are autoimmune patients who. I have patients personally who have autoimmune disease with implants, and they don't feel like their autoimmune disease is any worse, who are fine. So all we can really tell patients is the odds are in your favor that you're not going to have an issue. I don't have a test that I could test you to tell that you are. But I do think that you should be aware that this is something that is happening. And while we don't have proof, we have real patients that are being affected. And so we need to take that into account when you decide whether this is right for you.

Yeah. In my personal story, and I don't want to go too far into it because you all, if you listen, a couple episodes ago, I went into the whole story of, like, symptoms and what. What I was feeling there. But I will share that. For years, I actually felt great with implants. I didn't. I mean, other than I had the standard problems I had. I had capsular contracture twice, which is when you. That's when you're the tissue. Actually, you should explain it. What is capsular contracture?

We talked. We talked about that sac that forms around the implant. I have my props with me. So once that sac forms around the implant, we believe that something called the biofilm theory, where the implant gets contaminated with bacteria, can send a signal to the overlying capsule to start to squeeze tight around the implant. So you probably got a really hard, firm feeling.

Super hard. Yeah. So I had that a few times. And what I learned was the different surgeons that have fixed that, they didn't fully clean out that capsule. They didn't replace the capsule. They didn't create a new pocket. So I kept getting it. So I had that problem. I also had. This was my second rupture. My first rupture happened in my 20s, before they did imaging, before your surgery. So we didn't know it had ruptured. So it was not capsule Contained. So I did have a full silicone leak in my body. I do have an autoimmune. I have celiac. Not. Not that big of a deal to me, but I'll never know. Could that have triggered that? Possibly. I don't know. So. But other than that, I will say I pretty much felt great with implants other than my. Those random things and having to replace them, which was annoying and a pain to do. What. What changed for me was in the last year, I started having really weird labs. So I started with high liver numbers for no reason. Like, just made no sense because I eat clean. I wasn't taking crazy supplements. Like, I don't drink alcohol. So liver numbers started. Then I started having some extreme gut problems. I ended up having parasites, blood sugar issues. So the more I was digging into that and getting to the root of it, Laura Frontiero, who was actually helping me with my gut health, she kept saying, there's something else. There's something else under this. There's either heavy metals, there's mold. There's something else going on. I still connected to the implant until I had a confirmed rupture. And then I started noticing more and more things. And I even told you at an appointment, I don't know if it's psychosomatic. I don't know if it's because I know there's a rupture. But I started having. It was joint pain, and I started having these heavy bags under my eyes. And then I started. I got a rash. So those are, like. It was all connecting. I will tell you all the day he took them out. And I would have never believed this had I not walked through it myself. Because you feel like crap after surgery. Normally, the day after, I didn't have the bag under my eyes, and my joints stopped hurting. And I thought, okay, is it the anesthesia? The pain meds? But I'm a week out, and that stuff has not come back.

Yeah, I mean, look, I think it's really important for people to. To understand that the symptoms that a lot of people talk about, BII could be related to other things. But that doesn't mean that we should exclude that implants are an option.

Sure.

I think it's important to try to discern between the two, but I. The story that you tell, it's a similar story that I've had with some of the people that have come to me with BII that have had them removed. They're like, oh, my God, ten pounds down, five days later, my eyes aren't puffy anymore. The rashes that I've had went away, and you touched on the psychosomatic part. A point that I want to make that I think is really important is I firmly believe in people getting this and this happening. There is also no question that once we start to believe that we're sick from something, we can escalate it exponentially to something even worse than it is. It's not. I'm not saying that it's psychological for people that they're making themselves sick, but once you start to get symptoms right.

Like I said, that's what you focus on. Yeah.

I'm like, oh, my God, how many times have I given myself cancer in medical school for a pain or something? I'm like, I have cancer. Oh, my God. I'm dying, you know?

Yes. So I can't explain, like, what was not. I just know the bags on my eyes are real. Like, you saw me yesterday. I mean, I have my. I'm 52, so I got something, but it's not like they were. I had these dark circles, and. And I am £9 down on the scale, and I was not overweight. That's like that. I think I had some heavy inflammation going on.

So crazy.

Yeah.

It's getting hard to deny.

Yeah. So it's hard to me, it's hard to deny. So I want to go a little deeper here, because what I don't want is. I don't know that people need to go rush and take implants out. Like, so many people have asked me, like, oh, now should I go get to get mine out? And I don't know that my answer is just yes, a flat yes. Can you speak into that? Like, who should actually consider taking them out and who should just leave them alone? Like, what? Let's talk. Start with that.

Yeah. I mean, it's a tough call. If someone's not having any problems with them, then why. Why do anything? If you're happy with them, you're okay with them, you don't feel sick from them, then there's no reason to do anything. If you aren't feeling good and you're getting workups and there's other things that are happening, and you start to believe that maybe it's from your implants, you could consider it. Here's the problem. When patients come in, I tell them, even BII patients, I'm like, listen, I cannot promise you that taking out your implants that you are going to feel better. None of us can promise patients they're going to feel better. And so a lot of Women that do take them out are very remorseful because they're happy with them and they tell me I am otherwise so happy with them, but I don't feel good and I want to take them out. So to me, I think you just have to listen to your internal voice, and if something's not adding up and you think it could be your implants, while you might be nervous to take them out, it might be the only move that you can do and just realize you may not get better.

Yes. So I think so if I'm hearing correctly, you have to be prepared that that might not fix it. Like, to be prepared that I'm taking them out, and if it doesn't fix it, it doesn't fix it. Like, so. So that's interesting. I will also share that I. I was a double D and I had boobs for 33 years. I had implants. And, you know, because we talked about it, I was really scared of what that was going to look like. And I really prepared myself that I was going to like a boy and I was going to hate it and awful. And honestly, like, I'm not. I'm okay. I don't. I don't think it's that weird. Like, yeah, I'm, like, it looks a little strange, but I'm not. I'm fine with it.

You'll get used to it. And I. A lot of women like the big question we get is, what am I going to look like when I take them out? None of us can really tell you. What we can tell you is we get an idea whether you're going to need a lift or not need a lift from how stretched out your skin is. We can do a pinch test to try to quantify how much breast tissue you have. So the general comment I give people is the following. You're going to be smaller. You're definitely going to be smaller. You're not going to have the upper pole volume that you used to have, and you're going to have something and you're going to have some tissue. You just need to be prepared for being very small. And a lot of my, My. My program director, where I trained for plastic surgery in Nebraska, used to always tell us the best indication of what you're like afterwards is kind of what you look like before. And I think what he meant was.

I seem to remember because I was 19.

Yeah. I mean, exactly. Like, why your skin does kind of stretch and your breast tissue thins a bit. Overall, you'll generally kind of. You just have to be okay with being small. And there is nothing wrong, in my opinion. And I do this for a living.

Yeah.

I tell women this all the time in the clinic. It's okay to be small.

You know what's funny? I met. I met his wife yesterday. And your wife has them. I'm so. She's. And she's. She's petite and mall. And her. She has them. And she actually said to me, she goes, I've been watching your Instagram, and you look so good, it makes me want them out. Like, which is funny because. And I'm hearing that a lot, like, people actually like the way that it looks. Yeah.

I mean, it's a trend. I think. I think it's. People are kind of trending back towards, maybe I don't need these. Maybe I don't want them in my body anymore. They served their time. Or when I thought I needed them, I really didn't. There's all kinds of emotions behind it. But, yeah. My wife hasn't had one problem since the day that she got them. She's never had a contraction, never had an issue, but she worked out a lot like you do. And she's a fitness girl, and she's kind of like, I don't know, like, maybe I don't need them now, you know?

Yeah.

I support whatever she wants. Just like, you know, Brooke supported you.

But if she had had five surgeries and this was going to be her six, I think you probably would have leaned her towards.

I would have told her to take them out.

Yeah.

I think that this is an important thing that you're bringing up, like, six surgeries for your breast is a lot. And I think it's really important for patients when they go to their surgeon is to realize it's not a one and done. They are not lifelong. You might have two surgeries, but you're going to have two surgeries. There will never just be one.

Right. They're not supposed to last forever. Okay. So I've got a bunch of random questions I'm going to ask you. I'll just kind of fire them off. So one question that keeps coming in is, what if I have saline and vers silicone? Does that still create a risk for bii? Is that still what. In your opinion, what's the difference between the saline and the silicone when it comes to that?

Sure. So there's no difference. So we don't have the scientific answer to this. My anecdotal answer to this is it's a foreign body inside of your body that is not Supposed to be there that's leading to this inflammatory response. So it doesn't matter if it's saline or silicone. I get patients who have both who have bii. And by the way, a saline implant is made out of a silicone shell. So you have silicone in your body no matter which. And so I truly believe that it's the presence of a foreign device that is leading to the problem, not whether it's silicone versus saline.

But the rupture is easier to clean up if it's saline. We know that because if there's a.

Saline rupture, it's salt water. Your body reabsorbs it. You take out the bag, you're done. Like in your case, we'll have to get into eventually why we took your capsules out and whether you need those out or not. But yes, it's much easier.

Okay, so let's talk about that next, because some doctors want, say they'll just take out the implant, you're done. And we discussed an actual capsulectomy, an M block. Like, can you share? Like, what are those things? Who needs that? And then I'm gonna ask about the lift situation.

So people now are educated about the capsule. Right? It's a silicone ziploc bag around your implant. It's your own body's material. So the question is, do we just take the device out or do we take the capsule out and then why do we take yours out? So you had the textured device. So this is a smooth shell device. This is the texture device. This device is off the market. This is the Allergan 410 style implant that led to this really weird, rare breast implant associated large cell lymphoma, which is not a breast cancer. It was a reaction between the capsule and the implant. These are off the market in Europe.

And here, which scared me because mine's not that brand. But it's the same, looks the same. It's like.

Right. So I was going to tell you. So the studies are. There's a lot. I looked, looked this up before I saw you in the clinic. The Recent numbers are 1,130 cases worldwide. Worldwide.

Okay. But if it's you, if that's you, it's still a lot.

Of course, I don't want to minimize the fact that it's a small percentage of the population, but if one person gets it, clearly it's not totally right. So you had the mentor version of these. And those weren't taken off the market because well over 90% of the cases were the allergan textured implants. That said, Sientra and Mentor had a small piece of the pie, too. Right. So my comment to you was, if you were my wife, I would take your capsules out, too, because even though there's an extremely small percentage risk of you getting that weird lymphoma, you don't ever want to look over your shoulder for the rest of your life. And taking out the capsule solves that problem, as far as we know.

Right. So the question, what is an M block, then? What does that mean?

So en bloc means that is a term for taking everything out in one big package.

Okay.

So imagine we go into the pocket. You've got this collagen Ziploc bag around your implant. We dissect that free from underneath the breast, from the chest wall and rib cage, and we take the whole thing out in one little package where the implant comes out inside of that collagen sac, and we set it on the back table. Or you can just open up the capsule and pull out the implant. There's a lot of argument about which one is the right operation. We don't have an answer. I truly don't, you know, believe we have an answer. I have an opinion, but that's all. All that en bloc means is removing the whole package together.

So what did we do? On me, and I'm curious, your opinion?

Yeah. So on you, it wasn't fully on block. It was almost completely on block. Okay, so here's the thing. The breast implant illness community has dictated that implants need to come out on block. We have zero clinical evidence to prove that that is necessary or needed.

Okay.

A couple years ago, they did a study where they randomized women who were having implant removal for breast implant illness to two groups. Removal of total capsule on block with implant and just taking the implant out and leaving the capsule behind. The two recovery groups were the same. So the question becomes, do we need to take out the capsule or not? We don't have an answer. But in my true opinion, I do not believe that the capsule is the problem. I do it for women who want it out. I try to take it out on block. If they believe that that is the problem. What I tell patients in the clinic is, if you're going to look back for the rest of your life, taking your implants out, feeling like if you don't get because you still have your capsules, then we should take your capsules out. If you truly don't believe it's your capsule, like, I just don't believe that the capsule is harboring anything that your body can't detoxify totally. It's your own collagen. And what I think the population at large doesn't understand, as a surgeon, we have to literally strip that capsule off of your rib cage. Your rib cage, the muscles in between your ribs are millimeters away from your lungs and your left ventricle of your heart. Damaging those structures is very possible. Doing a total capsulectomy.

Wow, that's scary. You gotta be really aware.

Yeah. And on block can be even tougher, because when you're trying to take the whole thing out together, sometimes the capsule's just totally attached to your chest wall, and it's really hard to peel up to the point where, oops, I got into a lung.

It's never happening.

And also sometimes it's extremely easy, and it peels away. So it depends on the patient. So what I tell my patients is, if you really want your. Your capsules out, I will try to do it on block. It's going to take a big incision to do it, your whole inframammary fold to do it. And if I, at any point, feel like I am at risk for injuring your lung or getting into your heart, I will take the implant out of the capsule and finish the capsulectomy without.

The implant, which is kind of like what we did with me from. At least from when I watched it.

Yeah. I got to a point on yours where it was pretty plastered to your chest wall, and I was. I was making headway, but I got into a couple of dicey spots where I was like, listen, I'm not worried. I just opened up the capsule, pulled out the implant, finished the total capsulectomy with no problem at all and no harm done. I just don't believe, Natalie, that opening up the capsule and exposing the breast pocket to the implant for two seconds causes your illness to be worse.

Yeah, that makes sense to me, and I would much rather that, because I don't. I don't to want. Want. I don't want to be dictating to the surgeon. Like, you're the one with the training. So that gets a little scary for me when you have a community saying, you have to tell your surgeon to do this, like you're the expert. Like, you want it. You got to do what you see is the right thing when you're in there.

And listen, Dr. Chung in California, one of the biggest explant guys around. He and I have exchanged DMS before, and he's even said to me like, it's not always possible to do on block. Like, we try to do it, but it's not always possible to do it it. And the question is, is it worth putting a patient at risk, life versus death, to do it on block? I know to me, the clearance, I do this for a living.

Okay, let's talk about the lift now. Like, to me, it wasn't even an option. I was like, I have had double Ds. I'm gonna have hanging skin. There's no way. So I didn't even. It wasn't even an option. I said, I want a lift. But how do you decide that with patients? Or, or how do you. Is. Does everyone get a lift that you remove them for? Like, how do you. How do they decide? How do you decide? Side.

It's really up to me. I can usually tell at certain, at the consultation how stretched out of the skin, how big are the implants, what's the quality of their skin? Like, so in some patients, I'll look at nipple position, which is where we really determine whether someone needs a lift or not. I look at what the breast overall looks like, what's the quality of their skin? And if someone's got really good quality skin and their nipples in a good position, I usually tell them, let's take them out. Your skin will contract down over time. Let's see what it looks like. I really don't think we need to make all these scars on your breast. And just like I told you, you could always put an implant in. I tell them, I, it means a second operation, but we can always lift you later. Right?

Okay.

So if a woman's really worried about the scars, we might go that route. And then there's sometimes where I see patients, I'm like, listen, thin skin, saggy breast tissue already. I know that when we take these out, you're going to be sagging, which.

Would have been my case.

Yeah, which would have been your case. And so you clearly articulated like, hey, I'm not going to be happy if I've got like saggy handbags. So I knew that it was the right operation for you. Yes.

And so can you talk about why so many scars? Because it sounds like lift technique really the right way is what you did. It was around my nipple, There was a vertical and there was underneath, which usually goes in the fold. And then some people say that their surgeons didn't do it that way. But why is that the standard way? And why do people try to work around that?

So it really. Most surgeons that try to Work around it is because they're nervous that a patient's not going to come to them if they tell them they have to have all those scars. Okay, so here's my answer to this question. There's what you guys know as the lollipop lift, where we just make an incision around the areola, and they have a little vertical one. There's one called a peri areola, which is where we just make an incision around the areola and we tighten up the skin. That's not. That doesn't have a place here or hardly ever, in my opinion. Sometimes the third one is the anchor lift, like we did on you, where we had to make the vertical, the one in your breast fold and then around the areola. The reason that most women need the full anchor lift is because everyone's got laxity in the horizontal plane. We need to tighten them and lift them. And then they have laxity in the vertical plane where we want to pull the breast tight around itself to make it look round again. And then always the nipple has to be moved up into a new central position. So it really depends on the quantity of skin that you have. And the vertical lollipop lift just doesn't account and give you the ability, in my opinion, to take out as much skin as is needed to.

Makes sense. Okay, why the. The nipple thing? I want to ask about that because I. When. Because I had had. This was my sixth surgery when I went to you, when my areolas had just, like, spread out. And I know some other women have shared that that happened. That. Why did that happen? And I'm so happy because he basically carved out new ones, and they're small and little, and it's like, they're perfect now. But why did that happen, that they spread out like that?

Just. Gravity wins. Skin stretches. The areola is just pigmented skin. And when you have an implant underneath there, that's pushing out on the tissue your whole life. And as many of you. As many implants as you've had. The implants are basically tissue expanders. So when they stretch the breast skin, the areola stretches, too. It's just the natural progression of aging. Skin stretching. Things change.

Okay? Now, I certainly am not going to be a topless dancer anytime soon. That's not my goal. Not my goal. But I was really scared because of what I had been told by their surgeons that I might be concave that I would be flat as a board. And honestly, I have more tissue than I thought. So is that your experience with people where they are surprised by that. That.

Yeah, most people are shocked. I tell everyone, I'm like, listen, you're gonna have something. You're just gonna feel dramatically smaller because you're so used to having your implants. And so I just try to tell patients, just give me three months. Can you give me three months? Like your perspective will change. Most people's perspective adjusts and they get used to what's their new normal. So most patients have some quantity of tissue. If they're an A cup, they're an A cup. If they're a B cup, they're a B cup. Whatever it is, it is. But they're not flat as a board generally.

Yeah, I honestly thought I'd be concave. And I'm not that, like. Yeah, no. What about. I've heard. Not from you, but I haven't asked you about this yet. About the fluffing. Some. A lot of people told me that over the first three months they sort of fill out more and they. You're surprised. What is that?

It's just scar remodeling. Right? So remember, scars take a full year to remodel. Whenever we make an incision or create a surface for scarring, you get a bunch of collagen that just gets laid down into a wound and everything scars together. So the reason that a lot of women, after BII and total on block capsulectomies or total capsulectomy, me get this weird puckering in their skin post surgically is because the chest walls are raw surface from taking the capsule off. Underneath the breast is a raw surface. Because we strip the capsule off. Those two things robustly stick together and it pulls the skin against the chest wall. What occurs over three months to six months to even a year is all of that collagen starts to reorganize. You guys start massaging the tissues, things soften up. That's what we call fluffing. And it's really just dust. The scar changes over time. Now, some people will still have some puckering they don't like, but that's. That's what happens.

Okay, what about. I'm going to ask about nipple necrosis, because that was another thing that some doctors scared me about. How does that actually happen? And is like, do you. Does it increase your risk every time you have surgery? Is that a surgeon technique thing? Like what creates that? How does that happen to people?

So the. The nipple is very resilient. It does have a very robust blood supply. But that blood supply, the nipple has to live on certain blood supply. And if you've had multiple lifts, we don't sometimes know what technique the other surgeon is used. So if they took out the blood supply in this area, and then I take out the blood supply in this area, oh, my gosh, the nipple has a problem. So what that means what we're always worried about is compromising the blood supply to the nipple. With that said, usually when women have implants, you've interrupted the blood supply coming from the breast, must from the chest muscle to the breast. We cut through those. So you start to regenerate and build up more peripheral blood supply through your tissue. It's more robust. This is a. A plastic surgery effect that we see where you cut off blood supply in one area, and then the surrounding blood supply gets better. So actually, in a case like yours where for so long you've had interruption of that blood supply between the muscle and the skin, I'm not as worried about nipple necrosis because you've built up such good, robust peripheral blood supply to the nipple that the likelihood of you having a problem is very slim. It can happen.

Okay.

I can't predict it sometimes. I've never fully lost a nipple. I've only had a partial loss once in 14 years. But that's what we're talking about. We don't know what other surgeons have done, and we don't know if certain blood supply has been interrupted or not.

Got it. But that's what that is caused from when?

Yeah, it's called. It's just basically you. The blood supply to the nipple gets cut off and the nipple can die. Now, usually in surgery, we can see like it's struggling. Sometimes we'll use nitro paste. Actually, in your case, case your venous outflow wasn't great right after surgery on the table.

So what does that mean? Venous outflow.

So we get blood supply coming in arterially, and we get blood draining out of the nipple. Venous outflow. Right. So just like veins return blood to the heart, and then arteries pump it away. So the same thing. Two things can kill a nipple. Lack of arterial inflow or very poor outflow. Now, a lot of times when we cut around the areola, the veins kind of constrict down. So the outflows that. Not great. We see a lot of blood flow coming in, but they start to kind of turn blue because the veins just are kind of in shock and they're not dilated. So just like people take nitroglycerin to help their chest. Angina pain because it dilates the vessels. I Rubbed a little nitro paste on your nipples right postoperatively because I just wanted to kind of dilate those veins. I knew your nipple was going to be fine. I wasn't worried about it. But there's things that we can do in the immediate post operative period to just sort of help things along long. So in your case, I wasn't worried about necrosis, but if you didn't have good outflow, that could kill the nipple as easily as not.

That makes sense. Okay, let's talk about drains for a minute. Because not every surgeon uses drains. You didn't know if you were going to use them when we got in. What are drains actually for? And how do you decide if someone needs them or not?

If you think about it, you put it in. That's the short answer. That's the surgical teaching. So drains are for draining fluid from a creation space. So when you've got an implant underneath the breast and we take out the implant, you got a big space. We want that breast to scar back down to the chest wall. And so in the time period for about the first seven to 10 days, we want all the liquid that will form in that cavity because it's a wound that forms fluid, we want to siphon off all that fluid to allow that breast to actually collapse and scar off and close off that space. Now for a total capsulectomy, me, we're creating such raw surface that you can bleed, you can collect fluid that you get, you get drains almost always with a capsulectomy because we want to drain off all the fluid that's going to collect. Now sometimes in women who have a much larger breast and I take out their implants and I do a lift at the same time because they have so much tissue, it compresses that closed when I tighten them up and I sometimes don't place it, place a drain.

Got it.

So it's really just patient dependent.

And then how do you decide when they come out? So like mine stayed in for six days. I know some people that they had them two weeks, they had them, like had what. What determines that?

It's usually the amount of liquid that's coming out of the pocket. So we look at two things. When you come back after surgery, we touch the skin to see if there's a fluid wave underneath there, which would indicate, oh, there's fluid collecting here. That's not draining, that's one thing. And if they don't have that, then we look at the outputs. And generally we like to see about 30ml or less in a 24 hour period from wherever we're draining fluid before we pull them. And yours was very low and you didn't have any evidence of fluid waves. So I knew it was time to take them out.

Makes sense. Okay, let's talk about mastectomy for a minute. Because what makes me sad is some of the women that have messaged me like, my gosh, I went through breast cancer, I had a mastectomy and now I have implants and now I'm having problems. It's like, it's like this extra whammy that they're dealing with there. How do you, does that change your perspective on putting them in on mastectomy patients? Is BII a bigger concern? Like, I just, I'm curious about those questions.

So I don't treat anyone differently. I tell breast cancer patients the exact same thing that I tell breast augmentation patients. Here are the risks of implants. I think it's important for us as surgeons to even tell mastectomy patients. One of your options is to not reconstruct. Here's what you will look like without implants. Give them a picture of what they're going to look like and let them decide whether they would be okay with that or not. But I really educate both patients, cosmetic and reconstructive. We talk about bii, I tell em what we know, what we don't know, like we discussed earlier. And I let them kind of decide if this is the path that they want to go down. Now people might be questioning why I still do implants because I still think they're overall safe for most people.

Yeah, yeah. Like you and I talked about yesterday, I'm honestly not against them. I think people are villainizing. I'm like, it's this horrible thing. I mean, they serve. I, I personally wish I didn't do them. Me personally, because of, because I didn't know what I would be going through for so much over 33 years. That's my story. Had I not had those problems though, I would have probably felt different. And I do see it changes people's conf level and things like that. So I can't say I'm anti implants the way that some people are. So I don't know that I agree with this whole villainizing of surgeons for doing that. Also, when the case of somebody that has a mastectomy, I mean, that's a really big deal. So if you think of that like you're losing a breast, like implants are really psychologically a big deal for them.

100. Because, look, it would be great if, you know, when we get these comments on social media, like, just be happy with what God gave you.

Yeah.

Why can't. I can't.

Well, then don't color your hair or don't get your eyebrows exactly what I say.

Why do you put deodorant on? Why do you color your hair? Why do you get a spray tan? Why do you do. It's because we all look in the mirror and want to look and feel a certain way. And there's no question that sometimes the way we look helps us feel better about ourselves. And it's not shallow, and it doesn't mean we're not confident. It just means there's something I would like to change. And as long as I understand the risks of doing so. So I'm with you. And I think that for certain people, it has great value. You. But as our. As surgeons. We're not just surgeons. We're psychiatrists, too. We're kind of like psychologists. We have to make sure that people are doing it for the right reason and they fully understand the risks and the benefits of everything that we're doing.

You and I were talking yesterday. I said one of the big reasons I wanted to be done with them is, you know, I'm 52, and I'm thinking, I've already. This is my sixth surgery. I don't want to be 75. I don't want to be 85 replacing them again. And you mentioned you actually truly still have patients that come in wanting to replace them. Them.

So I just. I just had a woman who is 61 who took her implants out years ago, came in and wanted a breast augmentation. We had a long conversation about why she wanted to do that. At the end of our consultation, I felt like her reasons were valid for why she wanted them, and I did them. And what we were talking about was have women who come in that are, like, 75 years old.

Yeah.

Have contractures that are like, oh, my God. They've been hard for, like, 20 years. I never thought of doing anything. And I'm like, cool. So we're gonna, like, take them out and live. Right. Like, we're done. And they're like, oh, God, no, honey, I could not imagine living without my implants. And I have this conversation of, it's not so bad. You could take them out back in. And some of them are like, no, they want them.

They're clear. Yeah, we do live in Scottsdale, so maybe that has something to do with it. Yeah, I I just knew that that was not going to be me. I was really tired of having to go through this year after, you know, dealing with this so many times. So many times with this. What about. I just want to ask about this because I know we. We're talking about me with breast implants, but there's this whole trend of other things like butt implants and stuff like that. Is that truly getting more common or is this, like, is this just something we see on social media?

I think it's probably. I think a lot of the crazy, absurd plastic surgery that we see is sensationalized by social media. I mean, look, gluteal implants are a real thing. I do not do them. I am not. I'm not pro gluteal implants for many reasons. Number one, you sit on them all the time, and they can rotate, they can extrude through the skin, they can get infected, and it's horrific. There's reasons why I am not a big fan, but I do also believe that a lot of the botched, crazy stuff that you see or like big lips is a bit sensationalized. Like, I don't see those patients.

Okay, so when you. If someone wants to come in and they're trying to fix their. Their rear end, do you do like a Brazilian butt lift? Is that. And what is that, like a fat transfer? What is that?

Yeah, so I will do fat transfer. Sometimes it's either lifting and filling, so we have to actually. Actually cut skin out of the lower back to pull the butt up. And then sometimes they need to be filled. So it depends on what they need. But, yeah, I'll do fat transfer. And we. That's another topic we can talk about. The safety of that is it's not as bad as what people had been talking about, but I do do that, and I do think it's a safe operation. And I do do gluteal fat transfer with a lot of my mommy makeovers.

If somebody was going to get an implant right now and they're. They're about to get one, what are some things that. That, like, do you have a preference on if they do go with saline or silicone? And how do you help them decide that? And it sounds like you're pretty much against the textured silicone now because of the ones that were recalled. Is that accurate?

Yeah, I don't use it at all. And I'll tell you why. Even though there's two companies that still have theirs on the market, I'm just the kind of person that I'M like, listen, if there's even the smallest chance that my patient's going to get this weird lymphoma from textured devices, I'm not going to use them. Them.

Yeah.

Not going to use them because we have smooth, round devices which have never, ever had a case of that lymphoma. So silicone versus saline. I just tell people the pros and cons we go through. You know, silicone is a silicone filled implant. Saline is a saltwater filled silicone shell. Saline is more firm and hard. Silicone is more soft and more natural feeling. Patients who have thin breast tissue, thin skin, like they breastfed, had a lot of kids. Silicone tends to be a softer, more natural feeling device. Nice. For saline implants. If you have a lot of breast tissue and good quality skin, you can get a good result with either one. There's certain pros and cons that I explain to patients and then I just let them decide which they think is right for them.

Okay. Of all the explants you've done, and I know you still do a ton of implants too, but of all the explants you've done, how many people said they wanted them put back in?

Good question. I've only had two or three come back. I've had one come back that had no resolution of symptoms.

Okay.

She wanted them back, back in. The two others just couldn't live without it. So the big question is, what do I do?

Yeah.

I have a policy. If you come to me for BII and I remove them, I don't care if you want them back in. I will not put them back.

Yeah, you don't want any.

You have to go see another surgeon. Because if you truly thought you were sick from implants.

Yes.

Then why are you asking me to put them back in? So I just. That's a. That's an ethical thing for me that I decided that if I take them out for BII reasons, I will never reimplant you. You're gonna have to go somewhere else.

Okay, that makes sense. You know, and I. I'll share with me. I was sure. I was sure. I didn't think I'd want to put them back in. I was sure that I was going to take them out. I was gonna hate it, and I would be like two days out, and I was gonna be already booking a fat transfer for three months from now. But I. I'm not. I feel good. I'm like. I'm like, this is great.

Look great, though. Like, you've got Again, there's something to be said. When you posted that picture the other day and your pink top, I was like, she looks really good.

The only reason I could see myself ever, like wanting to deal with it again is if for some reason when they healed there was like a gap or something, maybe I would want something like that. Yeah. But I don't see myself. I feel like I'm going to embrace it. It feels. I'm like I'm actually looking forward to it. It's like a new thing. And when people told me that, I didn't think I would have believed it. And now I'm really on board with it. But what's funny, it's kind of like when you're buying a new car and you, you notice that car everywhere. Like, I'm literally noticing every woman's boobs. Everyone. I just notice it everywhere.

So crazy.

Like, that's all I can see. But I'm actually really happy. Any advice? Well, I'm going to share my advice on it. I'm going to ask your advice. And then he's also going to. We're going to link something below in the show. Notes of like, just how, if you're considering just any plastic surgery, like how to go about picking a good plastic surgeon. But I want to share with me because God knows I've had many plastic surgeries now. These was my six time here. It's been always for me, me, it's a gut thing. It's not just even the research. Like, yes, you do want to research. But honestly, like some surgeons pay to get their stuff put up. Like good reviews put up and stuff. It's a gut thing for me. It's my conversation. Do I feel seen, heard and understood? Do I feel like they're truly giving me options or do I feel like it's a sales pitch? Like, I really listened to that. I had one botched surgery over the years and it was a very different experience in that consult. Someone told me to go to him. It was a very quick consult. It felt like a sales pitch. Pitch. It. It just wasn't the same. So the reason I chose you, the reason I chose Dr. Ricky Brown is like I really felt seen, heard and understood. I felt listened to. I felt like really educated. You. You didn't rush me. You really went over options with me and you told me what you would do. You suggested if I was a family member. Like I. And I really liked that. So what's your thoughts on that? Because with the world of marketing, like there's so many Choices.

Yeah, yeah. Look, we're, we're going to create something for people to help them make this decision. But the things that I think are important. A lot of what you resonated is that you, what I think is most important first is that you start out and people probably don't understand what board certification means. So.

Oh yeah, can you explain that? Like what is that?

Sure. So the only surgeons in the United States of America who are considered board certified plastic surgeons get their degree from the American Board of Plastic Surgery. Right. Right. An ENT doc or an ER doc who has a cosmetic residency.

They are not or called a cosmetic surgeon.

Right. They're not considered plastic surgeons. Now I'm not going to get into some of those are great surgeons who do great work. But I'm just speaking from the perspective of the only board certified plastic surgeons are surgeons who are certified by the American Board of Plastic Surgery. And what that means is we did the residency training. We sat for the 200 plus question written exam and passed it. We then sat through a two day grueling oral examination where they hammer you on cases to make sure that you're a safe surgeon and know what you're doing. Those things are what make a board certified plastic surgeon. Now not every board certified plastic surgeon is a good surgeon. Some of them suck too. So after you, I think it's most important first of all to realize you need to find a board certified plastic surgeon. Now if you're having, having facial cosmetic surgery. I fully believe that ENT surgeons can do rhinoplasties and facelifts.

Okay.

Know the anatomy better than anybody. They do just as good of a job as any plastic surgeon out there. But when it comes to breast and body surgery, you need to find a board certified plastic surgeon. Then the next thing you have to do is determine who's good and who's not. So this is what you're really asking me. What I think is important is that you do look at some reviews, you do look at their social media. Right. Because you get an immediate vibe about a person when you see them. Them then make several consultations.

But I don't think it's follower number on social media. It's like looking at.

Yeah, I don't. And there was an article that just recently posts, does having a lot of followers mean they're good now does I have a lot of followers?

Yeah, that almost, it almost worried me. I was like what is this marketing?

It's all me. I run it myself. It's just I'm authentic and real And I. And I do my own social media, so I don't think that having a few followers or a lot of followers makes or breaks the surgeon. What I think is really important is that you get a general vibe of the information that they're giving you. Do you like what you hear? Do you like what you see? The next step is to pick four or five surgeons that you think you want to go visit. Go visit them. And I always feel like you want to listen to the staff. Does the staff seem like they like the surgeon? Are they connected or disconnected? Did the surgeon seem genuine or were they in and out? Or did they give you time and give you the. The answer the questions that you had to ask? Those are two really important things to me. In my opinion, then not only do you have to interview people and go see the surgeons, but talk to friends in the community. There has to be other men and women who've seen these surgeons and see what their experience was. Did they have any problems? And then another thing people can do is go to your state medical board's website and look to see if there's been any rulings against your surgeon or any foul play or anything. Those are things that people can do. And I think at the end of the day. But I would have told you, and we didn't. I didn't have to tell you this, but I always tell my patients, if you're seeing other surgeons and you don't choose me, I am not offended. What I think is most important, if you don't choose me, please make sure that you find a surgeon that feels right to you if they don't feel right. And something when you leave is just telling you, this isn't the person. You should listen to them.

Yeah, you have to listen to your guy. That my botch surgery. I did not listen to my gut. I. It was like I had a friend. Hers looked good. I just did. And it was. That was my only. That was my bad experience. One. So I didn't.

People get caught up in why I paid 100 bucks to see this person. I paid 200 bucks to see that person. I'm like, listen, you're going to pay thousands of dollars to have a cosmetic procedure.

Yeah.

Just throw down 500 into a pile that you were willing to part with because you're going to go try to.

Oh, yeah. And I definitely. I spent lots of money on consults. I didn't. I wasn't. But to me, that's like part of your investigation. Like, you're. That's what you're doing there. I also wanted to bring that up about, you know, a lot of people message and said, why doesn't insurance pay for this or what? First of all. Well, what I'm learning is sometimes insurance might, I'm actually going to submit. I might as well like because I had a rupture. We'll see what they do, what they don't do, I don't know. But what I want to share is for people that are like, I don't have the money or this you found the money to put them in. So if you truly believe you're having problems, I know you can find the money to take them out. Like I, nobody ever has just extra lots and lots of money laying around. But I just want that to be in people's heads because that victim mentality is not going to fix your problems. So just, just find a way. There's, there's medical credit cards. Like you, you had like some great credit. I mean I was like, why not? I'll do it. There was like some credit card you. It's like six months free, no interest. Like why wouldn't you do that? Why not?

Yeah, there's care credit. Sometimes I do layaway surgery where I just tell patients like put money down every month and once you're paid in full, we'll schedule surgery. But your question about, well, why won't insurance covered I think is a good one. I think people need to realize this, their perspective. And I hate insurance companies, but their perspective is, is you put them in for cosmetic reasons.

Of course.

Why should we cover to take it makes sense. It's not our fault. Like that makes sense to me. Right. But you should try.

But I especially with a rupture because it's creating other problems. So I think it's worth trying and correct. But, but, but not taking the, the mentality that if they don't like being the victim around it. Because we did make that choice to put them in us.

Yeah. Like you're not owed anything. Right? Like you're owed, right. You want to feel better, you want to get better. But I think that that expecting the surgeons to, to submit is something that needs to be talked about. Most surgeons will not submit. You'll have to pay them up front for the surgery and you can on the back end deal. And like I'm doing with you. Not every surgeon is, is as nice to do this. But I'm like, here are the codes, here's what we would use. I'm happy to. Whatever you need.

So what I did and you can ask your surgeon. I just asked them for a super bill with the codes. And then so then I just myself will write a letter and try, you know, it's worth trying. That's what we're trying then also I wanted to just touch a little bit on price. I just want to share because people said, well, how much does a couple costs? I had quotes anywhere between, for everything that I did, all the things, anywhere between 12,000 and 85,000. I just want to put that out there. Like it's such a range. So it's also. I wouldn't advise letting price dictate things, but just know there is a big range and there's a lot of reasons for it without. I mean, I know your, your prices are different and you depends on cases and everything's there, but do you have any thoughts on like surgeons in general and where they, how they come up with their prices? Because there really is a big range change.

I think some of it depends on the area you live in. Right. Like if you're in Beverly Hills, you're going to get quoted something higher than if you live in some small town in Nebraska. For sure, it's just a little bit of market dictation of price. The other thing is how much the surgeon loves themselves. Some people think they deserve to get paid a certain amount of money and they're going to charge a certain amount. For me, I mean, in here in Scottsdale, there's a lot of plastic surgery, so there's a lot of competition. But for me, I try to just charge what I think is fair for the time that I'm going to spend on the work that I'm going to do. It shouldn't. I mean, I'm never thinking like I'm going to be the cheapest or I'm going to be the most expensive, but I'm going to value myself and my time based on what I think that, that what I provide is worth. And for me, you've seen this firsthand. I am all up in my DMs talking to patients.

Yeah, you are.

Emails. When people need me, I try to be present for them. I don't disconnect just because they paid me and I got surgery. Like, you're mine forever now. Like, you will always have me.

Me.

I will always help you if you have questions. And not every surgeon is that way.

No, and I love that about you.

But so I just feel like I give people 10x in value what I charge them because I stand by them to help them.

I also want to share this. And this is like, maybe a plug for you, but I want to, I want to share it. So I've had a lot of surgeries, not just my breasts. I mean, my audience knows I caught. I joke that I'm surgery Barbie. I'm gonna get rid of that identity because in, you know, the last years, I had a ruptured disc twice in my lower back. I had my, I had a torn bicep. I had a broken. I had, like, a lot of surgery. So I'm, I'm up there on surgery Barbie. So I've had a lot of experiences with surgery centers, anesthesiologists. I will say, hands down, I have never had such a good experience like I did at your center. Like, you from. Even my husband told your. That if she's your. I don't know if she's your nurse or she's like, he's like, you have the best bedside manner. Manner. Your team was. They're fun, they cared. They were engaging. They made me feel, feel so good. It's like I can't even. It didn't even feel like it was a surgery. It was awesome.

Yeah.

Such good care of me.

It's very common. We have a good crew. And listen, I have been working at that surgery center for over 10 years. The plastic surgeon that owns that center is a very good friend of mine. His wife does anesthesia. I only.

Was that his wife that did my anesthesia?

Let's see, was yours on a Wednesday? Yes, Dr. Gollitz. That was Dr. Goll's wife.

So she was great. She was, like, funny. She told me, she asked me what my favorite drink. I'm like, I don't drink. She's like, well, it's going to be like, you have a cocktail. Like, she just. They were funny. They were awesome.

Awesome. The two females that do the anesthesia at that center are the, the I, I, I, I mean, this. Of all of the anesthesia staff I've worked with my entire life, they are two of the best anesthesiologists I have ever worked with. They are, they're incredibly proficient. They're very smart. But they're funny. Fun.

Yeah, it was fun. I mean, I, I felt I didn't want to leave. I'm like, this is great. Like, I, I remember I checked in. I was a little nervous. They, they right away, like, just were talking with us and calming me. They, they did something that's never been done. They gave me something before. I even, I don't even remember, like, coming into the surgical room or moving to the table.

Who knows what I said they gave you.

I was. Yeah, I don't even. Who knows what I said or didn't say. I don't even want to know. But I don't remember anything. I remember nothing. I just remember waking up and eating ice chips and being done. Yeah, great.

No, it's a top notch center and I, I always tell my patients I would only bring you to a place that I would bring my, my family. Like everyone there is board certified nurses, board certified doctors, every. It's a Medicare certified facility. It's top notch. So I'm glad your experience was good. That's very commonly what I hear. So it's nice to hear it from your end because that's how we feel like we provide that kind of a level of care.

So I know I asked you a lot of questions. If I miss any questions, for those of you listening, please, you know, let us like either message one of us on Instagram or what's your. Do you want people to go to your Instagram or TikTok or what?

Or yeah, Instagram's great. I. Anywhere. But yeah, my. It's Dr. Richard J. Brown. I'm trying to change my name. I can't change because I'm verified.

Okay, me too.

Change your name if you're.

I know. I'm Natalie Jill Fit forever. It doesn't matter what I'm trying to.

But yeah, Dr. Richard J. Brown. I try to get into my DMs and answer people's questions. I'm sure you'll link below my TikTok.

Yes, I'm going to link. I'm going to link below. We're going to. He's going to put together a little guide of like how to things that you should be asking and knowing before you select a surgeon. If you do want to make the trip to Scottsdale and go to him, I think he is highly worth it. I'm telling you all. I don't put everyone on my podcast because I had a surgery with him. Like he is top notch. I'm so happy right now with my results. So happy. I have a little pain on my right one that he knows. I keep telling him but he said it's normal. But I feel very happy. I feel like I'm in really good hands and I'm. I would recommend him a million times. So we'll put his information below if you want to do a consult. You also do virtual consults, correct? Like somebody.

Yeah, I get a ton of out of towners And I, I want people to realize and know that a lot of people feel like they're limited because they live out of town. Oftentimes you don't have to stay that long.

Okay.

Help you get here and get the accommodations you need. People freak out because they're like, I can't travel. I'm like, yes, you can. You can travel to see a good.

Got it.

And you should travel. Yes. It's a little bit more to get a plane flight, but people travel here all the time.

Southwest comes here. It's very inexpensive. Oh, I do have one question for me personally and other people ask me too. So I have, I have all like the biohacky stuff at my house. Like have the hyperbaric oxygen chamber, which I've been in every day since, which you said you like to. I have. I. I'll have a red light, which I'll start today now that I took some of the bandages off. But I also have a. An infrared sauna. And you had mentioned I need to wait four weeks. A lot of people ask me, why, why do we wait four weeks? Then I'm going to ask you about exercise.

And then, yeah, the reason is heat. Right. So in the early post operative period, for about the first three to four weeks, we don't want people getting into a swimming pool or a sauna. The reason is, is your incisions are fresh.

Okay.

If you sweat bacteria that ingrain themselves through one of those incisions, you can end up getting an infection. So it's just not good. We want your incisions to be perfectly sealed off from the world where nothing can penetrate them or cause an infection. That's usually around three to four weeks. So usually at three to four weeks, if all the incisions are looking good and everything is healing, great, I'll let people get in a swimming pool or a hot tub or a sauna. But that's really why. It's really, really. It's about wound care.

Yes. Makes sense. Okay. And I have separate episodes if you all want to hear, like, why those things. But mainly infrared, I'm excited to get into because it helps you eliminate toxins from your body. And clearly I had them on my report, so I want to get that stuff out. So that's why I'm excited to do that. And then now exercise people ask me about that. He has told me I could walk, which I've been walking low key every day. Low key. I've not gotten my heart rate up, just walking around my neighborhood. But he said at Four weeks, I can do cardio so I can start hiking doing that. He did say no workouts for six weeks. Can you explain that? Because I know I've asked 100 times, but other people want to know, too.

It's not no workouts. It's no heavy lifting. So the reason that we don't want you lifting more than about £20 for the first six weeks is because that's the point at which your scars are the strongest they're going to be. That's the point of maximum collagen being laid down in the incision to seal it and make it strong. Okay, so it's six weeks. We know that the tensile strength of your incisions are good enough to sustain starting to work out, out. So at six weeks, we allow you to start lifting and doing things like that again. But before then, you're just endangering yourself to tear open your incisions. And for you, you had a muscle repair.

Yeah.

I don't want you to rip away the muscle that I sutured down because it was already thinned out. And we're worried about the stability of that over time that'll get stronger. So you don't want to stress it too soon, but.

So you all heard him. So at four weeks, that means I can do air squats if I want. I'm just not lifting. So if you see me in the gym doing that, I'm not against doctors.

And you could do weights, you could do leg extensions. You can do things like that. But you have to be careful. If you.

At four weeks, handles.

Yeah, but if you grip onto the handles to do a leg extension and really flex your pecs, that's a problem.

Okay.

Got no upper body involved. It has to be strictly legs.

Amazing. Well, thank you so much for being here today. I'm sure we'll have more questions. If you all have more questions that we didn't answer, please ask us and we'll do it. We'll do a continuation episode, and I'll link up all of his contact information below. I highly suggest doing a consult with him if you're considering this everything as you're hearing him here. This is exactly how he is in person. So if you're getting. You'll. You'll see why I'm recommending him. You'd be in very good hands with him. Thank you so much today.

I appreciate you having me.