111. Breast Explant Tips with Dr. Robert Whitfield

Dr. Robert Whitfield 2:01

I'm very critical of both their diets and their hormone status.

Dr. Stephanie Gray 2:08

Welcome to the your longevity blueprint podcast. I'm your host Dr. Stephanie gray. My number one goal with the show is to help you discover your personalized plan to build your dream health and live a longer, happier, truly healthier life. You're about to hear from Dr. Robert Whitfield who is a plastic surgeon specializing in breast X plant surgery. Today we're going to learn why one may need to explain how they can prepare for the best outcome and we're going to dive into what testing Dr. Whitfield has performed on X plants and his findings. Let's get started.

Welcome to another episode of The your longevity blueprint podcast. today. My guest is Dr. Robert Woodfield, who is an experienced board certified plastic surgeon he completed six years of surgical training at Indiana University Medical Center. He remained at Indiana University Medical Center to complete his plastic surgery residency and at the completion he chose to gain additional training in microsurgery and aesthetic surgery by completing a one year fellowship in Las Vegas, Nevada under Dr. William Zamboni. He's an active member of the American Society for reconstructive microsurgery American Society for Aesthetic Plastic Surgery, a fellow of the American College of Surgeons and the American Medical Association. Dr. Whitfield focuses on providing clients with nutritional guidance, nutraceutical advice, personal genetic predisposition, screening, minimally invasive and surgical options for treatments all over the body. He's completed over 4000 breast procedures since 2004, including over 500 implant removals and we're going to talk about that today. He has the largest series of X plant specimens with PCR testing. While serving as the president elect of the Research Foundation. He gave testimony at the FDA hearings and 2019. Regarding breast implant illness. Dr. Whitfield's Philosophy Statement choosing to have surgery is a major life choice. Dr. Whitfield has personally been involved in helping make decisions about surgery since 1992, when his sister was diagnosed with breast cancer. Each patient has to know the risks and benefits so they can make an informed decision. With a proper plan and meticulous attention to detail. Each patient has the best opportunity for a successful outcome in his hands. Patient safety is incredibly important to him and at the forefront of each surgical decision. After spending so many years training and practicing, he only tries to provide the safest and most appropriate surgical care. Welcome to the show, Dr. Wakefield, like I have to somehow get that very abbreviated.

I was talking fast. Well tell us my listeners are eager to hear what you have to say today. Really tell us why you started taking care of Explant patients and do you believe in breast implant illness?

Dr. Robert Whitfield 4:37

Through the first part of the question is how I got involved with taking care of breast implant illness patients? Well, first I never knew breast implant illness you know existed i revolved my career round oncologic reconstruction. So when I was training after all those long years that you mentioned nine of them, I worked in an academic institution and basically performed oncologic reconstr correction for head neck cancer, breast and sarcoma. So I became more of a specialized oncologic reconstructive surgeon, and they did a small amount of cosmetic surgery, which typically involve the face press body what, what was needed, I left my academic post and went to a group private practice in Austin, Texas in 2012. And there I continued mostly to do oncologic breast reconstruction and increase the amount of aesthetic surgery I did mostly as it pertained to breast. So breast lifts and breast reduction and the like. One day a patient who had relocated from Georgia actually, and called the the consultation regarding breast reconstruction was having not necessarily payments wanted to know what options were about revisions, or possibly removal, the reconstruction, which was implant based, she came to see me and from time to time, I've had patients over the course of a 10 year oncologic career that needed to have a revision, a removal, a takedown. And so there's basically just like my bio said, my sister had breast cancer diagnosed the second week, I was in medical school. And so she called me Of course, the expert on all things related to medicine, that two weeks of medical school. And so my colleague at that time, was teaching us that, oh, I'll get you, you know, your sister preferred. And so we got her taken care of, but you know, basically, for breast cancer patients or any patients, you want to treat them more like your family unless like a patient so that it's personal, and you don't want to deep personalize the interaction. So I listened to her and she just was not happy with this reconstruction anymore. And basically, at the conclusion of it, I said, you know, I'm happy to, to remove it for you. And she said, I want you to do an enbloc capsule estimate, when SARS at turned around the subject, what the heck is that? I said, Okay, I mean, that's a pathologic Term or Term we use in cancer for resections, which is common to me because I had done so many oncologic either reductions or, you know, I had to go to a tumor board, like every Wednesday for my entire career. So I said, Yeah, I can do it that way. It's It's not complicated for me to do. So it's an odd request. And then she gave me this fistful of papers about heavy metal testing and toxins, and now it's like overwhelming. Okay, I basically don't know what to do with any of this. But I can do the surgical plan. I'll go through all this. And you know, one thing led to another I got her scheduled, and she had to be taken care of in a hospital. She had a pre existing medical condition, her primary doctor and such wanted her to get her hospital observed overnight. So I took care of her I did her X plant, actually in the in the manner she described, but when I did an oncologic x plan, my entire career was the same way. I took everything out regardless. And I did cultures, pockets, so that the time of X blunt, I knew exactly the bacterial situation in the pocket, if in fact, there was a problem. And I use drains on those patients, they typically had heavy layers of scar, lots of bleeding, typically, I mean, not necessarily the easiest thing to do. But I did that for her and I started her post operative visit, we were checking our laboratory results, and lo hace, came back with an E. coli infection. I feel after, you know, 10 years of seeing examining patients and nine years of training that was pretty astute about picking up infections, she had no laboratory abnormalities at all, she didn't have temperature problems. She had no external signs of infection. So this was a very bothersome debate, you know, is this poor lady been walking around with an E. coli infection? It's an infection. If you find for your listeners, an infection on a CLIA based lab system in a hospital, that means you have over 100,000 bacteria in the sample. So that's a significant burden for somebody to deal with. And so I put her on the appropriate antibiotic therapy. And I saw her and by a month, she was like a totally different person, because she had been carrying around and implant infection, not a quote unquote, vi type situation, but I'll get to that. So this was a implant infection. And so like, yeah, that was not good. I don't know how to figure. Yeah, I always look back and retrospectively it's like, okay, what would I have done differently in that situation to determine she probably had infection, MRI, CAT scans, blood work, mammograms, none of that was gonna tell you that you have problem.

Dr. Stephanie Gray 9:35

Can I miss such a good story, but can I interrupt you? So you taking cultures was that uncommon? Is that something that you were trained to do? Like, that's how you found the C. Coli. You found the E. coli because you were you cultures is that something that was not common practice like could not have been commonly missed otherwise by another surgeon?

Yes, this was a cancer patient and I always treat those takedowns or removals the same way As a protocol, you never want an immunosuppressed patient or a cancer patient to have an underlying infection that is not known at the time of an X plant or another surgery that you would have to treat because immunosuppressed patients, then this patient wasn't on chemotherapy, or I just I don't want anybody get confused, but you do that. So you know how to treat them after the fact. So if they got sick or D compensated, you then could go back and go, Okay, this comes from oncology transplant surgery, none of these are actually none of it's novel. And that's in a cancer or transplant setting. So I always treated those two clients the same aesthetic, and cancer, breast clients always were treated the same. And that's why it'll lead to how I've done things over a large number of years. So you don't miss a patient. It's infection, you don't miss a recurrent cancer, because you send everything for pathology. So the two things you do when you take it out as you send it for culture, and you send it for pathologic examination. So what I do now is I send that for PCR testing and pathologic examination. So I haven't stopped doing what I used to do. I'm just doing it better now. So we'll talk about why I did that the patient went on to do well, she invariably put me on some forum, Facebook group something and so I started getting patients who wanted their implants removed. Who wanted this inbox capsule.

Dr. Robert Whitfield 11:26

Yeah, so she probably said that I said, Oh, it's no problem to do that. That's easy enough. And so then I started having cosmetic patients show up on solicited, I didn't advertise anything, I wasn't doing anything, it just all when they started calling our office and everybody the office is like why are these people calling them wanting their implants taken out? So I would see and try to listen to the story and try to understand like, is this an implant infection like I had before? Or is this something different? The thing with plastic surgeons is, I mean, it's, it can be a little complicated. But if you just listen, then you'll get to the root cause or try to be able to help them get to their root cause it's not, it's not for me to determine whether or not you want your implants or not, I don't care. If it'll help you get to the place, you know, then I'll help you get there. The biggest problem in the long run is can I get you, as we get further into how this evolves? healthier, feeling better, you know, feeling good about yourself? Those are all different parameters. But so I started to these x plans for BI, right. And then as I said, I was put on different committees and leadership because I was part of the aesthetic society. And I was on the ALC L. subcommittee. So the ALC l committee is based on anaplastic large cell lymphoma, which is associated with textured implants. Please define what that is. Yeah, yeah, so textured implants have a rough surface, and that surface makes contact. And in the reconstructive patients, we used to use them for their mental hold still, because they don't have the tissue structures around them, because those have been violated by removal of the tissue, say, in a mastectomy. So this would give a woman the best possible size shape combination relative to her frame and dimensions. And it's been around conceptually for an extremely long period of time. You know, early reports came out that their textured implants were being associated with this anaplastic large cell lymphoma. And of course, because I was in leadership, I heard about it early. And I said, Well, I never use textured implants for anything but cancer cases, because that was my indication. That's how I was trained. That's how I was taught. And so I never put them in cosmetic patients. And I didn't do a lot of cosmetic breast implants. In my career. Because of where I worked, I worked at a tertiary Medical Center because I was an academic surgeon. So I wouldn't have seen a lot of people coming for a cosmetic breast augmentations. So I didn't have a lot of people. And then when I transitioned to private practice in Austin, Texas in 2012, I didn't do a lot either, because I was still doing oncologic surgery. So I don't have a frame of reference of oh, I've done 5000 breast donations, I've done 5000 breast reconstruction. So my skew is the other direction. And the majority of those are not done with implants, the majority are done with your tissue, that Tummy Tuck tissue that's discarded and a tummy tuck I used to use connected to the blood vessels to transfer to the chest and using microsurgical technique revascularize it and make it a breast. So that was my jam. When I was growing up in plastic surgery. That's what I did.

Dr. Stephanie Gray 14:39

That almost sounds like this was one of the last questions I was gonna ask you but a better option like is that called a fat transfer? I'm learning here I don't know.

Dr. Robert Whitfield 14:47

But when you're doing reconstruction know what I just described. I'm just kind of d i EP free flap. And then once that heals, invariably there's a little Halloween there may be a little dimply in there. may be a lack of volume. So then to make that better, you would borrow fat via liposuction and inject that into the spaces needed. And that would create a better volume eyes, breast reconstruction, better shape, and that is a fat transfer. So I've done oh my god for the better part of from 2005 to 2017, I would do between 100 and 150 Fat transfers a year because that was the second or third stage of a breast reconstruction. So when people on the Facebook groups, my favorite, demonize fat transfer, or say it doesn't work, my question would be to you, what is your frame of reference for what doesn't work, because if you go to my website, and look at the fat transfers with reconstruction, they're all exceptional results with just their own tissue and fat transfers. So...

Dr. Stephanie Gray 15:53

Does that fat last? That's just one thing I've heard.

Dr. Robert Whitfield 15:56

It's a little bit more complex and a breast cancer patient because they're made postmenopausal through chemotherapy many times and you know, our hormones are really important to fat metabolism. So when people say fat doesn't last, you have to put an asterisk next to that and say, what is the hormone status of the patient receiving the fat transfer. So if I take a pre menopausal woman, and I put three or four or 500 cc's of federal breast after she's had kids, or whatever, I call that and I have to trademark this my holistic mommy makeover, I don't put an implant, there isn't one implant, she just wants to have the volume back. She locks. So anyway, yes, they worked very well. But the things I do with my patients is I'm, I'm very critical of both their diets and their hormone status. So to get people who are really inflamed like me, I clients normally are, we take a lot of care into evaluating, you know, that preoperatively, and we can discuss why and how I do that. So yes, BIA is real. I testified at the FDA hearings about it, both societies are aware of they acknowledged it, the FDA knows about it, they just don't understand it. So and when you don't understand anything, it's really scary. And it's hard for them to like, fathom, you know, but I had the big wake up call when I had a lady who examined by preop. I did their console, I did all the aspects of their care and had the infection I didn't know about. So I don't take any thing for granted. When I see somebody with implants, whether it's a hip knee breasts, your assumption is, Are they fine? Or do they have an implant infection? And you would know that otherwise? It's not overtly obvious. So don't assume that it's not there just because you can't see.

Dr. Stephanie Gray 17:40

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Can you define for the listeners what breast implant illnesses like what symptoms might someone have? Or might did some of your patients have who came to you wanting these special X planned surgeries? Like how would someone know that they may need to have their implants removed? And actually let me add to that question like some patients. I have heard like I've had patients who have had implants who may have them read down every 10 years. I mean, is there as a surgeon, is that something that you recommend for patients like would that reduce any likelihood of breast implant illness? I'm asking too many questions. So let's come back to...

Dr. Robert Whitfield 19:59

That's a complicated question. So when you go to my new website, breast implant illness expert.com, there's an assessment tool to help determine if you have breast implant illness. So it'll ask you a series of questions which are common. Do you suffer from fatigue? Do you suffer from brain fog? Do you have cognitive decline? Do you have anxiety, depression, and gut health issues? Do you have joint pain, muscle pain, hair loss problems with menstrual cycle, recurrent BV, all these different things I've seen in my clients over time. And so once again, this makes it very, very hard for us traditional allopathic plastic surgeon to understand that this is in fact, a problem. And not only to the plastic surgeon does not understand it, the rheumatologist don't understand it. The family doctor does understand it, the OB doesn't understand it. Got the GI doctor doesn't understand it. So...

Dr. Stephanie Gray 20:58

None of them are even thinking about the implants. None of them are asking the patient what she's eating, and none of them are even thinking of implants. Likely. That's just my opinion.

Dr. Robert Whitfield 21:05

I'll put it this way. So we still do the same testing for people. That was done when I was a medical student. CRP said, right, total blood count, liver function tests, complete metabolic panel, they're all the same when you really should be to see their DNA and doing a saliva test. So the company I've partnered with out of Toronto, the DNA company actually uses saliva. But they have a special program using AI to look for what's called indels. So unlike snips, which are spelling errors, single nucleotide polymorphisms, this looks for an entire paragraph of missing code. So why does a patient suffer from bii? Well, can you do a task, like I just said, and get an idea of your patient has bi? Well, first of all, BI is more of a collection of symptoms than it is to me a diagnosis. So using your DNA, if you were to come to the office, Stephanie and do the test, and we go over your results, and you have the say you completely lack the glutathione metabolism pathway. So you just can't metabolize glutathione Well, that's a pretty big deal. Say you methylate okay, but not great, your MTHFR positive, but you also have trouble methylating and that affects your DNA repair. What if you don't have a very active peroxide dismutase to enzyme? Well, then your entire pathway for oxidative stress is limited. Okay, I live in Austin. Austin has a tremendous mold problem. How many of my patients do you think have toxic mold exposure superimposed with breaston? What else?

Dr. Stephanie Gray 22:55

Wow, that's that's how I started learning about this, as I was treating, I still am treating many patients with mold toxicity. And some of them also have breast implants. And there's just overlap there. And that's how I kind of have been sent down and attracted those patients.

Dr. Robert Whitfield 23:07

So, the big thing is, as you know, once you've reached your level or load of oxidative stress, then the cycles tipped and you can't get back and then they start having all these symptoms. So the symptoms that I see that I've highlighted already are indicative of just somebody in so much oxidative stress, and that they can no longer manage it. And what doctors are doing are masking the symptoms, which is our standard practice. So I've had people get placed on methotrexate for joint pain, I've had people placed on Plaquenil people are getting put on steroids. But so I basically, you know, sit there as a plastic surgeon having a functional medicine consultation in the midst of my plastic surgery consultation almost routinely. And I say, Look, if you have mechanical symptoms, which are caused from scarring, that's pain, that's nerve sensations, those are going to go away immediately upon waking up, those are gone, because I'm going to take those away. Now the symptoms associated with oxidative stress have to be managed differently. So I put people just as a baseline on a gluten free dairy free diet and plant based protein. We try to manage their circadian rhythms just typically they're all out of whack. So I'll put them on this glycinate at night and some melatonin extended release. We don't necessarily do a Dutch on everybody, but to check their cortisol levels so that they're peaking right we can I do and recommend mycotoxin testing a lot for these clients because it's obvious some of them though, they won't be obvious to them and they don't like hearing that their home or their workplace has the problem. But environmental toxicity is a huge problem. So I try to give them as well rounded of explanation with as much access to the best testing available, plus testing that almost nobody has besides us. And for anybody with brain fog. I must be the only plastic surgeon in the world. Who doesn't EEG preop And that three months. So the point is, I think we understand it, can we characterize it perfectly as we uncover more of it, we'll get better at it. I would never spend too much time patting myself on the back. That's stupid. But I certainly have a good feel and flavor for it when I see it. Sure.

Dr. Stephanie Gray 25:18

I want to just comment on the labs real quickly. Because I've mentioned in past episodes, I have yet to have a patient with breast implant illness, who has gone on to have an explant and not feel better, they all have felt better. But they all have also had elevated TGF beta one that is a marker that I've said I checked with biotoxin illness patients, and so far 100% of them now you could have breast implant illness and not have an elevated TGF beta one in my opinions. I'm not saying that you have to have an elevation. I'm just pointing on my observation that I've seen that marker to be commonly elevated in these cases when the Senator and CRP and all those are just part normal, right? So tell us how important it is to use a surgeon like yourself who specializes in explants. And is this where this unblocking capsule ectomy comes in, kind of share with the audience what that is.

Dr. Robert Whitfield 26:03

So it became more of like, I don't like problems that don't have answers. So as an oncologic reconstructive surgeon, that was my thing, I had to figure out how to solve a defect that normally would cripple or leave someone immobile, or they would ultimately die because something vital was exposed. So it was just being a problem solver. It was fun. My mom used to give me Legos. As a kid, I'd spend all day playing with Legos, problem solving has always been something that I wanted to do. And you know, when we started getting faced with more and more of these cases, I started doing more and more of them. And I was really conservative in the beginning, I wouldn't do lifts, I wouldn't do fat transfers. Because I was I didn't know what I didn't know, because I hadn't done many of them. I've done over 500 of them now over 400 with PCR testing for biofilm. And I can reshape and lift a brass that has some moderate tissue. It's better if you have more tissue and get a very, very nice aesthetic result. The enbloc capsule ectomy you know everybody's probably familiar with an easter egg that has the candy in it. And so you don't want to crack the shell of the Easter egg when you're taking out the implant because maybe the candy in the middle is bad for you, or it's leaking silicone gel. So in this instance, you want to take it all out as carefully as possible without disrupting it's much easier if it's above the muscle, but in the majority of the implants placed in the United States after 1996. They're behind the muscle. Why? Because the moratorium on silicon jaal prosthesis was in 1996, Connie Chung went on the news. And the implants were removed from the market. On my implants. Yeah, the saline implants had to be used. And the thought process was placed to bind the muscle partially or completely to help obscure the implant shape or the feel of it. And so that's basically what surgeons in the United States did, after or circa 1996 beyond. And so 2013 silicone was really reintroduced to the market. Now, it's always more difficult to get something off of ribs, that's a bit more risky. That's why people in my position as plastic surgeons either don't like to do it, don't want to do it or say it shouldn't be done because it's too risky. So there are certain steps to take to mitigate risk as in any other surgical procedure. Now, I will tell you my backgrounds and oncologic surgeon and oncologic reconstructive surgeon made most of this a non sequitur after a period of time. But enough of these, to me, it was just like another type of case I had to do, or that I was able to do adding to the repertoire. Now as I've gotten older and operated since 1996, I'm now decreasing the number of things I do because I just I don't like doing them all anymore. I like doing the ex plants because as a service, it's a very complicated, very difficult patient group sometimes to deal with. But when you get them to the other side, it's a very rewarding group of patients that have had the ability to take care of much like my oncologic patients, I once again I told you I don't I'm a problem solver and I never liked to lose. So I wasn't really interested in being told I couldn't do something that never happened. So I feel like as we expand our testing capability with DNA testing, we can make more inroads with nutrition and supplements geared to decrease autoimmune systems, autoimmune symptoms and inflammation, then we'll get further of these symptoms. And I would encourage people if they've had implants a long period of time, beyond say eight years to just have a discussion with their plastic surgeon and if they can't get a positive kind of vibe from that then certainly I'll do a virtual with them or they'll find Somebody who can do a virtual with to just listen to them and see if there's a need for that now I no longer exchange implants and put new ones in. I either take them out and remove everything and replace with fat, or I take them out and leave them out.

Dr. Stephanie Gray 30:15

So this eggshell you mentioned this capsule like does everybody has a hard capsule? Or does that get harder over time? Like when they're hitting the eight to 10 year mark, whatnot?

Dr. Robert Whitfield 30:24

Yeah, it's variable. It depends on the type of implant. The rougher surface implants tend to produce a more thicker capsule like the textured implants, the smooth ones don't. People who don't have an intense immune response typically don't. It's really variable. But I think basically what you need to know is that you would like to get that capsule removed in blog if at all possible, if not a total capsule ectomy so that all the material has been removed by test every single sample since February 14 2019. With PCR because I was getting aggravated by clear base labs telling me when there was nothing there, there was clearly a biofilm so slimy that I could tell in I had a cleaner sample from another state to get taken care of. And she clearly had biofilm like, What's worse than an ICU nurse. She's been exposed to Godzilla bad actor, basically her entire career and she's probably got it all over the place. And say, I went out confidently and I told her husband after the ex plan on like, she's gonna get better. I'm confident this was total totally infected. So then, of course, when you're overconfident, you get repaid with normal Flora on her clear bass lab, microbiology coasters. And I was like, well, there's no way I don't believe that. And so I ended up draining as I did back then all my patients and placing her on antibiotics. And she went home and drains in place that drain for like three to four weeks. You know, most of it's inflammatory fluid, but you don't know what you don't know because you don't know what's on the pocket. Now I have over 400 You know, PCR tests, predominantly achieving them agonists some staff, rarely, if ever, any fungus I have a triathlete that had fungus, but it made sense because triathletes, women legs, they get out and run barefoot, they get punctures in their feet, or Spartan racers get Acetobacter because they're digging in mud. I mean, some of the things are just funny, but they all make sense. Forensic ly, it's like a vat of soda house.

Dr. Stephanie Gray 32:20

So to a listener, though, so essentially, what you're saying is a lot of those organisms are then like getting stuck in the biochem. And the breast implants. Is that what you're saying?

Dr. Robert Whitfield 32:29

So that's internally facing the implant. So the specimen is taking from the internal facing aspect of the capsule of yes, the exterior shell of the implant inside of the Easter egg shell up against the cambie. Yeah, so ultimately, biofilm can come from anywhere, if you had a hip patient or a total knee, they got a colonoscopy, and they weren't covered with antibiotics. And they had a biopsy in their bloodstream got showered with bacteria during the biopsy, and exceeded their knee implant, what would happen, they wouldn't have a biofilm of their knee implant. None of this is actually rocket science. This is all very old. So if someone has an upper respiratory tract illness, and this happened to me when I was covering for like my group, somebody's patient had a progressive Tory tract illness, they thought it was viral became bacterial. Basically, she developed cellulitis of a right breast, you know, those patients can take care of an oncologic patient who develops that, as you play some in the hospital, you place them on IV antibiotics. And if they don't resolve in 24 hours, you have to take the implant out, clean out the pocket, either wait or place a new implant based on, you know, the clinical setting. All this stuff's been detailed and literature for a long period of time, it's never been that clear and aesthetic patients because obviously, it's a much different, different scenario, you're gonna present to your plastic surgeon, they're gonna evaluate you. And of course, they better put you on or have you placed in the hospital on IV antibiotics if you have that situation, but the people were presenting without any clinical signs of problem that would be deemed an infection. So it doesn't register to anybody that we know what's happening. And the whole thing with autoimmunity and getting it like, it's just becomes complicated for providers who don't know anything about that situation to then grasp and understand like, okay, so what do I need to do to help this client? And the answer is take out the implant and remove all this capsular material, hopefully all intact, and then do these other steps. Like in our program, it's very different because we've already introduced the, you know, ways to establish improvement in circadian rhythm, and mood and nutrition and supplement support. So I had to learn that through you know, our functional medicine providers are functional nutritionist, but it makes a big difference if in fact, you can get the buy in on the client side.

Dr. Stephanie Gray 34:57

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I want to just go back for a minute here for listeners. So, I'm in Iowa I'm not even sure if you knew that I was referencing the snow on the ice earlier. So maybe by geographic location, but to my knowledge, like we only have like one search in the state who really specializes in explanting, like has a lot of experience in that. And some of my patients have gone that direction. Many of my patients have actually gone out of state like they've sought out a surgeon who really specializes in this. So it sounds like you're saying one of the things that specialists who are specialists in explant surgery should do is absolutely pick up the entire capsule. And the second thing is really the test for infection. Am I hearing you? Right? I mean, is that some of those some things that patients should be asking the surgeon in that console, or what else sets your practice aside?

Dr. Robert Whitfield 36:51

Yeah, I think I always want to, when we're completely done with the surgical process, like, people want to see what was causing this problem. So I take pictures of their specimens for them at their request and put them in their chart. So that helps someone know that I did the surgery and unblockable manner. So they can see that, that helps them see the device that's been quote unquote, the notice of this problem. And then if they want the device, they can have the device if it's not ruptured or leaking, I just give it to him. But I think if you're going to do this for folks, you have to be competent, you can do all that for them. And then that brings closure to them. So when I get those samples and send them off, I tell them, It's like checking all the boxes, right, I'm going to make sure you don't have an infection, or biofilm contamination, I want to make sure you don't have cancer, whether it's a LCL anaplastic large cell lymphoma, or breast cancer, because those things will kill you. I'm all about not being the guy that gets called in two months, two years or 20 years that missed the cancer, or didn't do the right thing. I want the clients to know that all that stuff's gonna be behind them. And if they're taking care of provider in another state, like you're helping them, you need to know that they had biofilm because that's gonna help tailor what you do for them, probably a bit ahead in terms of what I'm trying to show from a data standpoint, and then how to implement it as more unique to them functional sin or somebody who's interested in biotoxin treatment, things like that biofilm trip,

Dr. Stephanie Gray 38:22

You already mentioned, you'd post patients or bio toxins when you like, test the implants or anything else, like heavy metals, or how like how the patient knows they have silicone toxicity? Like?

Dr. Robert Whitfield 38:31

That's adifferent problem. So when I first encountered this, I told you, I don't like to leave things unanswered. And so the answer to that question is you have to digest or have the material digested to look for the heavy metals, the capsular material, so you have to send a sample somewhere to do very few labs do it incredibly expensive. So I can't commercially do it, and then pass that cost on to the clients because it's too expensive,

Dr. Stephanie Gray 38:59

But the patient could be tested. I mean, I assume the patient, right? If the patient's worried about heavy metals, I mean, not the actual capsule, but like after surgery, you could test the patient themselves.

Dr. Robert Whitfield 39:09

Yes, yes. Yeah. But for me, it was like I want to know at that moment what it is in that pocket, because this all goes back to an indictment of this device in this pocket surrounded by this star. So I get it. I'm trying to take the emotional component and just give you the data and the data speaks for itself. So if the tissues have the heavy metals there, and I kind of established that that would have been like full closure to that scenario, but we tried to fund a study for it before COVID. We got it funded through my board at that time because I was president and then COVID happened. Nothing beyond has ever really happened because COVID happened and I don't I don't know where any of that actually landed because nothing could ever get started.

Dr. Stephanie Gray 39:56

Sure. I want to maybe go in a different direction here for a second. So Do asking as far as I, I posted on Facebook prior to this interview, if anyone had specific questions they wanted me to ask you and I got just slammed with messages on Instagram, Facebook and whatnot. So one of the questions was like, how commonly do implants rupture? And I guess that kind of ties into potentially silicone toxicity? Like, can silicone implants leach into patients bodies over time? Like, can they develop a silicone toxicity? Well,

Dr. Robert Whitfield 40:27

I've taken out a bunch of ruptured leaking implants that are leaking into breast tissue. I mean, that was the whole reason they got took off the market in the early 90s. So when implants were reintroduced, and you heard of the whole gummy bear implant, they also think of something like jello instead of something like syrup. So you shouldn't, in fact, have any silicone going anywhere, because it's all stuck together. If you're talking about the old, old old devices from the 80s. Yes, if you're talking about the newer devices from 2013 on, then the answer should be no. It should just stay there.

Dr. Stephanie Gray 41:02

I had heard of the gummy bear implants, but I didn't realize that those are the new ones, you know, after the that were reintroduced?

Dr. Robert Whitfield 41:08

Yeah, basically, everything sold now in the United States is like that.

Dr. Stephanie Gray 41:12

So that saline implants are still sold. Right? So do you have about silicone? I was yeah, what's the difference? I want to go here for because patients and you know, ask, ask him what's what, in his personal opinion is better silicone versus saline? But aren't the saline implants still coated with silicone?

Dr. Robert Whitfield 41:30

Yeah, so from an oncologic perspective, when we did reconstructions, silicone was always a superior product because you don't have a thick layer of breast tissue anymore. Because that was removed by mastectomy, silicone breast implants were always softer, and held the shape better and felt more natural, if you will. The saline implants felt more tense because as they fill them, they expand and the more like water balloon effect. So if you had breast tissue over a saline implant, that would feel more natural, but it still would feel more tense than a more malleable silicone gel prosthesis.

Dr. Stephanie Gray 42:05

And out of all the explants you've done, I mean, our Have you seen more saline versus silicone? I've seen everything.

Dr. Robert Whitfield 42:12

This country, South America, Europe - textured, smooth, round shaped gummy knock dummy doesn't matter.

Dr. Stephanie Gray 42:21

It sounds like there's not one that's any better than the other. In your opinion, though.

Dr. Robert Whitfield 42:24

I think ultimately, it will be borne out that through your DNA analysis, it will determine how well you detoxify where you live determines how much environmental detoxification you can have, or toxicity you can handle. And then your work your diet, your sleep hormones.

Dr. Stephanie Gray 42:42

So how do you help patients heal from illness after so are you also incorporating functional medicine post explant? I guess sounds like you're with nutrition and like, Are you helping patients detox post explant? Is there a protocol that you have?

Dr. Robert Whitfield 42:55

Yeah, we we joke around here that I'm the functional plastic surgeon because my consults took an hour. And they're mostly revolve around not by how I operate. But what I have you put in your mouth, basically, once I hear the stories and listen to and examine the patients and establish that, you know, the best course is an x plan, you know, to relieve the symptoms from if it's breast implant illness, then, you know, we're going to talk about the functional medicine approach to their pre op planning. And that includes you know, how to get their circadian rhythms, you know, set so they'll have appropriate rest for both before and after surgery. The diets a huge deal for me, because I can't stand variance and outcomes. So I've operated a long time. I feel comfortable in any given situation, I can get the outcome. But as you know, with total body inflammation, poor diet, a lot of stressors, that people will stay swollen for many, many, many months. And then it's combination of like pain and heaviness and irritation leads to more dissatisfaction. And I basically say at this point, I'm a micromanager of everything that goes in the body before and after surgery because that's the way I get the best recoveries. We put them on a gluten free dairy free diet. If we know specifically, there's some other things from DNA testing that we can do will modulate that we put them on curated supplements free up from our store and including a probiotic spore based and then I have a specific protocol to run prior to surgery. So people do better if you actually get them started in a certain way the night before surgery. So we give them something for nausea. We give them something for inflammation and we give them something for nerve pain. nerve pain is a big problem in ex plants. So yeah, to treat it up front so that it's only in the background. The next day we have a son come to the surgery center we're using bring their medicines. Take more or Gabapentin typically, they'll have some Tylenol at the surgery center will do the procedure. Once I've taken out the implants and the enbloc technique, I'll inject alone a longer acting local anesthetic called Expo. And so what this medicine does is it helped blocks the nerve, the soft tissue, and the muscular tissue as well as rib surfaces for about five days. So you can make all that pain and discomfort that normally would be experienced right after surgery really minimize so that when they wake up in recovery, they're comfortable by page and stone a lot in our clinic after surgery at all. After surgery, we wrap folks in a strap that go home, they're encouraged to walk one to two miles a day, ask them to use an app on their phone or their watch or whatever. That's their exercise pattern. Ice packs, 30 minutes on 30 minutes off as much as they can for as long as they can the first two to four weeks, see them at a week. My talk to the next day by phone I see about a week. Those first two weeks are the difficult ones right there. There's this kind of relief that this has been done. But it's also very kind of disconcerting, because there's going to be a big appearance change. There's a lot of psychosocial issues. And that's what led me to do more lifting and fat transfers. But just in this basic situation, you know, it's getting adjusted to this new physical appearance. And then we have a small amount of narcotic. We try to get people week over week doing more activity. So we get the six week Park and then I get people doing more more strenuous activity, more strenuous exercise, by continuing them on supplements, you know, three to six months out and their diet three to six months out at least. And then I have much less like a window, I stopped this diet or window, I stopped the supplements or window I stopped doing this. I'm like, Well, do you feel better? They're like, Yeah, remember, it's not all the implants, right? We just implemented all these different changes about sleep and mood and nutrition and supplementation exercise patterns. So why would you want to stop any of it? Why would you not just call Stephanie and try to figure out how Stephanie can make it better? Because I'm not the end all be all for this. But I certainly programmatically have the my window.

Dr. Stephanie Gray 47:08

I wantto go as we wrap up here. I have a few more questions. I want to go into what other options patients have. Because ultimately, I want to ask you Do you still implant? Or do you only x plans now?

Dr. Robert Whitfield 47:18

Well, options if someone's if someone is experiencing mechanical symptoms, like nerve pain, that can be very debilitating.

Dr. Stephanie Gray 47:26

Yeah. Well, I mean, do you still offer patients breast implants mean? Is that like a service that you still offer?

Dr. Robert Whitfield 47:32

Yeah, so I don't offer patients implants anymore, I never actually placed a lot of implants, I put them in the majority of instances for cancer. And that was a small amount. So basically, for a holistic or from a holistic perspective, we feel we're going to offer fat transfers as augmentations. We're going to offer explants with fat transfers, we'll do reductions and lifts, but we won't place anymore implants.

Dr. Stephanie Gray 48:00

So I know some patients can really struggle feeling uncomfortable, like with what you said, with body changes that can happen after such surgery right after they have these implants removed. Now, some of my patients feel so much better. I don't know how they they just kind of hurdle through that quickly, because they know they made the right decision. And they're happy they did it. But for patients who are struggling with that, I mean, what do you recommend other than like therapy, obviously, there may be some body image issues here. Like what do you recommend to help patients through this change, right when they're, they're having their implants removed.

Dr. Robert Whitfield 48:31

So we have a variety of tools now. We've used like health coaching, other programs, support groups, with our patients support from patients within our patients face groups, I shouldn't say their Facebook groups, they run them themselves. I don't run them. I see patients so frequently, I see them at three month intervals the first year. So I try not to let anybody get too far gone. Now if someone needs more counseling, more help, I try to refer them out as quickly as possible. So that's been identified.

Dr. Stephanie Gray 49:05

Well, this has been very interesting. So tell us where listeners can find you kind of where your website is where you are on social media, like your Facebook groups. Um, tell us more about that.

Dr. Robert Whitfield 49:14

Right. So you can find me on Instagram at Dr. Robert Whitfield, Facebook, Dr. Robert Whitfield, MD and Tiktok at Dr. Whitfield. Now I have a new podcast called The holistic and scientific plastic surgery podcast. And I have a website specifically devoted to identify whether or not you could be someone with breast implant illness. It's called the breast implant illness expert.com.

Dr. Stephanie Gray 49:38

I'll post a link to that in the show notes. So tell us last but not least what your absolute top longevity tip may be.

Dr. Robert Whitfield 49:45

So I think as we move forward, we're going to leverage DNA to live longer. And the way we do that is looking at these analyses with artificial intelligence. So for instance, the fox three gene is the big aging chain That's something that we need to hack and work backwards from with dietary changes and nutraceuticals that answer.

Dr. Stephanie Gray 50:05

Well, thank you so much for coming on the show today and really enlightening our listeners on breast implant illness and just giving us guidance to help our patients on their healing journey. So thank you for your time today.

Dr. Robert Whitfield 50:14

Yeah, thank you for everything.

Dr. Stephanie Gray 50:16

Well, that was super interesting. He's a super smart guy, definitely someone I'd want to consider having for my surgeon if I needed excellent surgery. To connect with him further check out breast implant illness. expert.com other resources I quickly wanted to share with you that I looked into while preparing for this episode include the documentary X plant on Paramount plus and the book The Naked Truth about breast implants by Susan Kolb. If you want to hear more on this topic, consider listening to episode number 17. With Sarah Felipe on breast implant illness. Be sure to check out my book your longevity blueprint. And if you aren't much of a reader, you're in luck. You can now take my course online where I walk you through each chapter in the book plus for a limited time and of course is 50% off. Check this offer out at your longevity blueprint.com and click the Course tab. One of the biggest things you can do to support the show and help us reach more listeners is to subscribe to the show. Leave us a rating and review on Apple podcasts or wherever you listen. I do read all the reviews and would truly love to hear your suggestions for show topics guests and for how you're applying what you learn on the show to create your own longevity blueprint. This podcast is produced by Team podcast. Thank you so much for listening and remember, wellness is waiting. The information provided in this podcast is educational no information provided should be considered to be or used as a substitute for medical advice, diagnosis or treatment. Always consult with your personal medical authority.