EFR 846: Symptoms of Breast Implant Illness, Dangers of Explant Surgery and How to Improve Breast Health with Dr. Rob Whitfield

00:00 - Chase (Host) The following is an Operation Podcast production. Number one sleep for breast health. Number one is sleep for all health. The FDA said, quote BII breast implant illness is not recognized as a formal medical diagnosis and there are no specific tests or recognized criteria to define or characterize it.

00:21 - Rob (Guest) All right, do you agree with that? Breast implant illness to me is a chronic inflammatory process of which the medical device, in this case a breast implant, is a component, and when you take it out you don't resolve that process completely. But if the signal never turns off, eventually it becomes a chronic inflammatory process. It doesn't follow anything and so I don't make diagnoses of breast implant illness. I listen to how someone genetically detoxifies because everybody wants to know what's the evidence. Well, the evidence is it's Dr Robert Whitfield. Welcome to Ever Forward Radio. My discussion today revolves around breast implant illness and explant surgery.

01:09 - Chase (Host) Welcome to Everford Radio. I'm your host, chase Schooning, army veteran wellness entrepreneur, and I'm here today with Dr Robert Whitfield. He is America's breast implant illness expert. Rob has been a plastic surgeon for over 25 years and board certified for over 16 years. He specializes in what you're going to hear us talk most about today on the show is breast implant illness, or BII, as well as breast implant removal surgery and advanced cosmetic procedures. His unique approach to this even more unique area of wellness, especially for women who have undergone breast implants and are maybe experiencing BII, is his SHART method. This is the Strategic, holistic Accelerated Recovery Program. It is meant to help reduce systemic inflammation and assist his patients that are both preparing for or recovering from surgical procedures. Rob is here to educate and inform us about the perfect balance of art and science and ultimately give hope to scores of women looking to age gracefully or restore their health after BII. If this is you or someone you know, tune in, take notes, share with someone that you think could benefit from this message is experiencing symptoms of breast implant illness. It would mean the world to me if you would share this out with someone that you think it could help the most. Also, if you've not yet done so.

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04:20 Dr Woodfield, what's going on? Welcome to the show. Thank you for having me Rank these daily habits to boost breast health without knowing what comes next. Okay, so I'm going to kind of rapid fire some stuff and I want you to hierarchy 1, 2, 3, 4, 5, 6. Number one being the best, six being least important Maintain a healthy weight. I would go three. Okay, what about cold showers? Slash cold plunge, cold therapy. Six Exercise, particularly chest upper body focused.

04:56 - Rob (Guest) If you say exercise, go two, I don't chest focused, does it?

04:59 - Chase (Host) better, okay. Daily stretching and or massaging of the breast and chest.

05:05 - Rob (Guest) Five Regular screenings in terms of mammograms yeah, I mean, I would put that as four Okay. And then sleep in terms of consistent quality, Number one always.

05:16 - Chase (Host) So number one sleep for breast health.

05:19 - Rob (Guest) Number one is sleep for all health. So you have to sleep and it's the quantity and quality. And if you use a wearable like ultra human ring or whoops, like we're both wearing, do you understand what I mean by the quantity of deep sleep? That's restorative sleep. About two and a half hours is really necessary. And if you can't stay asleep that long, hormones can't get released and there's really no chance that you're going to heal and recover and be ready for the next day.

05:42 - Chase (Host) All right, moving on. I got myth or truth section Okay, healthy healthy addition here Breast health addition.

05:49 - Rob (Guest) One myth or truth breastfeeding will ruin a woman's breasts in terms of shape, size, sensitivity. It's really about how large the breast gets up and down. I mean, it's not so much every single case is going to be that way, but if a woman can produce a lot or very little milk and that will change the shape, that's really when you see people have it's stretching of the skin and that becomes the problem, the laxity that develops.

06:18 - Chase (Host) Interesting, Okay, cool. Myth or truth. Number two once an implant is in, it is in forever. No, no, False, that's a myth. Number three running is harmful for breast health for women. False Four if you have a breast reconstruction, it will be hard to detect breast cancer in the future. False Five breast implant illness happens eventually to anyone that gets implants. False All right. Last one, Sauna. Everybody's hopping on the sauna these days. Is it harmful to breast health?

06:57 - Rob (Guest) Okay For all the trolls. So the sauna is. We'll talk about the sauna and why extreme heat is a problem in this case. So think of, like the extreme heat and what happens with a water bottle and the phthalates that come out of a water bottle into the water and you drink it and that's an endocrine disruptor. I have evidence of patients that I've taken care of that have lost the integrity of the shell and that's letting down the heavy metals that are used in the curing process of the shell and they leach those into their system and then you can recognize those on toxicity screening. So that's more of a heat related phenomenon that I've seen. I probably have the most information on it in the world, which pisses a lot of people off, but that's fine.

07:40 - Chase (Host) Is sauna more harmful to a woman with breast implants than a woman who does not?

07:46 - Rob (Guest) Yeah, so we have our patients pause infrared in a barrel or any sauna for 90 days after explant and then resume it in a more measured way, with usually a binder in place so they don't suffer from a Herxenheimer reaction. So it's about achieving balance in their detox capability versus their toxicity burden before you actually send them off to detox more Binder being.

08:12 - Chase (Host) like you know, before you hop in the sauna, take some like activated charcoal or something.

08:15 - Rob (Guest) Yeah, that's pretty much the most basic. One is activated charcoal.

08:19 - Chase (Host) Is there any? Uh?

08:19 - Rob (Guest) what are your thoughts on that in general, for you know, women, men, anyone you know taking a binding agent like activated charcoal before getting into sauna therapy. Well, you would have to time that a little bit better because the absorption is different, because that's a capsule-based treatment. If you want to take something like we use, you can make a slurry out of something called carboxy from Cellcor and then that's more of a readily absorbable because it's a powder, okay, but it's a more aggressive binder.

08:47 - Chase (Host) So you wouldn't do that, like right off the bat I've used recently I found um, symbiotica is the brand they use.

08:54 - Rob (Guest) Uh, it's a liposomal activated charcoal right, so that anything that's liposomal you will get and achieve absorption more quickly. Okay, so that would be a better you like? Oh, I'm going to take it. Then I'm going to go get in the sauna versus I've got to time it. If I take a capsule or tablet of something then I have to give it a little bit of time to get into the GI tract and the stomach and open and be able to be used to absorb that.

09:20 - Chase (Host) Would you say most people most of the time could benefit or even should take a binding agent before getting into sauna, or is it just only if you need to kind of go through more of a detoxification process?

09:33 - Rob (Guest) Yeah, I mean in the book that you have in front of you, sharp, we talk about your genetic capability of detoxification and then, as your bucket fills up and then starts to overflow with your exposures, those people will be more inclined to be the ones you want to have using a binder versus the other folks. Like, some folks detoxify very well and they don't need to do adjuncts like that, so it's not like it's bad, but it's not necessary in every situation.

09:58 - Chase (Host) What makes someone detoxify better than someone else?

10:02 - Rob (Guest) So, yeah, we look at genetics. So we're looking at how your vitamin D metabolism, methylation pathways, how you manage glutathione in the liver and your antioxidant pathways in conjunction with you know my patients predominantly going to be female and they may suffer from problems with estrogen toxicity, so they may produce more metabolites that are not good for them with estrogen breakdown. So something called estrone is a bad actor, and so if you have that plus more problems with your methylation pathway like comp is a problem then they're really going to have a difficult time with detoxification, if that makes sense. So if you have those limitations and you have limitations in your hormone metabolism and you have a lot of exposures like mold and heavy metals and you know environmental toxins, if someone doesn't understand and put their the dirty dozen, you know you can look at the foods right and say like if you're not really focusing on the quality that's why I make a big deal about the quality of food.

11:04 Everybody is trying to probably do better and the term clean diet is thrown around as a very common term. But how clean really are you? Yeah, what does that really mean?

11:14 - Chase (Host) What does that really look like?

11:16 - Rob (Guest) So you could be trying, but then in fact, if you're, we'll just say a non-organic strawberry could have as many glyphosates, which is a herbicide, than the actual herbicide being sprayed on the fruit. No way, because the skin is so thin. A single strawberry, it's so thin, it's just absorbing it. So that's a big problem in terms of a woman's endocrine system. So as inflammation goes up in your system if you're a woman system, so as inflammation goes up in your system if you're a woman, the very first thing we see usually is like some disturbance in their thyroid. So a lot of folks will say they have Hashimoto's disease or their hypothyroid, and then they're very hard to control.

11:58 I have that happen every every day in my clinic that I'm there, I'll see somebody with that kind of same issue and then they start their journey of like all right, I should modify my diet and cut out gluten and cut out dairy and restrict or eliminate seed oils and exercise Like it's when things go off the rails and everybody goes back to like the basics. So the basics are you have to really control what goes into your body. Your body is really a performance machine. And the quality of the water or the fluid, if you want to think of it that way, the quality of the air, which I think is really kind of underappreciated, and then the quality, like we're talking about food, food, you know it's.

12:38 It's no disrespect to call food medicine. If you know how to eat properly, then you will definitely, you know, feel better and that, in conjunction with, if you have those limitations in genetics, proper nutrient dense supplementation to help those will help you. And then you mentioned liposomal. That's the way my line is formulated to help with people who have poor absorption, because if you have a poor um you know.

13:05 Just think of if you have imbalance in the gut microbiome, everything gets out of whack. And then if you can't eliminate you, if you have constipation, then all those things build up in your system and that'll make you feel unwell to say the least yeah, air purification is a new area I'm kind of diving into.

13:24 - Chase (Host) My wife and I are recently pregnant with our first child and so I'm sure, like a lot of new parents, you begin to kind of get how healthy can we be, or how healthy are we not? We're both pretty healthy and taking care of ourselves in all capacities is super important. But especially looking at the home, I just got in a mold test, I just got in a new Jasper, this air purification system for the house.

13:46 - Rob (Guest) So Jasper's out of Austin.

13:47 - Chase (Host) Yeah, okay, cool, good. Yeah, I'm super stoked to just make the best home basis possible for the baby. But we get to reap the benefits too.

13:56 - Rob (Guest) So that's critical when you talk about that. Here in Los Angeles air quality is a problem and we're in Austin, where you wouldn't necessarily think Austin has bad air quality, but there's a lot of cedar and there's a lot of mold and there's a lot of oak and because it never gets super cold there, it doesn't freeze in a way that limits that pollen, so it's kind of constantly there.

14:20 - Chase (Host) You guys have a lot more humidity than here as well, so things have to stay trapped more, I'm sure yes.

14:25 - Rob (Guest) So you have to be critical about that. And people who move from LA or the Bay Area to Austin complain about allergies. Well, it's not so much an allergy issue, it's the quality of air issue. So if you once again can't detoxify even we'll just say the air, because you obviously can't see what's going on in the air, but if that filtration system is doing its job, it'll be fine. So I don't take allergy medicine, but when I first moved to Austin, I had a lot of problems with runny nose, itchy eyes and I was like what is going on? And it's really the quality of the air that circulates. So where you sleep, that's a great place to have the filter. So where the baby sleeps, because that's where it's going to spend the majority of its time yeah, we put the Jasper in the baby room.

15:13 And that adjusts the quality of the air.

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18:15 - Rob (Guest) Yeah, and that was at their hearings. I testified at their hearings in March of 23 as the president-elect of a research foundation and after that we helped fund studies that had been completed and set some benchmarks. They were smaller studies and the one that I recently published was 600 consecutive samples that were the patient's scar capsule. So that's what forms around every implant hip, knee, breast, dental is a patient forms a scar capsule. That's your body's reaction, anything foreign. So think of like you had a splinter in your hand. You couldn't get it out. It would form a little lump around it because your body's trying to get rid of it. It's foreign. So that scar capsule, if you test it uh, which we did in over 600 consecutive samples, about 30% will have a bacterial component. So I roughly just say think of like thirds that's easy to remember About a third, depending on when you look at my patients will have that bacterial component. That bacteria can interact with the breast tissue and in the breast tissue there's oleic acid, which is a fatty acid, and the interaction between the bacteria and the oleic acid forms a metabolite called oxylipin-10-home and that is found to be higher in patients with breast implant illness. And when that metabolite interacts with the immune system. You get symptoms like fatigue and dry eyes and there are many oxylipins.

19:51 There's a scientist, dr Mathun Sina, who's written papers about this that have been published this year in January, and a recent paper profiling multiple types of profiling multiple types. So I think you know the kind of question to the practitioners was you guys need to go out and provide the research. You're seeing the patients. So we've done our part and published the largest series in the world showing the incidence of bacterial contamination. And then Dr Sina has shown that in these patients who have these symptoms, and then Dr Sina has shown that in these patients who have these symptoms, these biomarkers are being produced. So now we have to.

20:33 You know, with his great research, really, he's going to expand that. So now there's really scientific evidence, because everybody wants to know, well, what's the evidence? Well, the evidence is bacteria is found and PCR testing is, you know, should be the standard for that examination and termination. So we've used that since 2019. So there's no question about that. Okay, now it's, you know, his research has to be expanded to show these different oxylipins and then that will be the next thing Like, how can we, you know, use that tool to help patients. So it's true that there's no specific test as of yet, but what we do with our program, sharp, is look at their genetics, their current toxicity burden, gut microbiome, health, food sensitivities, hormonal balance and metabolomics and really try to craft a program that eliminates as many factors contributing to chronic inflammation as possible, because breast implant illness to me is a chronic inflammatory process of which a medical device, in this case a breast implant, is a component, and when you take it out you don't resolve that process completely.

21:37 - Chase (Host) How would you define chronic inflammation? Is it a timeline or more symptomatic base?

21:41 - Rob (Guest) Yeah, so for the audience. Acute inflammation is. I walk out of the podcast studio and I step off the stairwell and I twist my ankle.

21:47 - Chase (Host) It swells up, it hurts your body sends out we have liability coverage FYI, but please don't. We're good Workers, calm.

21:54 - Rob (Guest) Right. So your body sends out a signal because now it's injured. And those effector cells which carry the we'll just talk about it they Cactor cells which carry the, we'll just talk about it. They're going to stimulate the inflammatory cascade and when that you know goes through its timeline whether it's you know, a week, a couple weeks, a month, depending on the severity.

22:15 Those signals with them stop because healing will have happened, the swelling will have resolved you're, you know walking without, you know know pain or anything like that. But if the signal never turns off, eventually it becomes a chronic inflammatory process and that's really what these patients are facing. So I don't envy any practitioner sitting across from a patient describing this to them because it doesn't follow anything, and so I don't make diagnoses of breast implant illness. I listen to how someone genetically detoxifies and then we craft it based on their exposures and they all tell you like, oh, I don't go to the bathroom, I go to the bathroom you know, every three days.

22:59 - Chase (Host) Bathroom being pooping.

23:02 - Rob (Guest) So their system is not eliminating waste and you can tell by talking to them they don't. Probably 40 of the population does not methylate well. That's just known. I don't methylate well, you probably don't methylate well either. So if you worked out and stayed sore a little bit longer than normal, that's kind of a tip you have that problem. So if you know they don't methylate well, just by interviewing them and listening to them. If they have extreme fatigue, then probably their antioxidant pathways are limited and they tell you that they're chronically constipated, like those are all bad things. And then, if you just ask them, big red flags in overall health too Right.

23:43 And if you say hey, you know overall health too right. If this and if you say, hey, you know when you have a cycle, is it really difficult? You have a lot of problems. You have pcos or endometriosis. Those are all tips that their estrogen metabolism is is not good, their estrogen toxic. So, like all these things, when you listen to them you're like these are all bad, yeah no wonder.

24:05 - Chase (Host) And then?

24:05 - Rob (Guest) then it becomes very simple to see how they get into this cycle of inflammation and they can't get out. There's this risk of infection because every device that goes in has a risk to get infected.

24:19 I will say that in the literature outside of shoulder implants, the knees and the hips do better than the shoulders. Okay, from what I've worked on and for our paper, I had to review a lot of literature to end up when we wrote our paper, but it's an important aspect of every component of any implant. I use the example of if someone had or remembers being old enough, we had mechanical heart valves before we had pig valves.

24:48 - Chase (Host) Oh yeah, yeah, that's true.

24:49 - Rob (Guest) So a piece of metal was placed in to replace the valve and the cardiac surgeons would always give those patients a standing order for an antibiotic prior to any procedure like a colonoscopy or a teeth cleaning. Because if you stir up the bloodstream and shoot bacteria in the bloodstream, that could then attach to the implant. So all of these things because they're foreign, they're not yours, can't ward off a bacterial contaminant because they're not alive. An implant is not alive, it doesn't have a blood supply.

25:26 So when we took care of breast cancer patients, we always had this understanding with our patients that they had a standing order for antibiotics if they got a teeth cleaning or a colonoscopy or some other intervention that could potentially cause a bacteremia is what we call it. So for the audience, there's three ways to get an infection in the implant and I'll just explain how it is. For, we'll say, breasts. If I was placing a breast implant, if someone contaminated the brand-new implant when they gave it to me, okay, that's one. Two, I did it when I placed it, I rubbed the skin or I did something.

26:04 Now there's all sorts of steps we take. Both of those are super low. They almost never happen. There's so many procedures in place, big checks about what, the surgeon who's handing it, no touch techniques, nobody's manipulating devices, so I'm just talking about breast implants. And then the third one, which is the most common you're not nobody's, you know, manipulating devices, so I'm just talking about breast implants. And then the third one, which is the most common, which is what I was discussing is bacteria gets in your bloodstream. Think you get like a cold, a upper respiratory tract infection, or you get a urinary tract infection, or you get a cut on the skin and it gets infected. That stuff gets in your bloodstream and so obviously that's a potential way to get contamination.

26:49 - Chase (Host) Contamination masterclass. You too, contamination, you're on a roll. I love it. So I kind of already brought up the main topic for today's show breast implant illness BII. But if we could kind of go back briefly and give us 30,000 foot definition description of that, how do you define it? What does it look like? Who is most at risk for it?

27:13 - Rob (Guest) Yeah, in our experience, you know, breast implant illness is this chronic inflammatory process where you have the breast implant playing a role. I think the misperception is that you can just go have explant surgery with a complete capsulectomy and all your symptoms are going to magically go away. I think that's pretty flawed if you've, you know, followed me or listened to anything I say, because it's not just that, except for cases where there may be ruptures, the shell is breaking down and leaching chemicals, heavy metals into your system or it's, frankly, infected. So, you know, barring those specific instances, we're talking about a chronic inflammatory process that people face and deal with without breast implants and they don't feel well and they seek out care. You know, usually the standard thing we get is they've went to their family doctor, general practitioner, and they haven't felt well and they get their blood work done and everything quote unquote is normal and you know they still feel poorly and they don't understand why, and so then they're not satisfied with that typically.

28:23 So if they have resources or you know, or counsel for someone else, they'll probably go the functional medicine route and start evaluating other options, or they'll look to chiropractic care, acupuncture Somebody will have another avenue to explore because they get fed up with the yeah, they're so hungry and almost like what's the word I'm looking for.

28:42 - Chase (Host) They're not satisfied with our inability to help them. Fed up with the, they're so hungry and almost um, like what's the word I'm looking for? Um, they're not satisfied with our inability to help them.

28:49 - Rob (Guest) They're desperate, almost yeah. So I you know, after the pandemic, all of my great friends that were doing functional medicine in Austin, many of them stopped working or stop seeing patients in person, and I run an in-person business. So why the why did they stop, stopped working or stopped seeing patients in person? And I run an in-person business, why? Why did they stop? Just the problems with staffing or the brick and mortars, they didn't want to do it anymore. The whole country faces an extreme nursing shortage. So it's a huge deal for us and I have a great team in Austin, but for me it was important to build out a functional team to take care of the patients so that we improve their experience by limiting gaps and shortcomings. And we're not perfect by any stretch, but I have a group of patients who've actually become my team. My detox lead practitioner, as you'll see, is a patient of mine who's had an explant and is, you know, not a savant but extremely, you know, experienced in detox.

29:56 - Chase (Host) Been through it? Yeah, absolutely.

29:57 - Rob (Guest) So she understands all the different things that we're going to face. So it becomes a much easier conversation with my team. And she leads the team in my office my nurse practitioners at an explant so she understands intimately what you're going to face and ask that I can't answer. That's so relatable.

30:15 - Chase (Host) What a what a great practice for a potential patient to walk into.

30:19 - Rob (Guest) So that our team is very sensitive to what's going on. There's a lot of mindset, you know, if you get stuck in the what is this and everybody's concerned about the appearance. That's why they got implants. But in this situation you're trying to choose your health over that and although I want to maximize your aesthetic outcome however I can, it's paramount that we get the job taken care of and if you're too ill to start with, then doing an explant or explant and lift is the operation of choice, and then we'll delay fat transfers. We do a lot of fat transfers, but we want people in the best possible situations for that.

30:57 - Chase (Host) Of course, of course, yeah. How can someone determine if BII is actually driving their symptoms or it's just simply correlation?

31:07 - Rob (Guest) So right now it's just after an explant when we get the information back. So in that roughly third of patients we do PCR testing, all that comes back to show it. We can't establish it, particularly beforehand, unless someone comes in with very specific mechanical problems. Sometimes people come in with what's called a capsule contracture, so that's a tightening of the scar capsule around the device and in my mind every time someone comes in with that you have to prove it's not ruptured or it's not infected with that problem. Because the studies that were done previously did not use PCR analysis to establish the rate of bacterial biofilm contamination. Sorry, can you go back and define PCR analysis to establish?

31:44 - Chase (Host) the rate of bacterial biofilm contamination. Sorry, can you go back and define PCR analysis?

31:49 - Rob (Guest) So polymerase chain reaction is is what we use to look at DNA fragments from different types of bacteria, and when our samples are ran, it's 150 types of bacteria, fungi and mycobacteria.

32:02 So it really helps clarify the picture. So if you're in a hospital situation, they're going to have a very set, limited number of bacteria they're going to look at and they're not going to look at fungi you have to request that and they're not going to look at mycobacterium you have to request that. I'm specifically looking at everything, so that why wouldn't you? Well, I think in the situation for us, I have people coming from all over the United States, europe and Asia, and I'm sure we're going to need to expand how we look at everything to accommodate that, because it's going to be different in different areas of the world. But the point is this, what I would like everybody to understand I believe this is the way you should set the bar to do this, and the way we've been doing it is really substandard. So we send everything off for these tests with PCR and everything else is sent off for pathology because still the most worrisome thing and my sister passed away this year from breast cancer.

33:03 - Chase (Host) I'm sorry.

33:04 - Rob (Guest) Is your don't want to miss that and you can miss that. If you don't send it right, you miss a hundred percent of the things you don't look for. So we send the capsule off every single time and that just in the past six months I've had four patients have breast cancer. So there's breast implant-associated cancers and then obviously the most prevalent thing is always going to be breast cancer.

33:28 So you don't want to miss that. And if you find it on the surface of the capsule, that was not going to be typically seen very well on imaging, especially if it's early stage, because it's too small. And obviously we know with companies like ProNovo and other companies that do scans to identify things when they're small, because when we find them when they're smaller then it's more easily taken care of and doesn't harm the patient as much from a long-term health perspective. So not longevity but health span.

33:59 - Chase (Host) Right, yeah, so let me ask you there and I kind of asked this question at the beginning of the podcast but does having a breast implant reduce our ability to catch breast cancer early?

34:13 - Rob (Guest) In the studies you don't see it change the outcome of breast cancer. What I'm seeing is because I've done thousands of explants for everybody listening, so it's a little bit it's a bias because I do so many, I see more like, okay, people could do maybe five or ten a month. I do five or ten a week, wow, wow. So the for us, like I'm seeing more because I'm doing a much higher volume in general and I've had a lymphoma. The questions that people are concerned about is like, am I going to get one of these cancers?

34:49 Well, the breast implant-associated cancers are extremely rare and they present a certain way. Usually, swelling will be on one side, so there'll be fluid around it and you can test it. But what I see more commonly is, as you should, breast cancer, because it's far more common. One in eight women will end up having breast cancer. And if you send everything off and catch it early which I have this great patient, tiffany Blackman. We found her really early breast cancer. This is very disconcerting to her and now she just has to get her follow-up, but she, you know, credits us with saving her life from that, which is yeah.

35:31 - Chase (Host) I'm sure.

35:32 - Rob (Guest) Yeah, it's, it's, it's. You know, we're doing our jobs.

35:36 - Chase (Host) Why are you doing so many more explant surgeries compared to what it seems like the general public in healthcare?

35:44 - Rob (Guest) I think for us people one, I've got a lot of experience and that helps put people at ease. But two, my team and our protocols that are in the book sharp are basically what people are really clamoring for more of a integrative, holistic approach to their care so, would you say, your approach to breast health, and particularly explant surgery, is attracting more people to come in, or are you looking for?

36:13 it. I think we're just trying to set the standard for how you should approach the problem and then, I think, for surgical care in general, I would like to see practitioners elevate their level of care to give the patients the most complete experience so they can recover more efficiently.

36:28 - Chase (Host) That amount of surgery also makes me think about just the dangers inherent to surgery. I mean, anytime you go under anesthesia there's risk. Oh good, let's talk about that. Yeah, please.

36:38 - Rob (Guest) All right. So everybody thinks they're going to die under anesthesia. That hasn't happened in the 20 years I've been taking care of patients and I operate three or four times a week I said three or four times, Three or four days a week most of the time and I have a great group of anesthesia providers. Obviously we don't put anybody at high risk, so I don't take on high-risk cases, but just from the standard 25 to 55-year-old female with no underlying medical issues, extremely low-risk case.

37:11 And we prep everybody with our program so we get everybody in a really good position. We modify their diet, we work on their sleep, we get them proper supplementation, we make sure all of their labs are to the best of our ability improving. And then my anesthesia providers are awesome, so they really are experienced. They've done several thousand of my cases and they work really hard to improve the experience. So we do what's called an eras early recovery after surgery protocol, and so that starts the night before with some medicines to calm down the nervous system, because we want everybody in more of a parasympathetic state, not a not a fight or flight state is that actual medication or more like adaptogens, homeopathic remedies?

37:54 so we have a specific prescribed medication, and then we have a specific prescribed medication, and then we have a specific prescribed medication for inflammation and one for nausea. So that's part of a published protocol that's used around the United.

38:06 - Chase (Host) States. Can you share some of those, or is it like a proprietary blend kind of thing?

38:09 - Rob (Guest) Oh no, ERAS is pretty common. What we use is either Zofran for nausea, celebrex for anti-inflammatory, depending on your allergies If you have a sulfa allergy you have to switch and then Gabalin or pre-Gabalin for neuromodulation, because you're trying to get somebody who's going to have difficulty sleeping or be anxious, calmer. It's a really good predictor. If you can get in the right mindset and understand you're going to do well, we're going to take care of you. My team's very experienced. Everybody's worried about me sleeping. I'm like a sleep freak. I do the same things all the time. Your circadian rhythm is extremely important. I've been doing this close to 30 years, so I'm very regimented. You don't have to worry about me on the day of surgery.

39:00 That's what we like to hear the surgeons say I'm more worried about you calming down and getting yourself into the right state prior to surgery.

39:10 And then my anesthesia folks. They do a nerve block before the surgery in the pre-op area and that helps really get the area we're going to work on settled down on the breast and chest area and then back in the surgery suite when we're doing surgery I'm adding more local anesthesia. So when our patients come out it's a much, much different experience than I was ever taught and ever experienced and it's really helped keep things calmer, limit the use of narcotics to very minimal, and that's super important because we don't want anybody to be lethargic or sluggish or be constipated. We want you up and you're going to come to my office the day after surgery. We have hyperbaric in my office for every patient. The after surgery. We have red light decreases inflammation, helps improve testosterone levels which promote recovery, and we have a device from New Zealand called a Flopressa which enhances lymphatic drainage, and I have a masseuse as well. So we have all the things, as well as my entire care team which I already mentioned, and that's the team, for, no pun intended, makes the dream come true.

40:22 - Chase (Host) So let's say, someone's listening right now and they're not a patient of yours and they're going to go through explant surgery. Is there a protocol, a breast implant or, excuse me, is there an explant protocol you would recommend that they could adopt to get all those results, to put their mind at ease, their body at ease and just really enhance the probability of the surgery going well and recovery?

40:44 - Rob (Guest) Yeah, so we're encouraging everybody through the book to learn about and advocate for those tests and strategies, and then we run a remote detox program for them. They just have to contact us and we help and we help, and that's where we can help the most people. Obviously, I can't uh operate any more than I I physically do. Now we hired another surgeon, dr Thomas Chung, who's joined us with a similar background to mine as well as working in the wounded warrior project. So he's been a tremendous addition, great demeanor, tremendous experience, great inpatient care. Patients love him. So we've doubled our capacity to do the work. But the detox program, the SHARP program, is going to be how we can help the most people.

41:27 - Chase (Host) So it seems like you really focus a lot on detoxification in pre and post-surgery. Why is detoxification so important when we're looking at breast implant illness and overall breast health?

41:40 - Rob (Guest) I think the genetic limitations we see in this particular patient with breast implant illness are some of the more difficult that you will see. They already have difficulty detoxing and then as their exposures grow through food, fluid, air, environment it just gets worse. And so if you operate on those patients without that kind of preparation or understanding, some will do okay, most will take longer and there'll be a group that takes literally ages to recover. And so what? We're trying to take that big bell curve and squish it down so that everybody's more on the same path. So we don't want a big bum, okay, we just want, like a nice linear pattern.

42:31 - Chase (Host) That's the dream, right?

42:32 - Rob (Guest) yes, unintended, I guess that is so if you start instead of reacting to how they're doing, so that I'll repeat it. So I'm more interested in preparing people, not reacting to their problems afterwards. So when I was trained and there was a problem, you reacted to the problem and you're backtracked and try to figure out what's going on. So here we're trying to do all the work up front so that, okay, we've already identified that you know you have a problem with glyphosates or aflatoxin, which is a mold toxin, so we know we need to work with that and get that better for you, so that at two, three, six months after surgery, if you're still having trouble with fluid retention or lymphatic drainage, maybe we need to look at that test and repeat it and see where you are. And if you haven't eliminated that, then we have to work and strategize with you and help you detox that. Okay, I just use that as an example because I don't think most people think of it that way.

43:33 - Chase (Host) No, I mean I think across the board, whether we're looking at breast health, breast explant need or I mean any kind of acute or chronic illness, prevention should be top of mind. Preventive care is the best care. I'll say it, that's right. Why worry about dealing with a problem if we can do things to ideally never have the problem?

43:54 - Rob (Guest) The things you can do right now, listening to this, are think about your air quality and if you want to get a Jasper, get a Jasper, but do something about your these are all things you can do right now.

44:09 You can think about and not drink out of plastic. You can get a stainless steel, I don't care what vendor. You can be more scrutinizing about the quality of the food, which is the most difficult and perplexing aspect of this. Like we eat a lot of organic foods, we go to farmers markets. We try to be very careful.

44:31 I'm a very I like a carnivore diet and that's not for everybody. I have clients who are vegan. I have clients who are pescetarian. I have all sorts of folks to take care of. I don't really care. I just want you to get enough protein in your diet so that you can recover. So recovery is dictated by sleep, the quality of the food, the amount of the protein. So we want, you know, almost a gram per pound of body weight, if not more, and you can know how you're doing by in the afternoon after surgery. If you're needing a two-hour nap, you're not getting enough protein in. Then we have all the supplements I have everybody table, whatever they're taking, because honestly, just so you all understand this, I don't really care what you're taking. I know what works, based on the genetic reports of my patients with this problem.

45:19 So I'm being very specific about what we're doing and how we're going to do it, so that I level the playing field for everybody and I don't have a bunch of outliers. The thing that you can do the most to help yourself is do EDMR or therapy to get yourself in the right mindset, because I can't change that for you. Surgery does not change mindset.

45:40 - Chase (Host) I love your answers. Love your answers. This is fantastic. If you can kind of maybe take a quick scan, you know, of all the thousands of explant surgeries you've conducted, could you say there is an average diet that most of them have had? So what I'm trying to deduce is is there a diet that can lead to the need for breast X-plans?

46:06 - Rob (Guest) Well, I think it's anything that promotes inflammation. So my folks who just don't understand their limitations, or most people that understand non-celiac gluten sensitivity is probably a huge problem that's under-recognized, under-appreciated. I had it. I never knew that.

46:22 - Chase (Host) It's a lot more rampant than people realize. Huge problem.

46:25 - Rob (Guest) So, for everybody listening, you can have celiac disease, which is a whole different specific HLA typing problem, or you can have what I have, which is non-celiac gluten sensitivity. So my enzymatic activity to break down gluten is so limited that I'll exceed it really quickly. It's not that I can't have gluten, but I'll just exceed it so rapidly that I'll create inflammation in my gut and that leads to we'll just call not leaky gut, we'll just say my absorption would go down, I would not absorb the nutrients, it would just pass by and go out the system. I may get bloating, swelling, cramp, cramping, pain, all the things. So when I was younger and I would have a beer and the next day I'd feel like ugh, this is terrible, maybe I had too many beers, but gluten's in beer.

47:11 And then you know, one of my friends who I was working with later on in life said why don't you just drink like rum or something? So I drank rum and Coke and my problems with my stomach went away and I was like, well, I'll just do this, not knowing that we had just cut gluten a big part out of the diet. So I think for me simple things are behavioral right If you're eating gluten and you know it. If you're eating processed foods, and you know it if you're taking in too much sugar, and you know it. These are all behavioral things that you can change. We haven't talked about why GL1P agonists are such a big deal, but I think if the industry that produced GL1P agonists knew what they would actually do, they wouldn't have produced them, because it's changing behavior.

48:00 You're not binging anymore. So the fast food industry is going to lose hundreds of millions, if not billions, of dollars, which they already have. If you follow the money on Wall Street, it's moved out of fast food really, and DaVita is the largest since the kind of blow up of GLP-1 and Arzempic and all this stuff and if you look at the dialysis centers, when you cut down binging you you cut down binging. You'll cut down long-term type 2 diabetes.

48:24 So, true, then you'll cut down the need for dialysis, then you'll cut down the need for transplants. So, if you think about it, it seems like a weird thing for them to do, because they weren't really acknowledging what it would do.

48:37 - Chase (Host) Yeah, I mean there's a lot of fast money they're making now, but you're so, so right. You know kind of the downstream effects, kind of come back and bite them.

48:48 - Rob (Guest) It sounds like, which is great for public health and great for all of us, but Cause it's the first drug in my time that truly modifies behavior. Cause all we've been talking about is behavior modification to begin with. Because all we've been talking about is behavior modification to begin with. So I have people all the time asking me can they have a fat transfer and take semiglutide or terzapatide? And the answer is no. Just like I don't want you doing cycling or HIIT or Peloton training or Hot Works or any of this stuff with really intense intervals or cardio. Like women want to avoid osteopenia, which leads to osteoporosis. So lifting weights, walking is fine, but the things that burn like just so everybody listening, because the reason you do that is for dopamine are you saying you don't prefer your female patients to do that type of exercise in general, or just if they're having breast health issues?

49:41 - Chase (Host) Well, that's predominantly what I see.

49:42 - Rob (Guest) So, basically, I'm basically telling you the plan is push or lift heavy things to avoid osteopenia, which leads to osteoporosis, and then that helps you maintain your muscle mass. So those are just like basic things Eat enough protein, avoid processed food, avoid sugars. I mean, there's basic stuff, all the basic stuff. Really, it's so fundamental.

50:11 - Chase (Host) I'm so glad to hear that the science world and health and fitness wellness world it's hard to even say is coming back to this, because these are all things again are so fundamental and, yeah, those of us that have been in the industry for a hot minute have already seen this and known this to be true. But I feel like we went through this phase of we need all the hard science and the why behind the why, behind the why behind this mechanism of action, behind this enzyme, behind all this stuff. And now we're coming back to. Yeah, all that is true and cool and has a place, but at the end of the day, like the good doctor says, get good quality consistent sleep, move your body, hydrate, quality relationships just the most core, fundamental stuff, and most of it's free or super low cost. You got to change your habits. We're a good company here.

50:57 I want to dive into a couple like key areas, unique areas of life that someone might be experiencing more or less of or different than their norm if they have breast implant illness. So what about libido levels? Does BII impact libido?

51:16 - Rob (Guest) Oh boy, all right. Everybody so many times, and the patients that we've interviewed for my show, that I've done this procedure, for they'll tell us why they got implants. What was the impression or what was the stimulus for the implant? One was Baywatch, cj, one was Barbie dolls Wow. One was seeing a woman on a bus who had large breasts and then seeing a woman board the bus after them with a flat chest. One was being bullied as an adolescent for not developing breasts in a you know a volume to avoid being bullied. And then one example was given to me that it was a peer group acknowledgement. So the moms had breast implants. So then the daughters, it's fine.

52:16 So I will say the Baywatch and the Barbie thing really got me, and then the impression of a young person on a bus got me. So whether it's in a magazine or a film or the examples we gave, those are really powerful informing opinions. And I often get asked when I let my daughter get implants. I have a 16-year-old daughter. My daughter's a Leo like me, and you're not going to tell a Leo what to do. For everybody listening, you can't do that. So if someone forms a super strong opinion, it's not my job to change that opinion.

52:57 It's inherent that I explain the risks and benefits so someone can make the informed decision about a fat transfer, the informed decision about a fat transfer, a breast implant, a breast reconstruction using their own tissue, using an implant or anything thereafter. So that was always like my conversations with patients. They were never myopic. Yeah, we can do that for you. One, I never had to do that. Two, it's very hard to help young people understand the ramifications short, intermediate and long-term of a breast implant. Oh sure, yeah. So I found it interesting to interview patients and hear their why. Because that is just Barbie in Baywatch. I'm just like, okay.

53:52 - Chase (Host) Never would have thought of that. And so then, ultimately, what they think, you know, by changing their bodies to look more like these things that they think equate to what more femininity, higher libido, like. If I have this, then it will fix what I think is broken.

54:09 - Rob (Guest) So whether we just say that loud and say they think they're more attractive that way and that's going to attract the proper significant other, whatever we're looking, I think the bottom line is whether it's saying that that was done in order to enhance their ability to get a lover or a partner. When you look at patients with breast implants who've gone on to develop what we see breast implant illness, chronic inflammation take a guess at what their libido is like then.

54:42 - Chase (Host) Well, probably way below than anything they ever had. It's in the crapper.

54:47 - Rob (Guest) So they have the most suppressed free testosterone levels and the most abnormal derangement in estrogen levels, depending on how they genetically metabolize. But free testosterone level, when you ask them like and I have to be I say, hey, how's your hair growth, How's your nail growth? Did you work out? How's your stamina? Can you stay? Work out How's your stamina? Can you stay focused? Do you have libido? I always ask that last. Why do you ask that last? Because I don't want to make it about that. I want to like make sure that I get all those other answers.

55:19 - Chase (Host) You want to get them more in a health-focused context.

55:22 - Rob (Guest) Okay, because there's more than just that. Libido is a part of both estrogen, testosterone, sleep stress, all the things. But if your lab comes back and you have an almost non-detectable free testosterone level, well you can't have a libido.

55:45 So, you don't even have to answer the question because I know the answers. But that's I think if people knew that their spouse loved one partner felt that terrible and that's the cause, and if this was the solution and then that would help them reestablish a more normal lifestyle and sex life, that would be a powerful thing. For the men who are listening and I've got great spouses and partners of my patients and they're so supportive that's the best situation for them.

56:19 - Chase (Host) Have you ever seen a scenario where a woman comes into your office breast implant, illness goes to the explant and then their partner doesn't like them without the implants, yes, and leaves them.

56:33 - Rob (Guest) So those are pieces of shit People, so that happens and that's the wrong person for you. So if that's the situation, that's just not the right person for you and that's why you got to be prepared, because you got to have a supportive family, supportive friends and supportive spouse. I put that last because if that person leaves or is unfriendly afterwards or not accepting of the situation afterwards, you have to rely on this other support system to get through this process and my team is super helpful but they can't manage outside what's going to distract you and be a problem with your children and your family?

57:14 - Chase (Host) Have you ever encountered a patient that, by labs and by personal examination, without a doubt breast implant illness but they are so unwilling to go through an explant procedure because of the look they don't want to give that up, even though their health is deteriorating. Oh yeah, of course Do they stick with it? What are you doing?

57:38 - Rob (Guest) So basically, for those patients who are not yet ready to accept that they'll be interested in the program, you have to be careful with them after you show them the program, because sending something through detox without an explant can be complicated because they can detoxify too rapidly and have Herxheimer-type reactions. What? Is that so Herxheimer, means you've exceeded your detox capability, so you have more toxins in your system, so you feel bad. You may feel like you have the flu, okay, so um.

58:09 - Chase (Host) So there there's a point of diminishing return with detoxification. Yes, interesting yeah.

58:15 - Rob (Guest) So when we explant someone, we give them about 30 days before we do like a sauna session, because that can induce a reaction even when you're doing detox um with with how we run detox with Cellcor, you can still induce that reaction. You may have to back off. So we have a structured program that's followed. So nobody's doing unsupervised detox in our program.

58:37 If they choose, in fact, to work with me personally, you can't not do my program because I don't want people doing unsupervised detoxification off the internet or through someone else, because I love the fact that naturopaths and functional medicine providers and acupuncturists and chiropractors are all sending their patients to get explants. But the reverse I don't necessarily like, because they don't then know what to do with them afterwards.

59:10 Because they haven't experienced hundreds and thousands of patients with these problems, like my team has, who've had explants and who detox them. So rather than reinvent the wheel, it's better to just be consistent. And this is not a sprint, this is a marathon. And so we give everybody the same follow-up for a year. And this is not a sprint, this is a marathon. And so we give everybody the same follow-up for a year, and if they need more, they get more. That's just our agreement with the patients. Do the supplementation for the year, do these detox protocol for a year, do our surgical follow-up for a year, and we'll support you through the process.

59:45 - Chase (Host) Is there ever a scenario where someone goes through a breast explant and then they get implants again and they're in a much better position to do that?

59:55 - Rob (Guest) Not for me. I won't put implants in anymore. Why I think the problem for me is I did what you're describing once and afterwards the patient had an infection and I was just that. Why am I doing this? So I did an explant. The patient got markedly better but then, like you're you're saying, had a image problem. They convinced me that they were well, which obviously they were better. But I think how I bridge problem now is I won't put in implants again if you've had this problem, because repeating plan A is not the answer.

01:00:32 So that's where we use your own fat to help augment the natural breast tissue. Oh really, and you can do that very safely, very effective, taking fat from, say, the love animal area, inner outer thigh area, abdomens and then redistribute that in the right space. It does not. Fat does not cause cancer. Fat does not obstruct cancer surveillance. These have been worked out many, many years ago, so it's a very safe alternative. And then fat is the original filler. It's been around over 100 years and fat transfers I've done several thousand. So for cancer patients and cosmetic patients it's a very safe, effective way to enhance the breast.

01:01:17 - Chase (Host) Would you recommend someone consider a fat transfer implant? I'll call it that before ever getting a typical implant.

01:01:26 - Rob (Guest) Yeah, we provide that service, but it has to align with one the patient's body habitus. If someone's super lean, that's not going to work. So typically the younger patient who wants an implant placement is not the best fat transfer candidate, because they just don't have enough body fat. So then you have to work with them. But I have a lot of younger patients In fact one special patient of mine who's in medical school around this country, who sought us out specifically for that, because she did not want an implant and she wants her body image to improve. She wants to do it this way. We'll help her through that process and it may. In her instance she's had two fat transfers but she wants, you know, a big B type breast, and that's perfectly acceptable. I think the tides have turned and smaller breasts are totally acceptable in culture now.

01:02:19 - Chase (Host) So why not? Have you ever seen a woman want to do a fat transfer in place of a breast implant? But, like you said, they don't have enough. There's not enough body fat on them to safely kind of go through that procedure. Is there a safe way for a woman to gain weight so that she can then use that fat for the transfer?

01:02:42 - Rob (Guest) Yeah, I think it starts with what we were mentioning earlier behaviorally changing how they're exercising and modify their diet. I think it's probably you want those patients who are looking at it with that lens to have their inflammation lower so you're not getting confused by and you can look at it on DEXA scanning to see how much fluid retention there is, because you don't want to be confused on a lower body weight, lower body fat patient by fluid which can fluctuate with a cycle, et cetera. So you have to be more discerning with that and we have patients who are very focused on fat transfer. So I will get DEXA scanning to help just better clarify, like, what is fat, what is fluid, how much is in these given regions that I already mentioned previously, just to help us. There's no perfect situation in that instance, but you're trying to give them the best guidance and many times you'll say, hey, you've got to add these healthy fats, use avocados, use nuts, use supplements. But that is a harder road and I don't tell anybody to go gain 15 pounds.

01:03:50 - Chase (Host) That's not practical.

01:03:51 - Rob (Guest) But you know, stopping high intensity working out um, you know, lifting versus uh running or cycling, that will help.

01:03:59 - Chase (Host) But if you begin to exercise more typically, you're going to be gaining lean tissue, not body fat. You're going to probably lose body fat. So would there be a scenario where someone would go all right, I'm going to stop exercising for a short-term goal of gaining more body fat so that I can fat transfer, breast augment and then get back into lean tissue.

01:04:19 - Rob (Guest) Yeah, I've had patients do that and then strategically Is there a timeline that's? Good for that, or is it kind of super? It's probably going to take them several months to get that weight if they're really low.

01:04:29 - Chase (Host) Bmi Is there a number you're looking for on the scale? I know this is a big generality, but I'm looking for an excess of 10 pounds. 20 pounds of fat mass.

01:04:40 - Rob (Guest) I'm looking at like if someone comes in pretty lean, have them try to put on five. Oh yeah, I think you can, barring fluid retention. I'm talking about five of weight yeah, not fluid. I mean everybody listening. I can take 10 pounds of fluid off of anybody in a day. It's not a big deal. That's why you know initially when you start keto, basically you're just losing fluid.

01:05:04 - Chase (Host) That's the first thing to go. Water weight is the first thing to go. Water weight is the first thing to go Always.

01:05:07 - Rob (Guest) So when someone sends me a photo and they're like oh, I feel so heavy, I'm so fat, usually that is a product of fluid retention, not fatty accumulation or growth of hypertrophy of muscle. No, working out is not going to do that.

01:05:26 - Chase (Host) Kind of getting towards the end here, I want to bring it all the way back to what got you to make this shift in the specialty. Now, I understand that you had a former patient that came to you with these breast implants that really kind of caused you to pivot and go. This is what I want to focus on. So why this one patient? What was the experience and why was it so moving enough for you to go? This is what I'm focusing on.

01:05:49 - Rob (Guest) Well, my sister had breast cancer and passed away this year and, if I look back, my career is focused on cancer. My mom passed away from cancer as well, so I did cancer reconstruction predominantly in my career. And a breast cancer patient came to me in 2016 and wanted to go flat. So, for everybody listening, you can have a flat closure. Basically, you take all the implant material and capsule material out and then close it, so it's a flat closure on the chest. And I did those a particular way, based on training and trying to prioritize, making sure the patient doesn't have recurrent cancer. So all the capsule material and scar gets sent always to the pathologist to't have recurrent cancer. So all the capsular material and scar gets sent always to the pathologist to look for recurrent cancer. Then we would always think of something like a Q-tip and swab the inside of the pocket where the implant resided because you want to know if that was infected. So that would be done on every single patient and those were the standard examinations I did for 20-plus years taking care of patients. And in this particular patient, the pathology came back and it was absolutely normal no evidence of cancer, just typical changes consistent with an implant. The examination looking for infection showed that she had a e coli infection and so, for everybody listening, e coli is a very bad actor and this was a true infection. This was not what I said a biofilm is. This was a true infection. It was greater than 10 to the 6, so that's greater than 100 000 colony forming units per field looking under a microscope True infection. So I was pretty startled by this and felt really bad that I had missed this and I didn't know how I had missed it. So we went back through all the data and there was no sign or specific symptom other than she had fatigue, which many, many cancer patients have fatigue after chemotherapy and radiation. That's not a new thing. But I put her on oral antibiotic therapy based on the results and within a couple weeks all of her fatigue was gone. So she walked around with an underlying breast implant infection this whole time I don't know how long because no one can tell you that, but based on what we discussed earlier how you get bacteremia which leads to that contamination I don't know when that happened.

01:08:12 So she put me on a Facebook group to do as a surgeon who did explants, because I didn't even know I was doing that. I was just doing what I did for cancer patients throughout my career helping take care of them and all of a sudden, we just had people call the office wanting explant surgery. And my office was like what, normally you all put in implants for cancer, but now you're getting calls to take them out. And we did that the first couple of years as I was going through the process of understanding this problem, going through the process of understanding this problem, and then in 2018, we had a nurse who had she was pretty ill. She came to get an explant. I did her explant.

01:08:54 It was very I call it slimy and it always makes me think when I find that it's infected or it's ruptured. Something's wrong with the pocket where it was. And I went up to her spouse and I said, hey, all this stuff is out now she's going to do better. And at a week, the results came back to see if there were bacteria and it said there were none None. Yeah, it said there were none and the implant was intact. So we cleaned everything off and make sure, inspected it. It was, it was fine. So I was kind of at a loss and I got I got pretty irritated and but I'm super curious about. Okay, I know enough that we can reach out to companies and at that point breast implant associated large anaplastic, large cell lymphoma had been worked on and more was being learned about it and part of it was there was a bacterial contaminant. So I contacted the company that did the original work on that and set up a testing situation.

01:09:54 So all my patients starting in 2019 started getting PCR testing for all the samples.

01:10:00 - Chase (Host) So I deviated completely away from the old way we cover that back, like in the middle of the conversation everybody.

01:10:06 - Rob (Guest) And that is how we've moved forward and that's what the paper's published about that early experience. And now we've done thousands that way. What we hope is we've clarified this is the level of an amount of bacterial contamination on breast implants. There's no refuting the number. And then these new papers by Dr Mathun Sinha. Those highlight these oxylipins that are being produced by the interaction between the bacteria in the biofilm and the breast tissue.

01:10:43 - Chase (Host) Wow.

01:10:43 - Rob (Guest) So that creates what is going to affect your immune system and stimulate it. Cause I always said this is like being a hamster in a wheel it's just running around, running around, running around, can't stop. So that's just stimulating you now and you can't take an antibiotic, you can't take a biofilm buster, you can't go get in a sauna, you can't do something to make that go away. So now we know that. Now we have more of the pieces of the puzzle, so to speak, and with our program we're helping establish bio-individuality through genetic testing, their toxicity burden, gut health, food sensitivities. The thing we've added is metabolomics, looking at organic acid breakdown and then hormone balance. So we're trying to do our best to craft a comprehensive program to take care of everybody, get them recovered and get back to their activities and take care of their families and being present.

01:11:37 - Chase (Host) I don't have breast implants, but I'll say this I have gone through genetic testing to get all of those key findings and biomarkers you just talked about. To get all of those key findings and biomarkers you just talked about, and as someone who is in relatively good health, and cares personally and has a profession about health and wellness.

01:11:54 That was probably single-handedly the biggest eye-opening medical experience in my life. It's the biomarkers underneath the biomarkers. Underneath the biomarkers that I mean. You can get all these tests all day long, but that was the most eyeopening thing as to how I tick and immediately the next day began to make changes in my diet and my routine that the next time I got labs drawn like 60 days later incredible transformation.

01:12:22 - Rob (Guest) Yeah, it's very empowering. We switched to a vendor and vision labs and they've helped us with. My patients are very interested in the effects of anesthesia, like we covered, and nobody wants more medications and we don't want to give you more medications. For everybody listening, I don't use drains and I don't use oral antibiotics, so you don't have to be concerned about gut dysbiosis from antibiotic overusage because we don't use it. It's not really indicated for this procedure. And then the other is drain tubes. I mean, drains have not been used in tummy tucks for a long period of time and we've established that we don't need them for breast surgery. That's been around for ages but we don't do them now in explant surgery. I haven't used drains purposely in in four or five years at this point.

01:13:09 - Chase (Host) So those help diminish discomfort and make you anything that diminishes discomfort, increases mobility and then enhances recovery you kind of hit on it there on my last question, before my last question, you kind of hit on it about what you all are doing through this sharp method and in your practice. By the way, there's just been incredible, uh, you're so well spoken, you clearly know what you're talking about and I love to hear someone who has just niched down and not only what they do, but niche down in reducing as many extraneous variables of how they do it, which is crucial. That's the real science, that's the real science, that's the game. And so, like I said, you kind of already are talking about, I think, what you are doing in your clinic and through the SHART method here. But what is or is there on the horizon for what is the best thing someone can do in terms of reducing chances of breast implant illness or reducing symptoms maybe they're currently experiencing? What's the best thing we can do for breast health and BII moving forward?

01:14:04 - Rob (Guest) Right, right. So the things that I'll highlight them again and I'll list them in order. Priority number one is quality and quantity of sleep, and I think it's a misnomer to come into my office and tell me how well you sleep, because I don't believe you If you don't have a wearable, meaning you don't have a ultra-human ring or you don't have a whoop strap, which I use both and I know the data very well Is that ultra-human yeah.

01:14:32 I mean, I've had the whoop since 2016, I believe. So I'm very. I know my HRV, I know how much I sleep, so you cannot shine me on and tell me anything because I won't believe you. So quality and quantity of restorative sleep, that's, if you don't get that done, that is always going to haunt you. Women have estrogen and cortisol that usually are higher amounts than men. We already talked about a depressed testosterone level, which, for us, increased testosterone, buffers out those two other hormones. So we don't have as much stress, we don't experience as much.

01:15:08 Unless you go through menopause, like I did, then you have to supplement, then it's all about your air fluid and food. So everything you put in your mouth, everything you breathe, everything you drink, is important. So if you start addressing those things, you will start lowering inflammation. If you look at our inflammation support bundle, it's all geared on genetic results. So, although everybody can tell you they have the answers and you take this and you take that, I think without looking at genetic reports and seeing the proof, it's very hard for me to go outside of what we know works because I can put people on the program and drop their inflammation works because I can put people on the program and drop their inflammation.

01:15:50 So those are things that you can start doing to lower your inflammatory symptoms. But if that doesn't completely resolve it, then you have to look hard about what we've been discussing. And nobody wants to have explant surgery and when you come to me I'm not going to tell you you need an explant. That's something you have to decide before you ever show up to see me, I'm happy to explain everything we've talked about in your specific situation so you better understand it. But I don't decide who gets an explant. I help craft a plan based on the data and what you're asking me to help you with.

01:16:26 Everybody can have an explant and just wait and detox and do their thing. Many patients who need a lift can do that. At the same time, people constantly fly in and want to have fat transfers and typically it's the patients who are the leanest who obviously are going to have the most trouble and that's imperative that we try to help them and support them as much as possible. And I do a lot of higher expectation cases. We'll say so with those, and I have one in particular in my head right now, but that's okay, I'm happy to help however I can.

01:17:01 - Chase (Host) Well, the show is always meant to help me and my audience learn unique ways that we can uh, you know, move forward in life through many different areas of wellness, or come back to a reminder of what moves us forward. So my last question is I always ask my guests what does that mean to you? If I were to say, dr rob, how do you live a life ever forward? What do those two words mean to you?

01:17:23 - Rob (Guest) Yeah, I was the curious. I think in my position, the thing that's kept me and driven me is I'm never a person who wakes up, who doesn't feel like challenged, like every day is a challenge, like you got to be learning, you got to be striving to move forward all the time. It doesn't matter if it's like we were talking about our long form YouTube content to help educate patients, because that's imperative. If you help educate, then you empower and then it becomes their ability to understand and the better quality we put out, the better it educates people. So we're supremely motivated to do that. It's like an ongoing work that drives me.

01:18:06 - Chase (Host) Well, I'm going to have everything listed down in the show notes in the video description box for everybody, but where can they go to learn more about Sharp, your book, your work?

01:18:13 - Rob (Guest) So you can get Sharp off of Amazon currently and then you can get it off our store. Dr Rob's Solutions.

01:18:20 - Chase (Host) For more information on everything you just heard, make sure to check this episode's show notes or head to everforwardradio.com.