Speaker 1 (00:03):
Welcome to The Holistic and Scientific Podcast with board certified plastic surgeon, Dr. Robert Whitfield, Austin's natural choice for plastic surgery and the expert in smart laser and energy treatments.

Dr. Whitfield (00:21):
Welcome everybody. Today we're back with Candice and we're going to discuss, in detail, her journey to find an explant surgeon, her experience with surgery and afterwards.

Candice (00:31):
Wonderful. Well, once I decided that it was time to move forward with explant, that was definitely the decision that I needed to make. I started researching and like most people Googled explant surgeons, and then I was on some Facebook groups and different things, and they had their own list of surgeons. Combining the two, I set off to try to find the right surgeon for my situation. I met with different surgeons based on Yelp reviews and these Facebook groups that have their own list. And when I would tell them my situation and my symptoms, they would say, "Yeah, I can take your implants out, but you're probably not going to feel better, because there's no proof that implants cause these issues and you're going to look terrible." That was extraordinarily heartbreaking. And I continued my search and I ended up getting a consultation with one of the very top, very, very excellent, explant surgeons who's very heavily promoted.

Candice (01:47):
I was excited about that. And during my consultation, I felt very brushed off and I knew that they would do an excellent job, but I didn't resonate or feel a connection and I want to feel comfortable going into this scary surgery in my mind. I met with another surgeon that again, was not on this Facebook group and all of the other certain sites that have been set up but had good reviews. And I saw that he only did explant and that his background was in breast reconstruction, especially to do with mastectomies. And he did fat transfer. I was not a candidate for fat transfer at that time financially and with my health situation. And as soon as I spoke with him and he listened to my symptoms and he said, "I have many women that come in with very similar symptoms and their implants are removed and they get better."

Candice (02:45):
And he understood and agreed that he did his best to do an en bloc,

Candice (02:51):
But he said, "It's not always, you know, if you get a little tear or whatever, then it's not considered complete en bloc,

Candice (02:56):
It's very difficult." My capsules were very thin. So we did a total capsulectomy and I just felt, I knew in my heart this was the person that I was supposed to get surgery with.

Candice (03:07):
He was booked out for six months and they then had a sudden cancellation and I got a very quick turnaround, had to get my labs done and everything. And I was in there within two weeks and it was performed in a hospital, which was nice with my situation. And the surgery went fairly well. I had a lot of issues with recovery from the general anesthesia, because of the situation of my liver. It took me weeks to recover from that, but I'm 100% positive that had I gone to someone that didn't believe in taking out the entire capsule, didn't believe in testing, that I would potentially still be struggling with issues. That was very important to me. And I think that should be the deciding factor for sure on looking for an explant surgeon. Someone that listens to you, that understands that women do get sick and are sick from their implants and will support you in taking out your implants the correct way.

Dr. Whitfield (04:18):
A couple of things you said, when a surgeon talks about appearance changes after, or doesn't necessarily have recognition of what happens afterwards, I would say to the audience that's something that would raise concern for you, this is not a new entity. It's been established and discussed at FDA hearings. Second thing is that you mentioned somebody who had done reconstruction as part of their career. If you've done that as part of your career, you know how difficult that situation is for a patient who's facing the mastectomy and a reconstruction or the choice not to do that. And many times it's not well known in this country, but the majority of women don't get reconstruction. As someone who did those cases for long periods of time of their career, it resonates when you say that provider listened, which they should. Obviously that's the first thing you should do is listen to what's going on and try to recognize how you can help and then provide a plan that makes sense.

Candice (05:27):
Yes, absolutely. And it was interesting to me because the surgeon is incredible, but yet he was not on these boards that are supposed to have the best explant surgeons. I had to really recognize that and understand. And it's hard because there's a lot of women who are looking for explant surgeons. And I think there's a lot out there that are on certain sites and different things based on someone's opinion. As an explant surgeon, what are some of the things that women should look for as far as accreditations or history to find an excellent explant surgeon, that's going to make sure the capsules are removed and be able to handle reconstruction if they're able to do that at that time?

Dr. Whitfield (06:17):
Someone with a background in reconstructive surgery or reconstructive microsurgery. I think that term micro-surgeons has been used and maybe not appropriately in these instances, because of course you don't use an operating room microscope to perform this procedure, which is basically the definition of doing micro-surgery. Surgery you can't see without visual enhancement, if you will. I made my living sewing little blood vessels together with essentially suture that's finer than your hair. And that's why you needed a microscope because you had to magnify it in order to see it. Now we all have little special magnifying glasses. It's like wearing readers. They're fancier and they cost more money, but that's how you do more and more focused work. And I've never used an operating room microscope or what they call surgical loops or jewelers loupes to do an explant. I always found it interesting on your... As you used in your example, these different boards, that classify surgeons as micro-surgeons, because I am a micro-surgeon by training, I used to train micro-surgeons.

Dr. Whitfield (07:26):
I always found it fascinating when I knew none of the people on those lists given my history. I think as you've highlighted, it's more about... In terms of background, I think having reconstruction background makes it easier for me because I did cancer for the majority of my career, along with cosmetic surgery. I think you have to listen and understand, and each case is a little bit different obviously, and we've worked hard on different technical aspects of it to make it safer and easier and certainly limit the amount of discomfort patients have when they're waking up, which is the most important thing.

Candice (08:03):
And recovery was a little rough. I got an infection from the drains.

Dr. Whitfield (08:08):
All right, we're going to have to talk about the drains.

Candice (08:10):
And that was one thing which when you don't have all of the information, I was like, "I know that the doctor asked to do drains. If they don't do drains then there's something wrong, you got to do drains." I got drains. I had them for three days, everything had been going fine. On the third day, went into the office, had them removed by the surgeon and within 48 hours I had a fever, the area was red and very obviously infected.

Dr. Whitfield (08:42):
Just so all the listeners understand, all of the studies suggest that the use of a drain ultimately is associated with a higher rate of infection. And let's talk about why we would use drains in the first place. And I've used drains for breast cancer reconstruction, for tummy tucks, for breast implant removals. I will just give you my two cents on why. You use them initially as a surgeon because you don't want to leave a space that's open to fill just with fluid and develop what's called a seroma cavity. Because then you have this fluid buildup. And I would argue it this way, I've gone to not using drains except for in really specific instances. If I have a extra capsular rupture, which means your implant capsule, your scar, has been compromised by the rupture. That usually means the gel or filler of the silicon device is now extravasated or leaked through your capsules in your breast tissue.

Dr. Whitfield (09:48):
That is a very unfortunate situation that I don't find very often anymore. But in that situation, I am very apt to use a drain because I cannot get the pocket devoid or cleared of materials easily. Because breast tissue is not something you can just magically clean and, "It's fine." And be done with it. Now the other time I've used the drain... Now drains don't stop infections. They don't stop bleeding. They don't stop you from getting a seroma, just so that everybody's clear. We hope that they do, but that's not ever been proven really. If you have a particularly problematic case and there's a propensity of bleeding for reasons beyond your control, maybe it's difficult to control their blood pressure. Maybe they are somebody who has bled more during the case. Maybe they're more inflamed. You never know the given situation. I don't want to be throwing blanket statements here.

Dr. Whitfield (10:47):
I will use them in those cases. But most of what I do is create an environment where I don't have to, by lifting up the fold, so that the fold will rise, disrupting that lower area so that internally it will drain. And that may sound like heresy, but I don't use drains and tummy tucks either, haven't for a long time. That you can do with a progressive suturing technique and you can also do the same thing I just described, which is undermining and basically internally draining it, which is... Your body's going to, if you will, absorb the fluid and then eliminate the fluid, provided several things are in order. I put patients on a particular diet that's higher in protein. I try to make sure the foods they eat don't create more inflammation or more edema or fluid. And we use supplements and we use anti-inflammatory and we use ice.

Dr. Whitfield (11:45):
We're doing all these things in conjunction with compression to help mitigate fluid production. If you have a multimodal approach, you'll do better. And some thin people, tiny little BMI patient will produce a lot of fluid and you'll be like, "Oh my gosh, how can this tiny person produce all this fluid?" If they don't compress, if they don't use ice, if they don't use their anti-inflammatories, if they're not following the diet, they don't have enough protein in their diet. It's pretty predictable who will do that. As much as I can do to help, I need a patient who's really switched on to help themselves.

Candice (12:26):
Definitely have to take responsibility, but it's so incredible to me that you offer all of these protocols and even saying like, "Hey, if you up your protein and you reduce inflammatory foods, you're going to have a better recovery." I had to research and try to figure all that stuff out on my own.

Speaker 1 (12:52):
Dr. Robert Whitfield is a board certified plastic surgeon located in Austin, Texas near 360 and Walsh Tarlton in Westlake. To learn more, go to drrobertwhitfield.com or follow Dr. Rob on Instagram @DrRobertWhitfield. Links to learn more about Dr. Rob's smart procedures and anything else mentioned on today's show are available in the show notes. The Holistic and Scientific Podcast is a production of The Axis. the axis.io.