Dr. Robert Whitfield is a board-certified plastic surgeon who specializes in breast reconstruction, explant surgery, and optimizing recovery through an integrative approach that combines reconstructive surgery with functional medicine, genomics, nutrition, and environmental medicine. Over the past decade, Dr. Whitfield has become one of the leading physicians studying what has become known as Breast Implant Illness, or BII—a constellation of symptoms that can include fatigue, brain fog, joint pain, gastrointestinal complaints, autoimmune-type symptoms, and other chronic health issues that some women associate with their breast implants. Dr. Whitfield can be found at DrRobertWhitfield.com
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.
TRANSCRIPT:
Dr. Weitz: If you’re looking for clinically useful insights, not wellness hype, then this is the place for you. Welcome to the Rational Wellness Podcast, the podcast for functional and integrative practitioners who want to practice with greater clarity and precision. I’m Dr. Ben Weitz, and each week, I sit down with the leading clinicians, researchers, and lab innovators to explore the science, lab testing, and clinical reasoning behind modern root cause medicine.
This is a show focused on practical evidence-informed insights that you can actually use in patient care. Please subscribe to the Rational Wellness Podcast on Apple, Spotify, or YouTube. Please tell your friends and colleagues, and if you could give us a ratings and review on Apple or Spotify, we would certainly appreciate it. Finally, to access the show notes and the full transcript, please go to my website, drweitz.com. [00:01:00]
Hello, Rational Wellness Podcast members. Today’s guest is Dr. Rob Whitfield, a board-certified plastic surgeon who specializes in breast reconstruction, explant surgery, and optimizing recovery through an integrative approach that combines reconstructive surgery with functional medicine, genomics, nutrition, and environmental medicine. Over the last decade, Dr. Whitfield has become one of the leading physicians studying breast implant illness, which is a constellation of symptoms including fatigue, brain fog, joint pain, GI s- complaints, autoimmune symptoms, and other chronic health issues that women sometimes associate with their breast implants. His clinical experience includes thousands of breast implant removal procedures, advanced PCR testing for [00:02:00] bacterial biofilms, and he also uses a comprehensive functional medicine approach. While breast implant illness remains an evolving area of research, Dr. Whitfield has been in the forefront of trying to help women become better. Today we’ll discuss the current evidence surrounding bre- breast implant illness, possible mechanisms, and what we can do about this. So Dr. Whitfield, thank you for joining us on the Rational Wellness Podcast.
Dr. Whitfield: Thanks for having me on. Appreciate it.
Dr. Weitz: That’s great. So for listeners who may be unfamiliar, what is breast implant illness, and how has your understanding of it evolved?
Dr. Whitfield: Yeah, I think you know, implants have been around since 1962. They were placed for the first time in a cosmetic situation in Houston, Texas, 1962. So since that time, there’s been quite an evolution of the devices. They’ve had [00:03:00] their moments when there’s been, you know, more and more problems with them. And then as we look at it now, there’s a lot of devices in the marketplace, and then most of them are cohesive gel implants. They all have a silicone elastomer shell, and there are still saline-filled devices available. But saline is always gonna have a more unnatural feel to it because its density makes it so that when you fill it, it feels a lot firmer. It’s not as soft. So these have been principally used for breast reconstruction in the United States and around the world as the most common option. I think sometimes that’s a little confusing to hear if you don’t understand how breast reconstruction is done both in the United States and around the world. So by trade, I’m a plastic surgeon, so I traditionally trained in surgery for six years, so I could take out your gallbladder, colon, you know, do liver surgery, pancreas surgery. And then I did another two years of plastic surgery training, and then beyond that, I [00:04:00] did another year of just microsurgery and hand surgery training.
And then I practiced basically oncologic reconstruction or cancer reconstruction for head and neck cancer, sarcoma, and breast cancer. So the most prevalent of those is breast cancer. But I just listed off a lot of extra training or extra certifications or extra qualifications to use in an environment where you would need an operating room microscope. You would need sophisticated instruments. You would need, Technically you would need more staffing. You would need better staffing. You would need recovery room staffing. You would need floor staffing for the evaluation and monitoring of the patient after one of those procedures ’cause we would do basically– everybody understands what transplantation of an organ is now ’cause that’s been around for a long period of time.
So basically, we would do what’s called an autotransplant. We would take the tissue of the lower abdomen, keep it connected to blood vessels, disconnect the [00:05:00] blood vessels at the source in the rectus abdominis, the six-pack muscle, and then take it up, put it on the chest, hook it to the blood vessels under the sternum that the heart surgeon would use to revascularize the heart in a coronary artery bypass situation. So that was called the DIP free flap, and that’s what I principally did. My introduction into taking care of patients with breast implant problems from breast cancer reconstruction was because I could do that operation, I could undo anything that a implant-based operation or an implant infection or a radiation injury to an implant had caused through therapy.
But to summarize, the reason you see so many more implant-based surgeries for breast cancer is it’s accessible. Like our country’s enormous. You’re in Santa Monica, I’m in Texas. The World Cup’s right now. Spain is in the final. Spain actually fits geographically in Texas So once you get outside of [00:06:00] a larger community, we’ll say of a million people, your access to people like me with that level of training and that ability to, you know, execute the operating room and to do the things that we were talking about afterwards drops off. But everybody should be able to access a breast reconstruction at their community hospital that can be done by their breast surgeon and a plastic surgeon with, who’s board-certified or board-eligible in plastic surgery, because they have been taught and trained to use that as a technique, and they should be able to execute that.
Dr. Weitz: So I’m a little unclear exactly the distinction you’re trying to make between traditional surgeons who might just do a reconstruction after breast cancer surgery as compared to what you’re doing. Can you make that a little more clear exactly what you’re saying?
Dr. Whitfield: Yeah. It’s done with microsurgery. So microsurgery allows you to put vessels together, blood vessels, that are about the [00:07:00] size of coffee stirrers under either magnification with special glasses or an operating room microscope, which would be the most common way. So you would need all those tools in a center in order to do that.
Dr. Weitz: So normally people think of the breast being removed and then this implant put in and you’re done. What’s the importance of reconstructing blood vessels?
Dr. Whitfield: Yeah, so it’s your own tissue, so it can’t be rejected.
Dr. Weitz: Okay. So-
Dr. Whitfield: Right, because your thymus recognizes your tissue, your T-cells recognize your tissue.
Dr. Weitz: Right.
Dr. Whitfield: And so you can’t have a rejection episode. You can’t have a foreign body reaction, provided all the blood vessel work is conducted properly and there’s restoration of blood flow, everything’s fine. Now, in a implant, as soon as you put the implant in, the body recognizes it as foreign and starts to form scar tissue around it and wall it off. That’s what it does. [00:08:00] There’s gonna be, and we can talk about it later, but new litter-
Dr. Weitz: So what you’re saying is the surgery that you’re performing is different than what somebody might get at a community hospital where it’s all paid for by insurance.
Dr. Whitfield: Both are paid for by insurance for cancer reconstruction. The community access is what you should always have access to, and that’s why 80% of the reconstruction is basically done with implants. It’s the easiest, shortest route to get a reconstruction done
Dr. Weitz: Right. So the average woman is not getting their own tissue reconstructed.
Dr. Whitfield: Correct. That’s correct.
Dr. Weitz: Okay. Okay. So that’s the key factor. And the importance of having your own tissue reconstructed is what?
Dr. Whitfield: Right. So if you think of all things being equal, that can’t get rejected. That doesn’t need to be changed.
Dr. Weitz: Right. So what percentage of patients who get reconstruction without their own tissue get the implants rejected?[00:09:00]
Dr. Whitfield: So every device at the level of the tissue is being rejected. It has to be. It’s not your tissue. Okay. It’s going to be walled off. Okay. So whether or not you suffer symptoms is what you’re gonna ask me next. Like, how many of the people who have that then have problems?
Dr. Weitz: So you’re saying by putting their own tissue there, there’s gonna be less breast implant illness resulting?
Dr. Whitfield: You can’t have it.
Dr. Weitz: You won’t have it.
Dr. Whitfield: Correct.
Dr. Weitz: Okay. Now you also distinguish, you were describing the types of implants, and I think one of the points you were making is that these are semi-solid silicon as opposed to the older implants which had a more liquidy silicon that often ruptured and leaked out.
Dr. Whitfield: Yeah. The implants in the ’80s had a shell that was semi-permeable, and the filler was more like syrup rather than like [00:10:00] Jell-O.
Dr. Weitz: Right Now I noticed in reading some of your information about breast implant illness you tend to focus on bacteria and biofilms and some of these reasons. I, I e- expected that you would also be talking about the issue about silicon leaking into the tissues and causing breast implant illness. Is it your understanding that silicon is not really a problem?
Dr. Whitfield: Well, anything that’s ruptured and leaking is a problem.
Dr. Weitz: Okay.
Dr. Whitfield: I don’t have the data because the study I performed and published is about PCR testing for bacterial contamination. Right. It’s not about ruptures. So I’ve done, you know, several thousand removals. I wouldn’t even have enough personally to feel comfortable with publishing a series about ruptures.
Dr. Weitz: Okay.
Dr. Whitfield: [00:11:00] So, its consequences, I think, are poorly understood because we don’t have a great deal of understanding about how to measure anything in the immune system. I think we’re really limited by what we can measure and how we can tell each, you know, in each case, and you f- you probably talk about this a lot on your show, everybody’s a bio individual, right? So what to measure, how to measure it, what tools to use. I can tell you there’s some things that we could use that aren’t commercially available. They’re in the research setting that would be helpful. But, you know, to date, we don’t have, I think, the tool set to go help each and every person understand better, like, what’s going on in their particular situation, and that’s part of the problem
Dr. Weitz: Right. I understand removing the implant can be tricky and sometimes the part of the implant actually gets attached to the wall and has to be scraped off, and is… That’s a whole complicated issue, my [00:12:00] understanding is.
Dr. Whitfield: Yeah. Let’s address that because it’s really not. I mean, all the you know, surgeons like me who did a lot of cancer reconstruction have all faced far difficult, more difficult challenges than that.
Dr. Weitz: Okay.
Dr. Whitfield: In a cosmetic situation where the implant was placed behind the muscle but above the ribcage, ’cause that would’ve been the practice, especially for a saline device from the Mortarmen ’91 until 2006, you would have to get it off of the back of the muscle, right? ‘Cause it’s beneath or behind the muscle, and then you have to get it away from the pec minor, which is on the chest wall at the apex of, we’ll just say, if you’re looking at a pie chart, the, you know, upper outer quadrant. That’s where the pec major would run over the top of the pec minor and the implant sits-
Dr. Weitz: So it’s in between two layers of muscle and it couldn’t adhere to the thoracic wall?
Dr. Whitfield: It does. Okay. But the way to safely do it all the time is to make sure you get to that junction, and then it wants to come off.[00:13:00] Some come off more easily, as you would expect, Dr. Weitz, than others. Like-
Dr. Weitz: Okay …
Dr. Whitfield: what I tell everybody is if you think of a sticky pad, if you give me two to three stickies thickness, I can take it off almost undisturbed or without a problem every single time. The things that are hard for me to do after several thousand of them are things that are like cellophane That’s a problem.
Dr. Weitz: Right.
Dr. Whitfield: Things that are filmy are problems, but I don’t really see those patients.
Dr. Weitz: Okay.
Dr. Whitfield: But it was difficult.
Dr. Weitz: Right. So, what have you seen is… are some of the main causes for breast implant illness?
Dr. Whitfield: Well, I think, you know, we’ve identified, along with Dr. Mathun, Sena, and others, that bacterial contamination from biofilm is a problem. He showed in his work that people with staph epi, bacterial contamination on the device [00:14:00] really can interact with the oleic acid, which is a fatty acid in the breast tissue, and oxidizes it. Now, I’m sure you and others that you’ve educated know that oxidation is not good. We want to be in a reduced state as much as possible. The more oxidative stress we have, the worse things are. So that happens, and it has a lot of different effects through the immune system. It affects the T helper cells, all these things.
Dr. Weitz: Interesting. So only the oleic acid? What about the other fatty acids? Would they all become oxidized?
Dr. Whitfield: In his work, it’s the oleic acid, and it creates different profiles of that oleic acid.
Dr. Weitz: Okay.
Dr. Whitfield: Seems to be the one that’s affected, that he’s shown. He’s the first person in the world to show it.
Dr. Weitz: Right.
Dr. Whitfield: So that oxidative reaction leads to downstream macrophage polarization at the endgame, which is bad, and that’s what leads to more symptoms. So that molecule, oxylipin tenhome, is a blood biomarker.
It’s not commercially [00:15:00] available. You and I can’t send patients to Quest or LabCorp and get that drawn, ’cause it doesn’t exist outside of the research environment. But that is a true cause and effect mechanism. So you can say, “All right. When I find those cases where bacterial contamination exists, I think for sure that’s part of the process that’s affecting their immune system.”
So if you remove that trigger, along with a big foreign object, along with the scar tissue, and any debris that was coming off of the device, ’cause the device is a silicone elastomer, it can leach chemicals out of its shell. It can, you know, basically over time lose its integrity. We already talked about rupturing and all those things.
So I think it’s important to do a capsulectomy, get all that tissue out, and then let the patient recover. You know, we have a prep and recovery program that’s- By,
Dr. Weitz: by the way, how is oleic acid in the… is it part of what makes up an implant?
Dr. Whitfield: No, [00:16:00] that’s in the breast tissue
Dr. Weitz: In the breast tissue? Okay.
Dr. Whitfield: Right.
Dr. Weitz: Okay. It’s
Dr. Whitfield: not in the device, no. Okay. The device has things like tellurium, cesium, cadmium, platinum- And
Dr. Weitz: oleic acid is an essential fatty acid often comes from olive oil and other foods.
Dr. Whitfield: Yeah.
Dr. Weitz: Okay. Sorry to cut you off there.
Dr. Whitfield: No, that’s all right. Just m- whatever you need to make, you know, clear, that’s…
I’m here, I’m just here to provide some clarity about the, the situation.
Dr. Weitz: Right. So- So, yeah, go ahead.
Dr. Whitfield: Well, no catch me up on where you w- where you want to go next.
Dr. Weitz: No. Continue with explaining how the bacteria and the oxidized oleic acid leads to breast implant illness, and what do we do about it.
Dr. Whitfield: Well, so those patients who have that elevated blood level of oxylipin 10-home have more symptoms.
Dr. Weitz: Okay.
Dr. Whitfield: So, you know, it’s not a, “Oh, is there a correlation [00:17:00] anymore?” That’s a very strict correlation. You can do an analysis. We published the largest series of explant scar tissue specimens tested by PCR in the world.
It shows that 29% have bacterial contamination. In the literature, there had been numbers that I didn’t trust because they were small sample sizes, but I think 694 consecutive cases is more than enough to draw a conclusion from. And then in Dr. Sena’s work, although it’s a smaller sample size, it’s very telling what they found.
So the next step is a group in Denmark published a series last summer that showed that folks who have thicker, firmer scar tissue capsules, things that would lead you to believe they have capsular contracture for the patients- Which is really subjective, but nonetheless, those patients are experiencing more increased T-cell, B-cell, and plasma cell response.
So when you [00:18:00] have questions which you’ve, I’m sure, fielded, you know, can devices like breast implants cause autoimmune situations? Well, anything that’s stimulating plasma cell activity, which make antibodies, the short answer to that would be, yeah, that would be possible. So it’s not like a splinter in your finger, which is a classic foreign body reaction when you remove it, you would see on on the microscope slide giant cells and histiocytes.
In this case, they did a PCR analysis to look for biofilm. They did a RNA analysis to look for which proteins are being upregulated, and then they identified genes of the, the cells that were there. And so you just have T-cell activation, B-cell activation, and you have plasma cell activation. So that’s classically what you would get in organ rejection.
So that’s more of a… I know you talk about this on your show about [00:19:00] bio-individuality, but people ask me, like, “Is everybody gonna get this problem? Who’s gonna get this problem, Rob?” And I’m like, “Okay, I can tell you who’s more susceptible to problem. I can’t tell you who’s gonna get the problem.” The people more susceptible to the problem are people that don’t detox well.
They have a really poor methylation pathway, which 36% of the population does. They have poor vitamin D metabolism. They either don’t activate, transport, or uptake well. They have a poor glucuronidation pathway, so use of glutathione is challenging for them personally. And then they may have a poor antioxidant pathway, so things like SOD2 that breaks down O3, which is oxidative stress, basically end products, is very hard for them.
So you just add all those up, and that’s a really good picture of my avatar, a patient who doesn’t detox well, who has a foreign body, who may not understand their diet, and they have a diet that is very hard on them without them understanding it. They may [00:20:00] live in a bad environment. Maybe they live near ag and get exposed to more glyphosate than you or I.
Maybe they have used products all their life not understanding that parabens are something that are really toxic to their system, and they can’t get out of their system easily. Others would be like they got exposed to mold, and they have a real high mycotoxin level, but they don’t understand that.
They have no idea that’s a problem for them. The other thing would be all of my patients are women, biologically, and if they have poor estrogen metabolism and high levels of estrone, that is the sine qua non. If they have all of those things, that is the person who’s most susceptible to the problem.
Dr. Weitz: Okay. So how do you treat these patients? You obviously remove the implant. Do you treat the bacteria?
Dr. Whitfield: Yeah, so what we do is from the time we engage with somebody, we have a set of supplements that are started to help support those genetic pathways I mentioned. [00:21:00]
Dr. Weitz: Okay.
Dr. Whitfield: Will help them. We provide nutritional counseling, get them on higher quality protein diets, and we really concentrate on educating them about sleep.
Sleep hygiene’s extremely important. If you live in a very, very high cortisol, stressed out state, you’re not the person I want to come… have come to my clinic, right? So we need to do some things preoperatively to get you in the right condition. ‘Cause if we lower your cortisol levels, if we lower your toxicity burden, if we improve your baseline level of inflammation, you’re going to do better at the time of surgery.
So we look at genetic testing, toxicity burden testing with Vibrant Wellness, gut health, food sensitivities, hormones. We try to get a really good contextual picture of each person to help guide them along the way, and I have a group of detox practitioners, two of which I’ve explanted, who are very familiar with [00:22:00] all the things that we’re discussing and have had the surgery, so they’re super supportive.
My nurse practitioner’s had the surgery, so she runs our surgical recovery program. But this all starts from the beginning, not after, because Dr. Weitz, I’m sure you know this, at your point in your career, it’s better to be prepared than reacting to a problem.
Dr. Weitz: Absolutely. By the way, one thought about a supplement that potentially would be beneficial for these patients would be tocotrienols, which is our premier fat-soluble antioxidant that could maybe protect the oleic acid from being further oxidized.
Dr. Whitfield: Well, we’re always looking and trying to figure out what the next thing is that can help. So my patients have a ton of gut trouble just like your patients, so trying to get them to do anything and absorb it. I know you just recently had Chris Shade on the show talking about liposomals. That’s what we concentrate on. All of our supplementation that I have based our program on, D3, K2, glutathione, methylated B, [00:23:00] vitamin C are methylated, are all liposomal, and then we use a couple just simple powders because it’s very hard on our patient population to use capsules, tabs of any amounts.
Dr. Weitz: Okay. So we got bacteria as a significant factor, and you prepare the patients with this whole functional medicine nutritional approach. Then you remove the explant and put a new one in, and do you treat them with antibiotics during, before, afterwards?
Dr. Whitfield: No.
Dr. Weitz: Okay. So let the body clear up the bacteria.
Dr. Whitfield: Yeah, the thing is, if you’re if you- Think about where it is, right? It’s a device locked into an area, so when we remove everything out undisturbed, which is the goal, w- well, you’re not really in a contaminated situation like a abscess or something.
[00:24:00] So we’ll rinse out the pocket. We usually do a lower pH rinse, because fungus, bacteria, viruses, they can’t tolerate pH changes. So we’ll use that, then we’ll rinse everything out again and that suffices to control locally what’s going on. I would have no idea what to put someone on systemically, because I have no idea what they’re colonized with.
We do PCR testing, not culture and sensitivity, because most of what we’re talking about would not register on a standard culture and sensitivity test, because it’s too low of a quantity to be recognized. So with a DNA test, you’ll see fragments, you’ll see one copy. You’ll get a better understanding of what’s there at that time, and then that will allow you to make at least, “Okay, here’s what was there.
We took these steps.” And then putting people on any other antibiotic therapy I don’t recommend, because I don’t think there’s any way to, you know, predict what’s gonna happen. [00:25:00]
Dr. Weitz: Are there other causes besides bacteria for breast implant illness?
Dr. Whitfield: Those are what we found predominantly are the causes. I’ve had a handful of people have some mycotoxins on the devices, but in general, pre-filled silicone implants, the number one problem is bacteria.
Dr. Weitz: I’ve heard we had somebody else on this show who talked about platinum being included in the implant, maybe being a problem as a heavy metal.
Dr. Whitfield: There’s a lot of heavy metals in implants.
Dr. Weitz: Are there?
Dr. Whitfield: Adnium, tin tellurium, cesium. I mean, there’s all sorts of stuff in the shell, you know?
Dr. Weitz: Okay.
Dr. Whitfield: So the, the problem we found is people who were engaging in high intense sauna use and sauna usage and were having Herxheimer type reactions, not really recognizing what that is.
So when you- unload those things into your [00:26:00] system and feel like you have a, like a flu afterwards, or it takes you a day or two to recover, I always tell people, “Dr. Weitz if you feel worse after the sauna, that’s the the, you know, sign, if you will, to not do it.”
Dr. Weitz: Now, some people would say that means they need it.
Dr. Whitfield: Right. So if you test the people who say that- … and the test that’s full of heavy metals, I would argue that’s probably not the right thing. Maybe. Because they’re in a binder or anything before they go into it, they’re exceeding their capacity by definition and giving themselves a Herxheimer reaction.
Dr. Weitz: Right. So is it possible to make these implants without those heavy metals?
Dr. Whitfield: Well, that’s a manufacturer discussion, not mine. I don’t make them.
Dr. Weitz: Okay.
Dr. Whitfield: Not my job. Way
Dr. Weitz: above me. It’s it sounds like, y- you know, once this is identified, that it might be a, a opportunity for somebody to make,
Dr. Whitfield: Somebody
Dr. Weitz: else
less toxic implants.
Dr. Whitfield: That is for the smart people that create [00:27:00] devices not I.
Dr. Weitz: So that other breast implant person I had on also told me about a form of cancer called breast implant-associated anaplastic large cell lymphoma. Is that a thing?
Dr. Whitfield: Yeah, it’s a very low incidence. Okay. And it comes with textured devices, predominantly the Allergan textured devices from the Fortin implant.
And- It’s a really rough texture, so it increases the T cell response. We’ve already kind of talked about immune system activation. You can postulate that some people are more affected by that than others. And, you know, Dr. Weitz, it’s never just one thing, ’cause there are so many of those textured devices out in the world.
If it was only the device, we would have a lot more problem with that cancer. Fortunately, we don’t. So I think everybody’s interested in always the safety, always patient [00:28:00] safety. So if patients have those, you know, those re- implants were recalled in 2019. So I always give them the same guidance. You should be obviously followed by your surgeon, and if you don’t want to have or want to worry about an- that anymore, we can help you, you know, with some recommendations.
But everybody’s just… You gotta be aware, like, first of all, understand what’s going on and assess where you are, and everybody can make their own informed decisions, of course.
Dr. Weitz: Right. Now, implants only last a certain period of time, right?
Dr. Whitfield: So, you know, from training, what we were, you know, given in terms of how to guide patients was at the eight-to-10 mark, eight to 10-year mark after placement, you start having discussions about, hey, these have an increased rupture rate, a half percent per year annually around this point.
So it’s not that you have to take them out at eight years and one month or 10 years and one month [00:29:00] and one day, it’s that you need to guide your patients, check on your patients. And if your patients are having problems, then you make some decisions, you do further investigation. Say, for instance, a cancer patient, say they got into a car accident and the seatbelt depressed their breast implant, and that’s called a deceleration injury.
It can very easily rupture a device. You would have that investigated either with ultrasound or ultrasound mammogram or an MRI. Like, you just have to, like, see your patients, take care of the patient, answer their questions if it needs further investigation. I often get an MRI ’cause I get asked a lot, “Dr.
Weitz, about radiation.” MRIs have no radiation. It’s absolutely- Right … easy to do, and I just get out of the, the radiation discussion. That’s the easiest way to take care of it and have a idea. It’s not perfect. No study is, but at least gives you an idea.
Dr. Weitz: Right. So when should a woman [00:30:00] consider having her implants removed?
Dr. Whitfield: Yeah, I would have them really be cognizant after that eight to tier- 10-year window, and annually be examined, and then make decisions based on the exam, how they’re feeling, you know, any, any kind of investigations that are done, if there’s issues identified on physical exam or ultrasound. Usually high defini- high-definition ultrasound is a tool that you can use to evaluate the integrity of the device.
Dr. Weitz: So if MRI and ultrasounds look good you’d be more likely to say they don’t need them replaced. But when we look at the symptoms associated w- with breast implant illness, I can’t help but think that these are very common symptoms, and I- my guess is if you were to just survey a, a percentage of women, it’d be a large percentage would say they either have some fatigue or brain fog or joint pain or GI symptoms, et cetera.[00:31:00]
So just based on symptoms, it’s a little tricky to decide whether they might be having s- some breast implant illness.
Dr. Whitfield: Yeah, I think you’re talking to, you know, someone who gets a very biased sample size, right? So everybody can have those symptoms as you describe. You can have mold toxicity, parasitic infection, Lyme disease, EBV long COVID, all those things.
Dr. Weitz: You’re giving other causes for that same set of symptoms.
Dr. Whitfield: Yeah, so they get all that stuff looked at before they ever show up to me So I’m not checking those boxes.
Dr. Weitz: Right.
Dr. Whitfield: If they’re naive to those, then I tell them, “Those are things you need to explore,” because surgery for a breast implant is not gonna solve those problems if those are co-infections from Lyme disease or if those are chronic mold exposure.
Now, mold used to be a bugaboo for us, but we have a very good plan for that and address that frequently, ’cause it’s a really common problem. The thing that [00:32:00] is really difficult for us, ’cause of our proximity to Mexico, much like yours, is parasitic infections.
Dr. Weitz: Well, w- ha- hang on one second. Why was mold a bugaboo for you?
Dr. Whitfield: Just really didn’t understand and have a good plan to treat it.
Dr. Weitz: Okay.
Dr. Whitfield: And homeopathy in our patients, chlorella, bentonite clay, all these different things, cleanses, all these things don’t really work in this setting, because usually our patients have too much going on. We’ll say their inflammation is too advanced or their co-infections or other problems are too advanced to just respond to a simple homeopathic remedy.
Dr. Weitz: Okay. Now you feel like you have enough tools to handle it?
Dr. Whitfield: Well, we typically say for instance, we have somebody who has a pretty difficult mold exposure we can help them a number of ways. We put them on our protocols, and if they need a medical therapy, either their functional medicine provider or us will provide a medically prescribed therapy for an antifungal, for [00:33:00] a medical grade binder, and really try to work with them to lower that.
And repeat testing will show that it’s being lowered or not.
Dr. Weitz: And obviously, as well as, A- and so in this case, the mold would be coming from their home and getting into their breasts? Or would, where would it be coming from? Just environmental exposure and somehow it grows in the breast tissue?
Dr. Whitfield: Yeah, most likely environmental exposure.
Dr. Weitz: Okay, so not necessarily from their home.
Dr. Whitfield: I mean, you just, it’s dealer’s choice, right? You’re in California.
Dr. Weitz: Right.
Dr. Whitfield: And I get
Dr. Weitz: out- Yeah. Yeah. We from, my understanding is there’s a huge number of people have mold in their homes.
Dr. Whitfield: Yeah, 100%. Yeah. That’s the most likely place.
Dr. Weitz: Yeah. Okay. So let’s see.
What else? So, breast implant illness can lead to autoimmune disease, and so we have to consider that. Do you… how do we address that from your perspective?
Dr. Whitfield: I don’t think you can do the cause-effect with that [00:34:00] because I don’t have that-
Dr. Weitz: Okay …
Dr. Whitfield: has that in their you know, publications or literature to support that to the degree that you would be certain about it.
So that paper out of Denmark gives me the most information about autoimmunity that I’ve ever felt was available, and there are gonna be many grants written about that paper to identify and look at more mechanisms of action of how that can be happening to give us more information. I would love to have a commercially available RNA test to look at what’s going on in our patients at the tissue level, ’cause that would be super helpful to characterize what’s happening.
‘Cause that’s really a bio-individual characteristic. I think most people don’t get this, but blood work is not super exciting to me. Like, it does not help me. You know, tissue characteristics, what’s happening at the cellular level makes a big difference in my patients.
Dr. Weitz: Well, potentially there could be the right lab work that could help [00:35:00] blood work.
Yeah, I could see somebody putting together a breast implant autoimmune profile looking at antibodies to various things that could be involved.
Dr. Whitfield: Yeah, today it’s not been super exciting.
Dr. Weitz: Okay …
Dr. Whitfield: the lab companies, you know, the… I would say the functional folks that we’ve talked to, they’re trying to be helpful, but haven’t- been able to even add oxylipin tin home, like we know is a marker. They haven’t added it, and we’ve introduced the scientists to the lab and, like, unless you own a lab and I can tell you to do it, I don’t own a lab and I can’t tell myself to do it. So-
Dr. Weitz: Right …
Dr. Whitfield: is where it is. I mean, I’ve given you the information.
The information exists in the literature, so-
Dr. Weitz: Right …
Dr. Whitfield: now you have to have a lab actually want to do it.
Dr. Weitz: Right. Yeah. We should talk to Ari Vasztani, who the guy who runs Cyrex Labs.
Dr. Whitfield: Yeah. I mean, anybody can do it. I mean, they’re the people that have the strings. I don’t.
Dr. Weitz: Right. [00:36:00] Okay. So, what other kinds of therapies are you using for these patients to enhance their recovery?
Dr. Whitfield: So I think once you get them actually doing more of what y- you probably preach and I preach about is, like, good sleep hygiene, obviously paramount. Nutritional guidance is, I don’t wanna say that it’s not as complex as it’s made out to be, but it’s not. Like, you have to increase the quality of the food you put in the system and the quality of the fluid you put in the system, and an underappreciated source of controversy is air quality.
Like, now you see the wildfires affecting New York and Chicago and-
Dr. Weitz: Yeah. All across the northern part of the country, the Midwest, et cetera, all coming from Canada. Yeah.
Dr. Whitfield: And people don’t… They sleep on the fact that air quality is okay. [00:37:00]
Dr. Weitz: Yeah, no. Well, I’m in LA, and we had the Palisades fires, and we had massive amounts of toxins and asbestos and lithium batteries burning and all kinds of crap that was in the air that unfortunately we were all breathing in.
Dr. Whitfield: Right. So, like, I really say the same things over and over again. Can you just improve the air quality, fluid quality, food quality?
Dr. Weitz: But of course, you know, whatever you say about food, there’s somebody who has a different opinion about it. Yeah,
Dr. Whitfield: that’s why I don’t say anything specific. Can you incru- improve the quality of what you’re eating?
That means don’t eat processed things, first and fore- Right … just eat whole foods. Right. And then, like, I tell them not to eat gluten or dairy and avoid seed oils. And they’re like, “Oh, my God, you know, what am I supposed to eat?” So you have that battle right in the beginning.
Dr. Weitz: Of course.
Dr. Whitfield: So-
Dr. Weitz: And then should [00:38:00] we be eating protein, or is protein bad?
Should we be only e- should we be eating a vegan diet? Should we be eating a low-carb ketogenic diet? Should we… You know, there’s w- whenever you get into particulars about diet, it gets very tricky.
Dr. Whitfield: Yeah. For me, it’s always gonna be emphasizing protein and not you know, carbs or… You know, I emphasize good quality sources of protein and high quality sources of fats, which is the hardest thing to get back into the diet typically. I don’t ever talk about carbs because that’s not anything I need anybody focusing on for recovery. You basically recover when in fact you get your body in a positive nitrogen balance, and that doesn’t come from carbs That comes from proteins and amino acids.
Dr. Weitz: Yeah I know there’s a few surgeons in LA that have developed a post-surgery recovery protein powder product to enhance recovery.
Dr. Whitfield: Yeah, I [00:39:00] mean, we’ve tried to source and have a good quality supplement line. We use pea protein. I just try to use things with the least amount of ingredients, the least processed stuff, like the liposomals, very basic. Try to keep everything as simple as possible for patients so that we’re not getting into the too many fillers or too many additives or too many things that could affect them.
Dr. Weitz: So what are some of the biggest misconceptions about breast implant illness?
Dr. Whitfield: Well, you know, it’s a real phenomenon. I don’t know why it’s not… I do actually know why it’s taken a long period of time to be widely accepted. We haven’t drawn this direct correlation between implant-based infection that actually leads to an operation, hospitalization, et cetera, because I think we all learned back in our training there’s this prodromal phase that happens before you actually have signs of [00:40:00] infection.
And these patients kind of live in the prodromal phase. It’s chronically inflamed or low-grade infection, however you want to describe it, but they don’t show up to your office and say, “Oh, Dr. Weitz, I have this chest, breast pain. It’s all kind of red and swollen and warm.” ‘Cause you would say, “Oh, that’s an infection.
You need to go to the hospital and be seen.” And everybody would figure it out, right? It wouldn’t be hard. But now because there’s no blood work that’s wildly off, there’s no white blood cell count elevation, there’s no sed rate change, there’s no CRP change. None of these… That, that doesn’t happen in these patients.
So there’s nothing that just gives you the basic clues. There’s no physical exam clues, right? So if you’re just asking somebody, [00:41:00] oh, all right, from training, you didn’t have functional genetics training when you trained. I didn’t. The Genome Project wasn’t even done yet.
Dr. Weitz: Right.
Dr. Whitfield: So detoxification, f- you know, pathways, functional genomics, understanding somebody’s methylation boundaries, anything like that wasn’t taught.
A-
Dr. Weitz: and to be honest with you, most of that stuff still hasn’t hit the mainstream medicine, and it’s not really considered s- scientific at this point.
Dr. Whitfield: Well, that’s, therein lies the problem, right? It’s what I said about understanding the immune system.
Dr. Weitz: Sure.
Dr. Whitfield: Probably least understood system we have.
Dr. Weitz: Absolutely. No. You say detox to conventional physician, and they’re gonna just think there’s just nonsense.
Dr. Whitfield: Right. So that’s why we are where we are.
Dr. Weitz: So- of the breast implants on the market today, is there one or two that you think are safer than the others?
Dr. Whitfield: I’ve taken all of them out.
Dr. Weitz: Okay.[00:42:00]
Dr. Whitfield: There is one sitting on my desk, so rather than get a letter from them, I’ll just tell you no. I think they’ll all have their reactions. It’s more the bio-individual rather than the device to me.
Dr. Weitz: Right. And I think you’ve said that there’s really no biomarker that we can look at to really help understand whether somebody has breast implant illness.
Dr. Whitfield: Not that’s commercially available. If we’re in the lab environment, Dr. Sena’s worked it out, and that helps, you know- Right … identify some, but not all. But-
Dr. Weitz: Like, is there an inflammatory marker? Do you see CRP go up, interleukin 6, any of the available inflammatory markers?
Dr. Whitfield: The best one that we found was a urinary metabolite, thromboxane A2 metabolite, and that was elevated but could be affected by alterations in diet by just increasing turmeric and ginger in your diet or taking an anti-inflammatory medication.
So from a blood level [00:43:00] standpoint, highly sensitive CRP, sed rates, IL-6, none of that shows up to distinguish this patient population from anybody else. So-
Dr. Weitz: 20… Yeah. So there’s that one. Throm- What advice would you give to a woman considering getting cosmetic breast implants today?
Dr. Whitfield: Well, I think the main thing is if…
And we’ll take it in two groups. We’ll take the group who’s had their children, breastfed, and is unhappy with the appearance because there’s been this kind of deflation. There may be a little bit of low set breasts or sagging, and maybe all they really want is a lift and a little bit of volume added back.
I do that with a fat transfer, which should be talked about more and offered more. It’s a natural holistic way to do this. It’s not hard to do. I think I did two this week already. But so that’s not discussed, just a simple lift or reshaping [00:44:00] procedure and re-volumization with your own fat. I don’t put foreign things in people anymore, so I don’t discuss other products or other devices or things like that.
I think if you’re in that group of you’ve had your kids and you’re done, you should look at all options. If you’re the young person who’s not had children that means your skin is gonna be much, much tighter, and that lends itself to less options, if that makes sense. So to do a fat transfer, it’s best if the skin has already been stretched because fat cannot stretch the skin.
An implant can stretch because it’s a fixed volume and it’s non-compressible at a certain point. Saline is more dense than silicone, so saline will give you probably the most projection because it’s the dentist, densest, and when you fill it up, it’s like a water balloon. It also feels unnatural. [00:45:00] And then the softer is obviously the silicone device.
But, you know, there’s trades… You have to trade off something in every situation, right? So if you’re gonna get a device at a young age, and it’s very hard to explain all the risks and benefits, so we wrote a book about breast implants and tried to educate patients through patient stories that are included in the book.
So that’s available as a resource to help patients understand, oh, there are other things that can go on with this. So you should understand they’re not lifetime. They need surveillance. They need monitoring. You need to see your surgeon. You can’t just… It’s not one and done. You just don’t, like, go get it and then wander off and never go back.
I think that’s, like, this weird thing that happens. So-
Dr. Weitz: Well, I don’t think most surgeons are really prepared to give much aftercare
Dr. Whitfield: Yeah, that’s true. But everything’s a two-way street. It doesn’t really, you know, [00:46:00] do you a service to find one of those surgeons who doesn’t do that, and you can figure that out by discussing that with them at the consultation or with their staff before you ever go in.
Like, what is the cadence? So our cadence is very simple. We see people pre-op and work with them for weeks to months beforehand. They come in pre-op the day before surgery, whether they fly in from out of the country or they’re local to us, so we see them in person. We see them the next day. We have a very extensive preparation program, as you know.
The anesthesia group that works with us does preoperative nerve blocks, so they use local regional, local anesthesia blocks to really support the patient, so we don’t need to use more narcotics. We do individualized local anesthesia blocks in the operating room, further decreasing the need for post-op ana- narcotics.
And then we have a very aggressive hyperbaric oxygen, lymphatic massage therapy, red light therapy, and we have a human regenerator from Germany to really help lower, like, sympathetic activation [00:47:00] after surgery, if you wanna think of it like that.
Dr. Weitz: What was the last device you mentioned?
Dr. Whitfield: The human regenerator.
It’s from Germany. It uses cold plasma, basically, and it’s, to me… Think of, like, everybody’s in a really heightened cortisol state, like a high sympathetic activation state, and it’s meant to help lower that.
Dr. Weitz: And how does that device work? ‘Cause I’m not familiar with a plasma regenerator.
Dr. Whitfield: Yeah. It’s supposed to help electron transport
Dr. Weitz: E- are you actually taking the plasma out of their blood and-
Dr. Whitfield: No, you just lay on a bed.
It’s a, it’s a- Oh.
Dr. Weitz: Oh, okay. Yeah. It’s some kind of energy that’s going in?
Dr. Whitfield: More energy-based therapy basically.
Dr. Weitz: Okay. All right. The
Dr. Whitfield: only thing you don’t have outside of that is, like, sound therapy, which is really underappreciated in recovery.
Dr. Weitz: Yeah, my wife does sound baths, so I know a bit about it.
Dr. Whitfield: Yeah, but that’s we do that in the office for the first week, and then if you’re from out of the country, you stay a little bit longer.
Usually after a week we allow everybody to return home, and then our [00:48:00] cadence is after seeing them at a week, a month, three months, six months, nine months, 12 months. That’s just in the first year, and people can work with us longer, but that’s typically our engagement the first year.
Dr. Weitz: So let’s say somebody’s listening to this, wants to get their implants out, maybe doesn’t feel like they can fly to Austin to see you.
Mm-hmm. How, is there a way to find somebody like you in other parts of the country?
Dr. Whitfield: Well, there won’t be the same programming. So we’ve made that programming available to everybody across the country. So now you can work with my team remotely for the detox part.
Dr. Weitz: Okay.
Dr. Whitfield: Prep part. So that’s running… Basically the book and the program are called The Sharp Method, so they can engage with us that way. And then for surgeons, I think it’s really important that they go meet the surgeon, and be comfortable with the surgeon, and ask the correct questions. We have guides on our website about what to ask to make sure that you’re getting your questions answered properly and you’re making the best-informed decision for you. [00:49:00] Because, you know, that’s ultimately what you have to do, whether you come see me or see somebody else. It’s did you get your… Do you have your questions together? Are they answered in a way that you are comfortable with, and do you feel comfortable with th- that surgeon a- and doing that with them? Now, you can certainly go read reviews. You can hit up former patients. I just had a patient of mine on a live stream last night. She is always really interested in helping women, so, like, they will message her on Instagram or whatever and ask her questions. And that’s kind of, you know, there’s a lot put on the patients to figure out, like, who’s the right fit for them.
Dr. Weitz: So how can patients contact you? What’s your website? What other contacts do you want to use?
Dr. Whitfield: Yeah, so what I would do is mainly we run everything through our main drrobertwhitfield.com domain, and on that we have lots of resources about breast [00:50:00] implant illness, symptoms, diagnosis, recovery, things about capsulectomy, how to choose a surgeon, questions, things that will make sense and resonate, resonate with the patients. And then we have a private community that I live stream out of, ’cause I’ve been censored on a lot of platforms for talking about this, as you would imagine.
Dr. Weitz: I see. Yeah, I get it. All right, great. So I think that’s a wrap, unless there’s something you wanna leave us with.
Dr. Whitfield: Yeah, I think the things that you can start doing now have nothing to do with spending extra money, and you can just think about the choices you make about the products you use. So anything you put on your body, start just really being diligent about what you’re using. The fluid you drink, just try to be careful. Like, you don’t need to drink anything that’s got a bunch of… Like Monster or whatever those energy drinks are, or these, these weird things. Celsius. I don’t care none of that stuff [00:51:00] needs to be used. So try to get some, you know, filtered water basically. And then for food, you know, if you’re vegetarian, pescatarian, carnivore, I don’t care, just try to get the best quality stuff you can put in your body. And then sleep is really important, so stop eating about three hours before bed, stop drinking about two hours before bed, and get off screens about an hour before bed, and try to get yourself into a good pattern. Develop the habit of good sleep hygiene and that will carry you a long way.
Dr. Weitz: That’s great.
Dr. Whitfield: Thank you, Dr. Weitz, yeah. Thanks for having me.
Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. As you may know, I continue to accept a limited number of new patients per month for functional medicine. If you would like help overcoming a gut or other chronic health condition, and want to prevent chronic problems, and want to promote longevity, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111, and we can set you up for a consultation for functional medicine. And I will talk to everybody next week.
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