Latest / HKB Uncut | A Cosmetic Surgery Podcast / 16. Breast Implant Fatigue | Downsizing Implants, Breast Implant Illness, Capsular Contracture, and More

Transcript

16. Breast Implant Fatigue | Downsizing Implants, Breast Implant Illness, Capsular Contracture, and More · HKB Uncut | A Cosmetic Surgery Podcast

• 0:00
  SPEAKER_02: It it hurts my heart sometimes when I get to see a patient that have had implants for 30 years and like they don't look good at all.
• 0:05
  SPEAKER_02: And they're like, oh, I didn't know.
• 0:07
  SPEAKER_02: I didn't know I was supposed to do something.
• 0:08
  SPEAKER_02: So it's like every woman should have breasts that they're content with and feel good about and not like embarrassed about.
• 0:14
  SPEAKER_02: You know what I mean?
• 0:19
  SPEAKER_00: Welcome to HKB Uncut, the health, knowledge, and beauty podcast.
• 0:23
  SPEAKER_02: On this show, we unpack the newest techniques and trends in cosmetic surgery, how to tune out the social media noise to make empowered decisions about your appearance and what you need to know before you book a procedure.
• 0:33
  SPEAKER_02: I'm Dr.
• 0:33
  SPEAKER_02: Bill Cortesis.
• 0:35
  SPEAKER_02: And I'm Gora Vihardi.
• 0:36
  SPEAKER_02: We are board-certified plastic surgeons and co-founders of HKB Cosmetic Surgery, an award-winning practice with 11 locations across six states.
• 0:44
  SPEAKER_00: In other words, when it comes to aesthetics and cosmetic surgery, we've pretty much seen it all and we want to share our knowledge and unique approach to aesthetics and beauty with you.
• 0:53
  SPEAKER_00: Whether you're interested in cosmetic surgery for yourself or want to separate fact from fiction in the plastic surgery world, we hope you'll tune in each week.
• 1:10
  SPEAKER_02: Bill Cortesis.
• 1:49
  SPEAKER_00: Yeah, because there's not just one absolute reason for patients that come in to have their implants removed, right?
• 1:57
  SPEAKER_00: And so this is a catch-all phrase for all those patients that are coming in to want their implants removed, right?
• 2:04
  SPEAKER_00: This includes Yeah, give us all the reasons.
• 2:06
  SPEAKER_00: Your typical breast implant illness patient.
• 2:08
  SPEAKER_02: Okay.
• 2:09
  SPEAKER_00: Um, there are just a lot of patients that come in afterwards after having the implants for an extended period of time, they're just over them.
• 2:16
  SPEAKER_00: Like, hey, I I don't want to be this large anymore.
• 2:18
  SPEAKER_00: I actually want to be much smaller.
• 2:20
  SPEAKER_00: Doc, I want to get rid of them.
• 2:21
  SPEAKER_00: So a lot of menopause patients, their breasts get bigger, right?
• 2:25
  SPEAKER_00: Hey, I have BII, which we'll we'll cover.
• 2:27
  SPEAKER_00: I want to get rid of my implants.
• 2:29
  SPEAKER_00: That's another one.
• 2:30
  SPEAKER_00: Sometimes patients have these texture devices that and they're worried about the consequences of having texture devices.
• 2:37
  SPEAKER_00: Um, and so breast implant fatigue sort of covers all those topics because it ultimately the patient's gonna end up getting a similar type procedure um when they come in to talk to us, right?
• 2:52
  SPEAKER_00: That they want that implant removed, you know, for their lifestyle, for whatever they're going for.
• 2:58
  SPEAKER_00: And again, for breast implant illness, it's more functional.
• 3:01
  SPEAKER_02: Yeah.
• 3:01
  SPEAKER_02: And like, you know, it's important to note that, you know, even more reasons for removal are that patients might have a breast, they just don't like the way it looks.
• 3:10
  SPEAKER_02: Like it's just like it doesn't embody like what they think is a beautiful breast and they need something different to be done.
• 3:15
  SPEAKER_02: The other thing is that they could have hardening around the implants, like it could be hard and like literally cause something called a capsule contracture.
• 3:22
  SPEAKER_02: And when they lay down or when they hug somebody, it's not that soft, you know, human feel.
• 3:27
  SPEAKER_02: Um, the other thing is that the implant could be in the wrong place.
• 3:30
  SPEAKER_02: It could be kind of wonky.
• 3:31
  SPEAKER_02: And like sometimes it really um it hurts my heart sometimes when I get to see a patient that have had implants for 30 years and like they don't look good at all.
• 3:38
  SPEAKER_02: And they're like, oh, I didn't know.
• 3:40
  SPEAKER_02: I didn't know I was supposed to do something.
• 3:41
  SPEAKER_02: So it's like every woman should have breasts that they're content with and feel good about and not like embarrassed about.
• 3:47
  SPEAKER_00: You know what I mean?
• 3:48
  SPEAKER_00: Yeah, oftentimes removal and doing some version of reconstructive surgery, a lift, fat grafting, ultimately looks better than when they had implants in place.
• 3:58
  SPEAKER_02: Oh, 100%.
• 3:59
  SPEAKER_02: Like that's the best.
• 4:00
  SPEAKER_02: And like, so I think that's the biggest thing is we we want to make sure that people know, like, you know, just because you have implants and you're worried that if you get rid of them that you won't have a great result, that's that's simply not the case.
• 4:10
  SPEAKER_02: There's lots of things that we can do that are like obviously it's there's surgeries, there's risk associated with surgery, but uh, but it can be somewhere where it's really empowering.
• 4:17
  SPEAKER_02: A lot of our patients literally, like you were saying, like feel better afterwards, but also they look better and like and they're like, oh man, I had no idea.
• 4:25
  SPEAKER_02: And they're super happy.
• 4:26
  SPEAKER_02: So uh we love doing these cases because simply patients are happy.
• 4:29
  SPEAKER_00: So let's just delve into breast implant illness real quick as one of the subjects of that.
• 4:35
  SPEAKER_00: You know, patient comes in, you know, they they've gone down the road of of you know, saying, you know, with their primary care doctor and they haven't been feeling well, they can't figure out exactly what it is, they're saying, hey doc, I think it's my implants.
• 4:50
  SPEAKER_00: They come in to see you.
• 4:52
  SPEAKER_00: You know, what do you tell them?
• 4:53
  SPEAKER_02: I think the most important thing is I approach them with empathy and sympathy because obviously something is wrong.
• 5:00
  SPEAKER_02: They're in a pretty tough place.
• 5:02
  SPEAKER_02: Most of them don't just show up and say, I want my implants, I don't want you to take the capsules out.
• 5:06
  SPEAKER_02: I got breast implant illness, meaning that they've done a fair amount of diligence, they have had extensive workups, they've kind of really looked for everything, they can't find anything.
• 5:16
  SPEAKER_02: So their goal is to eliminate their implants and their capsules as a possible cause.
• 5:21
  SPEAKER_02: Um, and I tell them I can help you with that.
• 5:24
  SPEAKER_02: There are risks associated with that.
• 5:26
  SPEAKER_02: I cannot guarantee that this is going to change uh your symptoms.
• 5:30
  SPEAKER_02: I cannot guarantee that it will eradicate all these issues, but I can tell you that I can carefully and cautiously remove your implants and the capsules and that you might get better.
• 5:40
  SPEAKER_02: You might find out that something else is going on.
• 5:43
  SPEAKER_02: And that's kind of it.
• 5:45
  SPEAKER_00: You know, but I think it's our obligation as plastic surgeons, right?
• 5:48
  SPEAKER_00: If we're putting them in, we should definitely take them out.
• 5:52
  SPEAKER_00: And if the patients want the scar tissue removed at the same time, right, I I think it's it's o okay to do, and we should do it.
• 5:59
  SPEAKER_00: Right.
• 6:00
  unknown: Right.
• 6:00
  SPEAKER_00: And you know, studies have shown that I think a lot of reasons why we end up taking the the capsules out.
• 6:05
  SPEAKER_00: There are silicone particulate from the implants that shed onto the capsule, right?
• 6:10
  SPEAKER_00: And they want to get rid of any potential foreign body that could be causing it.
• 6:15
  SPEAKER_00: To your point, we can do it safely.
• 6:17
  SPEAKER_00: Yeah.
• 6:17
  SPEAKER_02: And you know, I think you know, everybody's different, everybody behaves in a unique way, and people's um immunologic um responses, people's um microbiome, people's tolerance to environmental threats, all this stuff changes.
• 6:33
  SPEAKER_02: And as you accrue more time in life, you just keep getting punched and beat up and beat up and beat up.
• 6:38
  SPEAKER_02: And I do believe that some people, their systems just don't keep up as much.
• 6:42
  SPEAKER_02: So I don't think it was a failure on anything.
• 6:44
  SPEAKER_02: I think this is just a multifactorial, multimodal thing.
• 6:47
  SPEAKER_02: And sometimes it's something else totally going on.
• 6:49
  SPEAKER_02: Like there's other stuff happening, but like patients are just like they're like, you know, they're desperate.
• 6:54
  SPEAKER_02: And so there have been patients we've taken care of.
• 6:56
  SPEAKER_02: I mean, like, you know, we've we've had the stories where like you do it, and like literally they they come back and it's like a different person.
• 7:01
  SPEAKER_02: And then there are other ones where we'll do the same exact thing and put a new device in and they still come back as a different person.
• 7:07
  SPEAKER_02: So I think that we're trying to do whatever's safe, but whatever a patient actually needs.
• 7:13
  SPEAKER_02: Um, but we're very careful to not like promise anything because you just we don't 100% know.
• 7:19
  SPEAKER_00: Yep.
• 7:20
  SPEAKER_00: There's no guarantee that removal of the implant in the capsule is going to make the patients better.
• 7:25
  SPEAKER_00: However, studies have shown that doing this procedure actually does benefit the patients wholeheartedly.
• 7:32
  SPEAKER_00: Right.
• 7:33
  SPEAKER_00: And so, like, again, I think it's our obligation as plastic surgeons, if they come in and they want it out and we can do it safely, I say, yeah, let's let we go down that road um to do it.
• 7:43
  SPEAKER_02: Only thing is that is that you I like the word that you're saying.
• 7:46
  SPEAKER_02: The other our other obligation is, and I think we're doing all doing better.
• 7:48
  SPEAKER_02: Hopefully, I know we are making an effort, and that is, you know, really explain to a patient when they're coming in for a primary, you know, procedure that okay, so you're gonna do this procedure, we're gonna put a device in there, it's gonna sit behind your breast, it's gonna either sit in front or behind the muscle, and it's gonna add volume.
• 8:05
  SPEAKER_02: Um, that device is not a forever device.
• 8:08
  SPEAKER_02: Okay, the device itself might last forever, but you are a changing organism, and that it may require maintenance.
• 8:16
  SPEAKER_02: Most likely it will require multiple surgeries afterwards, like an implant exchange, like a breast lift, um, like a pocket adjustment.
• 8:23
  SPEAKER_02: And then it might require that implant to come out because most of time people don't necessarily, you know, you know, go to their grave with implants in, or they may not, or may not want to.
• 8:31
  SPEAKER_02: And so I think setting that stage is really important.
• 8:34
  SPEAKER_02: Because patients like me and you, we don't like surprises.
• 8:38
  SPEAKER_02: And I think the generations before maybe didn't really think forwardly enough to tell them, hey, this is not a one and done procedure.
• 8:44
  SPEAKER_02: Matter of fact, it's multiple procedures, which isn't necessarily a bad thing.
• 8:47
  SPEAKER_02: The parallel I'll give you is like, you know, if you do like, you know, facial enhancement nicely, you can have primary, secondary, tertiary facelift and still look really good.
• 8:55
  SPEAKER_02: Same thing with your breasts.
• 8:57
  SPEAKER_02: You can have amazing results throughout your lifetime, but you have to have little tweaks.
• 9:02
  SPEAKER_00: Yeah, I mean, I tell every patient that comes in, and I know you do as well, you're buying yourself another surgery, be it a removal or a replacement.
• 9:08
  SPEAKER_00: We're gonna have to do something down the line.
• 9:10
  SPEAKER_00: And the follow-up question is always, hey, doc, how long is it gonna last?
• 9:14
  SPEAKER_00: Right?
• 9:14
  SPEAKER_00: When is that time frame, right?
• 9:15
  unknown: Right.
• 9:16
  SPEAKER_00: You know, I I think the old adage said 10 years.
• 9:19
  SPEAKER_00: Yeah.
• 9:19
  SPEAKER_00: Could it be less?
• 9:20
  SPEAKER_00: Could it be more?
• 9:20
  SPEAKER_00: Theoretically, yes.
• 9:21
  SPEAKER_00: You know, I think there have been huge advances in the plastic surgery field in regards to breast implants, right?
• 9:27
  SPEAKER_00: And so they're they're constantly iterating to a better ultimate device that theoretically can last longer, that has less inflammatory process associated with it.
• 9:38
  SPEAKER_02: But and so much of it too is the technical way that we do the surgery and then also just the patient.
• 9:43
  SPEAKER_02: Each patient is different, each patient is unique.
• 9:46
  SPEAKER_02: Um, you know, some people talk about that old adage, if it ain't broke, don't fix it.
• 9:50
  SPEAKER_02: And I I've seen like people on social, like, you know, just going, hey, while if your surgeon tells you you need to change your implants every 10 years, they just want your money.
• 9:58
  SPEAKER_02: Or the other one's saying if they tell you not to change it every 10 years, they don't know what they're talking about.
• 10:03
  SPEAKER_02: You know, what's your approach on that?
• 10:04
  SPEAKER_02: You know, this this concept because there's a lot of noise out there for patients.
• 10:07
  SPEAKER_02: What should they actually do at these tenure intervals?
• 10:10
  SPEAKER_00: Well, I actually think patients need to come back to see their surgeons yearly.
• 10:15
  SPEAKER_00: You know, I I think the problem lies in the fact that surgeons do this, they see that you know their patient back once, twice and say, hey, you're great.
• 10:23
  SPEAKER_00: Follow up if you need us.
• 10:24
  SPEAKER_00: That's not how we do things.
• 10:25
  SPEAKER_00: I actually think you should see your patient yearly, especially if you put a foreign body or device into that patient that's replantable.
• 10:32
  SPEAKER_00: You need to follow them.
• 10:33
  SPEAKER_00: You need to make sure they're tracked, they're followed up on, that you're taken care of.
• 10:38
  SPEAKER_00: That's why it's actually mandatory that we we set up all our patients within the um tracking system, within plants, right?
• 10:44
  SPEAKER_00: Because I think they need to be managed appropriately.
• 10:46
  SPEAKER_00: We've learned from devices in the past that have not been great, that they were not tracked properly, that now I think it's it's back to this obligation thing.
• 10:56
  SPEAKER_00: I think it's our obligation to make sure that we we follow these patients throughout their journey.
• 11:00
  SPEAKER_00: And for me, it's yearly.
• 11:02
  SPEAKER_00: And and then that way we can see if there's a problem going on, or if their desires change, or they want something different, they want a different look, or you know, hey, I gained a lot of weight.
• 11:11
  SPEAKER_00: I don't want these implants anymore.
• 11:13
  SPEAKER_02: That happens.
• 11:14
  SPEAKER_02: And I'm a 10-year guy.
• 11:15
  SPEAKER_02: I tell my patients this, I'll say it, I'll say it, I'll stand toe-to-toe against any plastic surgeon.
• 11:19
  SPEAKER_02: I don't care what their level of training is, how much of an expert they claim to be.
• 11:23
  SPEAKER_02: Because um, whatever happens, whatever you say, there's there is your body is interfacing with a prosthetic device.
• 11:30
  SPEAKER_02: There's something going on at that level, there's things that can happen at that level.
• 11:34
  SPEAKER_02: Maybe there's inflammation, maybe there's not.
• 11:36
  SPEAKER_02: What I'm not saying is that the implant's gonna have a problem or it's gonna be causing a problem.
• 11:39
  SPEAKER_02: What I am telling you is that human is dynamic.
• 11:42
  SPEAKER_02: The tissue is changing, the pockets are changing.
• 11:44
  SPEAKER_02: There's probably something there that they want to optimize.
• 11:47
  SPEAKER_02: So by explaining to the patient, like, hey, 10-year individuals, I would take a hard and fast look.
• 11:51
  SPEAKER_02: I'm telling you that my recommendation would be we need to really look at things to see if it can be improved from an aesthetic standpoint.
• 11:57
  SPEAKER_02: Also, you may want to change the tires.
• 11:59
  SPEAKER_02: You may want to, you know, whatever, rotate the tires type thing.
• 12:03
  SPEAKER_02: Like there, there's there's not downside there.
• 12:05
  SPEAKER_02: And also there's potentially just avoidance of a possible issue.
• 12:08
  SPEAKER_02: And like, I guess that's my thing.
• 12:09
  SPEAKER_02: It's being proactive about it.
• 12:11
  SPEAKER_02: And it's it's nothing's mandatory.
• 12:13
  SPEAKER_02: At the end of the day, that's the thing is patients um control their destiny in our care.
• 12:17
  SPEAKER_02: And we just have to empower them with their information, and then we can also give them our opinion, and then they can make that the decision.
• 12:23
  SPEAKER_00: So when they're coming back early or every couple of years to see you, you know, how are you examining them?
• 12:28
  SPEAKER_00: Like, you know, is it just hey by, you know, physical examination or using uh any other stuff?
• 12:33
  SPEAKER_00: Yeah.
• 12:34
  SPEAKER_02: Uh there's lots of ways to examine them.
• 12:36
  SPEAKER_02: I think the first is like how their level of satisfaction, so the subjective stuff, then more objective measures of physical examination, and then um imaging.
• 12:44
  SPEAKER_02: They obviously get normal screening imaging, like mammograms.
• 12:47
  SPEAKER_02: They can also do ultrasounds in the office.
• 12:49
  SPEAKER_02: You can do high-resolution ultrasounds also to look at the breasts and also assess implant um uh shell um you know uh stability and make sure there's not a rupture and things like that.
• 13:02
  SPEAKER_00: So patients they come in, they're ready to get their implants out, BII or any other reasons we talked about for fatigue.
• 13:11
  SPEAKER_00: What other options do they have to give their breast the best aesthetic outcome?
• 13:18
  SPEAKER_02: Yeah, so here's the the thing is if there's um a level of skin excess or droop, then you can think about things like breast lifting.
• 13:24
  SPEAKER_02: Breast lifting essentially gets rid of extra skin and cones the breast.
• 13:28
  SPEAKER_02: Negative, you get additional scar.
• 13:29
  SPEAKER_02: So patients need to really understand that.
• 13:31
  SPEAKER_02: Um, sometimes, even combined with that, you can do volume addition using their own fat.
• 13:36
  SPEAKER_02: And so that's autologous fat crafting.
• 13:38
  SPEAKER_02: Donor sites can be your tummy, your thighs, your inner thigh, your hip rolls, basically anywhere where you have excess fat.
• 13:44
  SPEAKER_02: Sometimes patients will do other procedures at the same time.
• 13:46
  SPEAKER_02: So some of these patients are actually gonna may do like an abdominal plasty at the same time, or they might do other interventions at the same time.
• 13:53
  SPEAKER_02: If there isn't a lack of excess fat, or they don't want to have that liposuction donor site, we can use off-the-shelf products like um allograft.
• 14:01
  SPEAKER_02: Those are products like um alloclay, Renuva, and they're gonna be more and more options like that, regenerative concepts.
• 14:07
  SPEAKER_02: Eventually, we're gonna be able to put in a soft tissue construct and do fat grafting with it.
• 14:12
  SPEAKER_02: And you essentially can have like a bioengineered, you know, breast implant that's not an implant, that'll be tissue.
• 14:18
  SPEAKER_02: So it's coming.
• 14:19
  SPEAKER_02: We all we all fundamentally, and I don't know, Bill, if you agree to this or not, but I mean the idea of using an implant is still archaic.
• 14:24
  SPEAKER_02: It works so well, though.
• 14:25
  SPEAKER_02: It works so well to give the breast the shape and volume that you that patients want, but it is archaic.
• 14:31
  SPEAKER_02: And hopefully in our lifetimes we'll have something that will replace it.
• 14:34
  SPEAKER_02: Um, we're getting close, but it's still a little bit away.
• 14:36
  SPEAKER_00: Yeah, the alternatives aren't are not as as good for actually giving you the look that you know some patients want.
• 14:44
  SPEAKER_00: So that that's the downside.
• 14:46
  SPEAKER_02: But the one good thing, I mean, you know, is that we're in a time now where um small perky breasts are very fashion forward or very in.
• 14:54
  SPEAKER_02: So lots of people, I mean, we didn't even touch on this.
• 14:56
  SPEAKER_02: A lot of people are are are getting their devices out because they just want small perkies.
• 15:00
  SPEAKER_02: And um, you can do that also.
• 15:02
  SPEAKER_02: And sometimes they look, like you said, better than they did with with the devices.
• 15:06
  SPEAKER_02: Without a doubt.
• 15:07
  SPEAKER_00: For in my practice, I would say a vast majority of patients when they get them out, they do a lift.
• 15:12
  SPEAKER_00: You know, I I would say, and I actually prefer that combination at the same time.
• 15:16
  SPEAKER_00: Yeah.
• 15:16
  SPEAKER_00: I'm plus or minus on the fat grafting, we can do it.
• 15:19
  SPEAKER_00: I I usually leave it up to the patient if they want to go down that road.
• 15:22
  SPEAKER_00: But I would say most of the time I I prefer to do the lift at the same time.
• 15:27
  SPEAKER_02: Yeah, yeah, I agree.
• 15:28
  SPEAKER_02: And I think patients should know that you can do fat grafting simultaneously or you can do it subsequently, and you can actually build on it.
• 15:35
  SPEAKER_02: So you can do multiple series of fat grafting.
• 15:38
  SPEAKER_02: The annoying thing is that it's more surgery.
• 15:39
  SPEAKER_02: And like who wants more surgery?
• 15:41
  SPEAKER_02: Most people don't.
• 15:42
  SPEAKER_02: Um, but I think that's another important piece.
• 15:44
  SPEAKER_02: Um, a couple of things I got that are uh quickfire questions to you.
• 15:49
  SPEAKER_02: When you when you take out capsules, what do you do with those capsules?
• 15:51
  SPEAKER_00: Everything gets sent to pathology.
• 15:53
  SPEAKER_00: Anytime we remove anything from the breast, it gets sent to pathology.
• 15:56
  SPEAKER_02: What are some um alarming things that patients should act on quickly?
• 16:00
  SPEAKER_02: They have implants for a long time and they're not sure if they should come see somebody.
• 16:03
  SPEAKER_02: What are things that are signs like come see somebody, do something quick?
• 16:06
  SPEAKER_00: They see immediate change, redness, swelling, um, you know, bruising that popped out of nowhere, pain out of nowhere.
• 16:14
  SPEAKER_00: I think those are you know signs of like, hey, I need you to come in, get evaluated right away.
• 16:19
  SPEAKER_00: Yeah.
• 16:19
  SPEAKER_02: Huge asymmetry.
• 16:21
  SPEAKER_02: Um how about patient gets in a car accident um and seatbelt goes across them, they're hurting real bad afterwards.
• 16:28
  SPEAKER_02: What should they do?
• 16:29
  SPEAKER_00: I think I I think if you're worried about anything, I think the best approach is always just to come in.
• 16:33
  SPEAKER_00: I uh I'm a big fan of it.
• 16:34
  SPEAKER_00: Go see your surgeon, ask them questions, they can examine you.
• 16:38
  SPEAKER_00: Again, to your point, we have high resolution ultrasound in the office.
• 16:41
  SPEAKER_00: We can look at the device um and just to make sure that everything is okay.
• 16:45
  SPEAKER_00: Oftentimes the device is not the issue, right?
• 16:47
  SPEAKER_00: You can actually rupture the capsule.
• 16:49
  SPEAKER_00: Yeah, right.
• 16:50
  SPEAKER_00: And so that in and of itself can cause pain.
• 16:52
  SPEAKER_02: Who needs to have their capsule taken out?
• 16:54
  SPEAKER_00: I think if you have it, what's called a pathologic capsule, right?
• 16:59
  SPEAKER_00: If there's an issue associated with it, severe capsule contracture, or there there's you know hardening or calcification of the capsule that is disfiguring the breast, or you have breast implant illness, I those are my two criteria that I say, okay, you have to have your your capsule ultimately removed.
• 17:16
  SPEAKER_02: Is it a if a patient has, is it a disservice, is it bad that I'm not going to take out my capsule?
• 17:21
  SPEAKER_00: If they don't have a pathologic capsule, they're not having any symptomatology associated with breast implant illness, and that capsule's thin and not causing any sort of um issue with the soft tissue, I think it's safe to leave in.
• 17:37
  SPEAKER_00: Do you differ at all in that approach?
• 17:39
  SPEAKER_02: No, I think I and if they're if they're hedging, they're not sure.
• 17:42
  SPEAKER_02: I just I want them to, you know, think on it, sleep on it a little bit.
• 17:46
  SPEAKER_02: And um but if there's any part of it that gives them any pause and they just can't sleep at night and they need to act on it, then they have the opportunity to.
• 17:54
  SPEAKER_02: But you know, no good deed goes goes unpunished.
• 17:57
  SPEAKER_02: So like when you do a total capsulom, there's slightly higher risk of a little bit more pain, potentially fluid collection.
• 18:02
  SPEAKER_02: So it's it's a little bit more of a you know uh recovery.
• 18:06
  SPEAKER_02: It's a more recovery procedure.
• 18:07
  SPEAKER_02: So I they should just know that.
• 18:08
  SPEAKER_02: And I think um empowering our patients to know that is is the most important thing.
• 18:12
  SPEAKER_00: Because with a total capsulectomy, you know, in our practice, we leave a drain behind.
• 18:16
  SPEAKER_00: Right.
• 18:17
  SPEAKER_00: So and they're ultimately gonna have that drain for about a week.
• 18:19
  SPEAKER_00: Yeah.
• 18:20
  SPEAKER_00: And so they need to be aware of that.
• 18:21
  SPEAKER_00: And then to your your point, recovery is gonna be a little bit longer, it's gonna be a little bit more painful.
• 18:25
  SPEAKER_00: Yeah, yeah.
• 18:26
  SPEAKER_00: Um, but again, if they're having you know breast implant illness symptoms or they're that capsule's pathologic, my God, it it it needs to come out.
• 18:34
  SPEAKER_02: And and and I and I would say, you know, I think that one of the big things is we shouldn't we shouldn't sweep anything under the rug or dismiss, you know, people when they say it they have breast implant in this, or dismiss people for saying that, you know, something's up.
• 18:46
  SPEAKER_02: These are causing it, they're causing a fog, because they could be.
• 18:48
  SPEAKER_02: They're they they potentially could be.
• 18:50
  SPEAKER_02: And we should not be dismissive, but we also should educate and let them know that we need to make sure that you are working up all potential things that could potentially cause an issue.
• 18:58
  SPEAKER_00: Because right now it's a diagnosis of exclusion, right?
• 19:01
  SPEAKER_00: They've already been down the road with their primary care doctor or somebody else that's looked at every other possible scenario that's going down this road.
• 19:09
  SPEAKER_00: Now, could it always have been the the implants have been causing the issues?
• 19:13
  SPEAKER_00: Yeah, it could be, but I think we have to make sure that there's nothing else that's going on at the same time.
• 19:18
  unknown: Yep.
• 19:18
  SPEAKER_02: And yeah, and that's why we tie it back to this concept.
• 19:21
  SPEAKER_02: It's breast implant fatigue, and that there's so many people who've done this and like had got 10 years out of 20 or 30.
• 19:26
  SPEAKER_02: They'd love to, but they're like, something's different, changed, kind of over it, whatever the reason for being over it.
• 19:31
  SPEAKER_02: And so, like, I think women should know that.
• 19:32
  SPEAKER_02: Like, they're at some point they're gonna be like, I'm done with these, or I need them to be improved, or I need them to be changed, or I need to be smaller, bigger, softer, um, or like I just feel something changed after I got these, and I just need to be out.
• 19:44
  SPEAKER_02: And like, I think we have to be responsive to that.
• 19:46
  SPEAKER_02: And we have to just see these patients, like you said, all the time, check on them, and make sure they're happy.
• 19:52
  SPEAKER_00: Because we we've seen both roads.
• 19:54
  SPEAKER_00: We've seen the patients that come in, they have what they refer to as BII.
• 19:58
  SPEAKER_00: We do the procedure, they get better, they're high-five and you giving you hugs, doc.
• 20:02
  SPEAKER_00: Great feeling.
• 20:03
  SPEAKER_00: We love it.
• 20:04
  SPEAKER_00: We've also seen the patient we've done the surgery on come back six months to a year later saying, Hey, doc, I didn't get any better and I missed my implants.
• 20:12
  SPEAKER_00: I want to back in.
• 20:14
  SPEAKER_00: So we want to prevent that repeated surgery because not only is it cost, but it's sure, it's you know, core morbidity on your body of actually like morbidity on your body of actually doing multiple surgeries.
• 20:26
  SPEAKER_02: Yeah, we're gonna be publishing our experience soon, and it's a you know, five-year, like 1,500 patient experience of implant removals.
• 20:34
  SPEAKER_02: And um there, there's a subset in that that actually had their implants put back in.
• 20:39
  SPEAKER_02: They had them put back in predominantly because they were just they hated the way their breast looks afterwards.
• 20:44
  SPEAKER_02: And so sometimes there's a group that even if they had improvement of symptoms, they want them back because their their femininity and their and their chest is so important to them that they were, they just would rather have that.
• 20:53
  SPEAKER_02: And so that's not all of them, but we we we explain that to patients because it just shows you once again that not everybody's the same.
• 21:00
  SPEAKER_02: Everybody's unique, everybody's different, and is gonna potentially require a unique approach.
• 21:04
  SPEAKER_02: Um, we really um enjoy you know breast surgery at HKB.
• 21:08
  SPEAKER_02: It's one of our our core um, you know, uh procedures and and areas that we're are experts on.
• 21:16
  SPEAKER_02: And I I think that it's important to know that like patients need different things throughout their lives.
• 21:21
  SPEAKER_02: And like that's the thing, is and I think for it's like a continuum of care.
• 21:24
  SPEAKER_02: You have to listen to your patient, right?
• 21:27
  SPEAKER_00: That I think that's the key where years pass, you know, you come in, the plastic surgeon said you need this, this, this, and this.
• 21:33
  SPEAKER_00: And the patient's like, Yeah, I'll just do it.
• 21:35
  SPEAKER_00: Now we're we're listening to them.
• 21:38
  SPEAKER_00: Yeah, trying to elicit exactly the look they're going for, and we tailor what we do to that look that they're they want.
• 21:44
  SPEAKER_02: Yeah.
• 21:44
  SPEAKER_02: And you'll see patients who've had, you know, breast enhancement done 20, 30, 40 years ago, and they're just chilling.
• 21:49
  SPEAKER_02: They're happy with what they have.
• 21:51
  SPEAKER_02: Um, and then there'll be some that'll, you know, they want an improvement and it's been five years or 10 years.
• 21:56
  SPEAKER_02: Um, and then there'll be some that'll have something else going on.
• 21:59
  SPEAKER_02: So it's It's just one of those things where we we have to take care of those patients.
• 22:02
  SPEAKER_02: We have to continue to take care of them for their entire life.
• 22:05
  SPEAKER_02: And I think before we thought you just went in and done get it.
• 22:07
  SPEAKER_02: So that we have a couple colleagues that we know that I don't see my breast dogs back after one month or two months or three months.
• 22:12
  SPEAKER_02: And it's like, what?
• 22:14
  SPEAKER_02: I don't think you should.
• 22:15
  SPEAKER_00: I don't like to break out with my patients.
• 22:17
  SPEAKER_00: I like to see them all the time.
• 22:20
  SPEAKER_00: Whenever they they come back and they're like, hey, uh, I don't need to see you again, it like breaks my heart.
• 22:24
  SPEAKER_02: I'm like, I know you're you're just like, uh just come back in here.
• 22:27
  SPEAKER_02: It'll be okay.
• 22:28
  SPEAKER_02: And then all our our team gets so mad when the clinics are so busy, there's a bottleneck, but it's it's important to see those people, you know?
• 22:35
  SPEAKER_02: I do we love seeing our patients, honestly.
• 22:38
  SPEAKER_00: I ran into somebody we saw somebody this week that I saw 15 years ago.
• 22:42
  SPEAKER_00: Yeah.
• 22:42
  SPEAKER_02: I think that was a great episode.
• 22:44
  SPEAKER_02: Um, we again, any questions that our viewers may have regarding, you know, breast uh implants, breasts, any kind of breast surgery, drop it in the comments section on YouTube or DM us on IG, and we will be glad to address those at a future um show.
• 23:00
  SPEAKER_02: Thank you all so much for listening.
• 23:02
  SPEAKER_02: Thanks for listening.
• 23:07
  SPEAKER_00: Thank you for listening to HKB Uncut.
• 23:09
  SPEAKER_00: If you enjoyed this episode, please subscribe to us on Apple, Spotify, or YouTube.
• 23:14
  SPEAKER_02: To book a surgery consultation or med spa appointment with our team, visit our website at hkbsurgery.com or head to the links in our show notes.