Breast Implants Are Making Women Sick—Here's What's Happening

Key Takeaway

This episode reveals a concerning reality: up to 30% of women with breast implants experience complications, from autoimmune reactions to cancer. Dr. Jonathan Kaplan, a board-certified plastic surgeon, has pioneered a groundbreaking alternative using fat grafting—a natural, safer method that eliminates foreign materials while achieving aesthetic results. The key insight: We haven't changed fundamental biology. Putting a foreign object in your body will trigger a reaction. The solution? Remove the toxic trigger and work with your body's natural regenerative capacity instead of against it.

Episode Overview

Dr. Jonathan Kaplan discusses the widespread but often dismissed health complications associated with silicone breast implants. The episode covers breast implant illness (BII), a constellation of autoimmune and inflammatory symptoms affecting 10-30% of women with implants, and explores Dr. Kaplan's innovative fat grafting technique as a safer alternative. Key topics include the gaslighting of women by medical professionals, the toxic nature of silicone implants, explant surgery outcomes, and the emerging field of 'surgery as ceremony' that integrates mind-body healing.

Full Transcript

Transcript of Breast Implants Are Making Women Sick—Here's What's Happening from The Dr. Hyman Show. Auto-generated from episode audio; may contain minor errors.

Women are being gaslit by the medical profession about breast implants. The gaslighting is essentially saying to women, "These symptoms are all in your head or take some Prozac, you'll be fine." I have seen many cases of women with severe illness correlated with their implants. What's even more impressive is when they take them out, they get better. Silicone comes from petroleum. So, this is a prochemical industrial product. industrial product. industrial product. We have not changed the fundamental laws of biology, which is you put in a foreign object, it is going to have a reaction.

Until I could predict who's going to have an adverse reaction to breast implants, it seemed completely unethical to be putting implants in for an elective procedure. The old paradigm of surgeons just cutting and leaving. I think it's done. You call it surgery as ceremony. I'd love you to unpack that. There is an altered state of consciousness, which is the medication that's using surgery. You know, body keeps a score. It's trying to make sense of what's going on. For example, one patient, her mantra was like, I want to come home to my body.

I work with a great team of lymphatic therapists that will help you land back in your body as you're integrating everything. Today on the podcast, I'm joined by Dr. Jonathan Kpki. He is a board-certified plastic surgeon in Los Angeles and a data scientist who advises Google and Neural. He is a leading voice in the treatment of breast implant illness, pioneering a transformative framework he calls surgery a ceremony. So, the big vision is that nobody puts an implant in ever again. This is the only place an implant should be, which is outside the body.

Hey, it's Dr. Heyman. I'm so excited to share this episode with you today. But before we dive in, I want to get your help. Please take a minute to hit that subscribe button. Whether you're watching here on YouTube or listening on your favorite podcast platform, it truly means the world to me and it helps my team and I bring you this podcast every single week. Plus, I don't want you to miss a thing. So, thanks so much for being part of this community and I'm glad you're here.

John, welcome to podcast. podcast. podcast. Thank you. You know, we've been friends for quite a while and uh talked a lot about regenerative medicine and health and functional medicine, but you come from the perspective of a surgeon. I deal more with the kind of biology stuff. Well, you do too, but in a different way. Yeah, we've had many conversations about the topic of breast implants and as a doctor seeing patients for now close to 40 years. If you include medical school, it's I don't know what the math is 43 years.

I would say that that I have seen many many many cases of women with severe illness, chronic disease who've had breast implants and it seems to be correlated, can't say caused, but correlated with their implants. And what's even more impressive is when they take them out, they get better. Mhm. And there there's something in medicine called doctor years which is like how many years of medical practice does it take to see X Y or Z condition like we both learned about a fiochromosytoma in medical school which is a rare adrenal tumor.

I've never seen one in 40 years. I'm assuming you've never seen one. It's always on the differential but I've never seen that and it's basically like a rare tumor. So it means like you it doesn't happen very often. But if you see something over and over and I'm just one doctor and I see it over and over and over. In fact, I'm dealing with a patient right now with a really severe autoimmune disease that's really resistant to treatment. We've tried everything. I don't start with removing your breast implants, but I'm like, listen, if everything else works that we do in functional medicine, and we can't get you better, then we've got to assume there's something that's toxic that's affecting you.

And we know that the silicone in breast implants is is definitely linked to adverse health outcomes. So, you've spent your life, you know, training as a plastic surgeon. You're you went to McGill. You trained in California for your fellowship. you you really are an expert in in this field and um you you're kind of a heretic because you're going against the orthodoxy of plastic and aesthetic surgery. We'll talk about the difference there, but you're basically saying that women are being gaslit by the medical profession about breast implants.

Can you kind of unpack that for us? So, thank you first of all for having me on so we can talk about this such an important topic and and the way that you dive into it is going to be just so helpful. So th this journey into questioning implants started about a decade ago. Uh a plastic surgeon by the name of Gary Brody was I remember still I think it might have been 20 2010 so even more than 10 years ago. He presented on something called B I A L C breast implant associated anoplastic large cell lymphoma.

And I saw it for the first time in a conference in Vancouver Vancouver Vancouver and that's a basically an immune tumor cancer. It's a cancer that's associated with the with the implant. And uh so this this very rare type of of cancer associated with implants was the first thing that sparked my curiosity. I was like there's there's something potentially wrong with these implants that uh patients are reporting. Very rare. Uh turns out it's more common now associated with implants. Then fast forward a few more years.

um implants still are not banned or you know there's no uh major warnings about them as as this uh information is coming out. Yeah. I mean the FDA still approves them. them. them. It still approves them now with a blackbox warning on all implants about a specific type of implant. But fast forward to I'm finishing I'm in the last year of my fellowship and uh in one day I had uh close about three patients that came in all saying I'm concerned about my implants making me sick.

I think my implants are making me sick. And I just I just heard that over and over again. Yeah. Yeah. Yeah. And up until that point, the medical community or the plasticity community by and large was saying, you know, it's it these symptoms are so vague. There were kind of this constellation of autoimmune symptoms like everything from fatigue to hair loss to joint pain, dry eyes. It really fitting the constellation of autoimmune symptoms, but with no specific easily um diagnosible symptoms, even nervous system symptoms. Oh, just just everywhere.

I mean there's anxiety, depression, you know, just just this the the constellation symptoms are so large and at times vague that it's hard to say, oh yeah, this is for call BI, right? Breast breastplant illness, but there's so much more than that. that. that. Yeah. And it's um even before that it was Asia. It was auto aduvent silicone associated autoimmune uh problem and then it's since been rec categorized as SSPI um systemic syndrome associated with breast implants. Anyway, bunch of acronyms, but the the ideology is the same.

something about the implant is causing a physical problem. I decided at that point until I could predict accurately who's going to have an adverse reaction to breast implants. It seemed completely nonsensical, it seemed unethical to be putting implants in for an elective procedure. Yeah. Yeah. Yeah. That have potentially up to a 30% chance of a complication. Yeah. It's not like you need a heart transplant cuz you need heart. Yeah. So, it's just like this this is strange. Until I can predict who's who's going to have these problems and why, I'm just going to stop using breast implants and focus on a a safer alternative.

And that's that's that was the what launched me into this exploration of uh no more implants. Let's remove the implants and focus on a safer natural alternative like fat grafting. grafting. grafting. So so there's more to talk about and unpack about this, but but the gaslighting is essentially saying to women don't worry about it or these symptoms are all in your head or take some Prozac, you'll be fine. And and and and it's beyond just, you know, I kind of looked it up and I was preparing for the podcast, but up to 10 to 25% of women have some type of complication.

That's one in 10 to one in four women have a complication and it's everything from capsule contraure, right? And so and you can talk about that to to um autoimmune and inflammatory issues you mentioned to this the ASIA you talked about this autoimmune inflammatory thing the breast implant illness and the cancer risk you mentioned this lymphoma even just local you know sort of endocrine effects is the silicone migrates and neurologic effects, cognitive effects, psychological effects. So, can you kind of unpack a lot of that and just kind of talk us through each one of those cuz it's a lot of stuff and it's not just one thing that it causes.

The complication rate is actually higher. If you look at all of the potential complications associated with implants, it's closer to 30%. So, 30% of women after receiving a after breast implants will either have a complication such as capsular contraure, breast implant illness or the more rare side effect is the the cancer ALCL associated with breast implants. Plus of course you know less common complications but hematoma like bleeding infection things like that but the three big ones that are known and uh make up most that 30% is capsule contractor BII and the ALCL capsule contractor is essentially that's the autoimmune or that's the cancer that's cancer that's cancer that's but what about the autoimmune that's a that's the biggest category but the one that's hardest to diagnose it's really a diagnosis of exclusion.

So the other two have very clear we know why they happen and they're very easily diagnosed. So capsule contractor is basically the capsule that forms around the implant. So a foreign body anytime this is a little Yeah. Yeah. Here you go. You got the implant. implant. implant. Tell us about Here you go. So this is a fourth or fifth generation which for those listening we're showing a silicone breast implant which you can't see if you're driving. But anyway, this is the only place the implant should be.

It's just outside the body. This is a a newer generation of implant. Um even if it's newer generation, it's essentially the same technology repeated with slight variation. So silicone shell with a silicone gel inside. It's a silicone gel polymer. If I was to cut this open, it's kind of like a gum. It It wouldn't leak out like liquid as a gummy bear. So, just just to be clear, silicone comes from petroleum. from petroleum. from petroleum. Mhm. Mhm. Mhm. Right. So, this is a prochemical industrial product.

industrial product. industrial product. Mhm. Mhm. Mhm. And we know that these petrochemicals have massive effects on human health like any other quote toxins. They they affect endocrine function or endocrine disruptors. They can cause autoimmunity. They can cause obesity. They can cause cancer. I mean the the range of effects of toxins is huge. And this is a you know when you say polymer that doesn't sound like something should be in your body. body. body. And silicone it's is one of hundreds of ingredients that are usually used in the process of making implants.

I brought one that's smooth. The ones that are really causing the problem are textured implants. And there's a whole science behind why they're textured, but basically some sort of abrasive chemical process is used to rough up the implant so it doesn't spin or move around as much in the body and it prevents capsular contractor. So capsular contractor this foreign body goes inside. The same exact thing happens if you get if you accidentally get a piece of lead in your fingertip or you know thorn from a bush.

The body encapsulates it. It's going to make that uh fiberblast covering around. It's going to cover it with scar tissue. This is a really this is a fairly large surface area of something to be covered in immune reactive tissue trying to wall it off from the body. And so when a capsular contraure occurs, the body makes this little gel around the implant of immune cells. And if you look at the pathology, like up close, the hystopathology of these capsules, it's got four layers and they're rich in immune cells.

It's got all these white blood cells that are reacting to the implant. And in some cases, nothing happens. And that's great. The body's not having this super strong reaction to it. In other cases, the capsule will continuously contract. Like any scar that contracts, it'll contract around the implant. It'll get really hard, and that's what caps are. So, they're like hard balls, like a baseball. baseball. baseball. Yeah. And so at that point the capsule needs to be removed and and adjusted but it's not considered medically dangerous.

It's just it can be very painful for the patient and um look uncomfortable. So that's that's capsictor. The other bucket is al the cancer associated with implants and that's also caused by the immune reaction continuously. It's a type of lymphoma. And then the third category is BII breast implant illness or or or yeah which is way more common than way more common harder to diagnose. It's the diagnosis of exclusion and and there can be autoimmune illnesses like Shoggrin syndrome, rheumatoid arthritis, systemic sclerosis, mixed connective tissue disease, Hashimoto's.

I mean one in five women have hypothyroidism. That's 20% of women. What's what's been noticed is if you have a predisposition to any kind of autoimmune illness, any family history, personal history, there's a higher likelihood that getting a silicone implant or silicone gel or shell implant is going to be what could push you over the edge to go from no symptoms to symptoms. So, if your immune system is already kind of upregulated and wired, something like that acts as an adgivant and it'll it'll upregulate the immunity.

It's impressive that the FDA actually finally recognized this as a as a a a real thing. They acknowledged a breast implant illness in 2020 as a real condition and it's not in women's heads. What's really interesting, maybe you can talk about this, is what happens, and you you've done a lot of this because you do what we call expplant surgery, which is different than an implant, right? So, taking out the breast implant. What happens after women do that? Do they get better? How how much how much do they get better?

So in my experience, the majority of women do get better. But there is um it's it's important to acknowledge how much the mind and body is connected in this experience. That there's a very clear physiology that we know that there's something that's causing this in the body, but there's also the way the mind associates to it. And I believe that's part of the reason why not everybody gets better. Some of the symptoms that patients feel, they'll get better right after the implants's removed or shortly thereafter, especially if they follow certain protocols.

But not everybody gets better. And that's that's a question you know there's an incredibly large growing body of research in this field and before I said you know the plastic surgery community was felt like it was kind of gaslighting women over the years but since then the attention has really turned inwards there's a lot more research being done good high quality research to understand the effects of what's actually going on so removing the implant with or without the capsule can improve symptoms the majority of women who uh seem to be experiencing better symptom relief It may have to do with the capsule removal.

The most recent study showed that removing the capsule or not doesn't it doesn't dramatically change the difference, but there is a strong psychological association and uh relationship to what it means to have the capsule and the implant remain. So, it's important to Why would the capsule remain? Why don't you take the whole thing out? Cuz it's stuck. stuck. stuck. It's a dangerous surgery. It's not easy. Cuz it's stuck in there. It's stuck. Yeah. There's a risk of pneumothorax. So you could puncture the lung while removing it because the the implants now live the implants that were placed between the pec muscle and the chest wall.

So it's and and there's this um you know the technique that was devel uh that the surgeons are doing for all is called onblock capslectomy. So it's like trying to remove this implant with its capsule as a whole without without rupturing the the implant or the capsule. So, it's it's technically challenging cuz you're operating in a small space trying to get all the way around it around it around it 360° and then deliver the implant hole with the implant int with the capsule intact. Sometimes it's easy.

Other times it can be very challenging, especially the capsule stuck to the chest wall. You can get into place it shouldn't be like the lungs. Yeah. So, it's it's it's a much more technically challenging surgery. And for that reason, unless there's a very clear indication to remove the capsule, I will I'll remove as much of it as I can, but not all all the time. It's a risk risk benefit harm. We just do no harm. And you don't think with the capsule remaining still has silicone in it that's going to cause issues or issues or issues or it's still reactive inflammatory tissue.

So anytime I can remove the capsule safely I do. Um if I think it's going to potentially put the patient at more risk obviously I wouldn't I wouldn't remove it. And it all has to do with I I screen the patient to see what are the symptoms you're experiencing. You know if a patient says I don't have symptoms I just want the implants out. We won't we won't go there. But what's interesting is is um the expplant studies because you know it's one thing to say well you know can you prove by cause and effect because they're not going to do like a randomized trial where they you know give a thousand women implants and they give another thousand or 10,000 women another 10,000 implants and they follow them for 20 years and see who gets sick.

You know that's that's a really tough study to do. But the the follow studies where they take the implant out and they follow people for a while and they see what happens. It the data is pretty compelling. It shows like 50 to 80% of women see improvement. I mean, you're removing this thing that's full of silicone that's causing this chronic inflammatory reaction. So, I think just just from the ideology, it just makes sense. You just take out the thing that's causing the problem and you you have less of a reaction.

Uh there's a plastic surgeon, her name is Patricia Magcguire. She's done probably the most research on expplant capsules, things like that. and she what she found was that um removing the implant helps but the capsule uh removing the capsule doesn't always create uh improvement in symptoms. So I still think the the source of the problem is is what needs to be removed. The implant is primary. Yeah. I mean that's sort of classic functional medicine. Someone's sick, you take out all the bad stuff until you see what happens cuz you don't know.

And and the truth is that you know many people have autoimmune diseases or issues for many reasons. And so the way I think about toxins is it's sort of like a cup that overflows. You kind of your body can handle it to a certain moment and then your toxic load gets so high that it tips over into a disease. And so you know there may be other factors and other toxins that are affecting you. There may be other things in your microbiome. There may be dietary factors.

There may be late infection. So there's a lot of reasons for all those symptoms that relate to immune activation and inflammation and autoimmunity and microbiome issues. Even there's heavy metals right in the in the silicone silicone silicone in in the things that are used to process the implants they all sorts of heavy metals you know the the dose amount is probably what is the most important question but they are they are present present present yeah it's small but it's it's a cumitive effect of all this and so I think that that you know we we're now in an era we're beginning to understand that you know toxins play a role in human health and doctors have been really notoriously bad at thinking about that or assessing it and unless you have an acute poisoning they don't think toxins are a problem because your body can handle it, you know, it just thinks you're fine.

And so what what's really unfortunate is that, you know, doctors because women wanted this, you know, developed a way to help women, you know, with their body image or get breast implants, but the the dark side of it is it's it's problematic and it has created a whole string of of issues that um are concerning and that have, you know, a lot of metabolic effects and cellular effects and cognitive effects. I mean it's not just the autoimmunity. You can get neuroinflammation and brain fog. You said some of the you know neur neuropathies, headaches, POTS, things like that.

So it's a concern. So I think that what I really kind of want to dive into now is kind of the work you're doing and what you've discovered because you know after listening this I'm sure many women who are listening either who want breast implants are disappointed or have implants are freaked out like going what do I do now? I don't want to get sick or if I am sick do I have to take these things out and what am I going to do because you know it's going to affect how I look and how I feel about myself and you know it's it's a big deal.

It's not just like, oh gez, you you've got a wart, take it off and big deal. Like, you know, but I cuz I'm dealing I deal with this regularly cuz I I treat a lot of patients of patients of patients who have autoimmune disease, who are sick, who have breast implants and it's always like it's always the hardest thing for me to say, listen, I think we tried everything and I think it's time you really explore this because this could be a factor and there's no way to prove it.

Although there was a lab in Germany that was actually testing for immune activity, silicone, other things. So, you know, there are ways of of potentially actually doing imunological testing to see there's there's there's ways to check how your how your white blood cells react to the silicone or your antibodies. There's two different kinds of of immune reactions. One is your white cells fight it, the other antibodies fight it, but you can actually start to test that. So, I think, you know, until we get better at that, it's going to be hard to know.

And the question is um for women who are listening to this and in despair right now or husbands who are worried about their wives or partners, what actually is available now? Because you you're pioneering a whole new field of surgical interventions around safe and effective breast augmentation surgery that doesn't involve foreign toxic material. So walk us through what you do, what you've been doing, and what's coming. So there's two ways that I think about this. The first is for anybody listening, if you do have breast implants and you're concerned, there is an ample amount of ways that you can explore what is safe to be done.

The first thing that I I notice among my patients is it takes an average of about 3 years from the time of thinking or being concerned about your implants to going through the whole journey of expplant removing the breast implants. So, wherever you're at on that journey, whether you're just curious about it or you think you might actually follow through with it, there's an abundance of support groups and information and ways to think about it. And surgeons are getting better and better at the technique of remov removing the implant and all the surgery around it.

It is a a big undertaking though because psychologically it's it's a lot to have undergone a surgery to change a part of your image to um you know that might impact your identity to then probably anywhere from 5 10 15 years later think about now removing the implants and reclaiming that identity. So it's it's a lot of the body but it's also you know how do I accept this new part how do I accept this new part of myself without implants? What does that look like?

Um so the second category is wanting to change a part of your body wanting to whether it's after you know cancer breast reconstruction or as a primary augmentation to increase or change the shape and size of the breast fat grafting is a safe option. It may not achieve achieve achieve what is that? Yeah. So fat grafting is taking fat from one part of your body processing it and then using it as a sculpting medium. So literally changing the shape and volume somewhere else. somewhere else. somewhere else.

All these women are saying how do I get rid of my belly fat? So, it's really double a two for a twofer, right? Two for two for one experience. So, you can you can shape and sculpt one part of the body and also use it as a medium. And I I I think it's the most natural way to do something cuz the the breast tissue itself is a combination of fat and gland. And so, we're just putting putting fat where it's supposed to be. Fat grafting has there's a lot of myth around it over the past, you know, it's been around for a long time.

Over a hundred years. hundred years. hundred years. The Yeah. Yeah. Fat grafting has been around for a long time. Amazing. The initial initial initial What was it used for? Um the very first case was a case of liposuction that was done in like the 1800s. It did not go well. This is an experimental procedure at the time, but using um transplanting a piece of fat actually for breast implant as a as a Wow. Wait, wait. In the 1800s, they didn't have anesthesia. So yeah, this is this was like late 1800s.

The story is it was it was a um I believe it was a ballerina. I can't remember, but it was exactly don't quote me on this, but they actually took like a lipoma and transplanted this lipoma as a breast implant. Yeah. So ball of fat put somewhere else. Of course, it didn't survive. We know a lot more about how tissue uh grows and regenerates now. And you can't just take a blob of fat and put it somewhere else in the body, expect to survive. Oh, what do you do?

Well, the technology has gotten a lot better. The myth used to be, well, you transplant fat, it doesn't survive. That's kind of true, but not entirely true. So, 50 to 80% of the fat that gets transferred will survive. It's literally like planting stem cells, and you know, you know all about this. You take these little um atapost derived stem cells, you plant them like seeds, and then all these new blood vessels grow in, and then that tissue grafts, and it lives in this new place. place.

place. There's many things that have been done to improve the fat graft survival and some things I do in my own practice. And everything from red light therapy to treating the fat with something called surfactant. It's like a little soap molecule that will help um preserve the fat cells after they've been removed. And it has a lot to do with technique the way that it's injected. You inject these little micro droplets. So not these big globs of fat, these tiny little fats with special tools. That is like planting little drops uh little little seeds in a garden versus just like throwing a big handful of them.

Mhm. Mhm. Mhm. So fat grafting became popular around the time that breast cancer surgery was was was really also being developed. So women would would have breast cancer, have a mastctomy, have an implant placed and then have radiotherapy and radiotherapy would completely just you know damage the tissue. It become really thick and tough and leathery because of the radiation therapy. So fat grafting was used as a way to regenerate the tissue. So fat would be injected. the stem cells in the fat would soften the skin and also have the benefit of creating more more of a contour.

Ironically, fat grafting became popular because of breast cancer to the breast. And that's what what what most breast cancer surgeons would do would then they'll do a combination of an implant because still if there's if a lot of breast volume is removed still in many cases the best option is a breast implant or a bigger surgery called a free flap. So taking like a big block of tissue from one part of the body to sculpt and make the breast. Yeah, but fat grafting is used throughout as a modality and it's getting better and better.

better. better. So that's what you do, right? So kind of walk us through, you know, how how it works and what women can expect and what kind of different options are in terms of sizes and stuff cuz I think, you know, you kind of think, well, how depends if you have fat or don't have fat. So the process is is really three steps. The first is we have to get the fat from somewhere. So harvesting the fat involves a process known as liposuction. So the areas are numbed and we remove the fat with a combination of vibration and suction under low pressure which minimizes the damage to the fat.

Once the fat's collected uh it's processed and treated and then it's uh reinjected back into the body and sculpted. So you like a needle needle? Yeah, it's tiny. So everything's done through little keyhole entry points. So about 2 to 3 millm incisions, no big cuts and the entry points are hidden throughout the body. So it's it's really meant to be as as aesthetically neutral. neutral. neutral. Yeah. So you don't you're not seeing big scars anywhere. And I I do all of the fat injection through one tiny entry point in the base of the breast.

It's about the size of a tip of a pen. So And it just kind of like fills up like a balloon. balloon. balloon. It's it's I'm literally sculpting. I'm literally sculpting. So when the tools go inside, I'm It's like I'm painting with a a brush, like 3D painting. Wow. And so it's about surgery is art. Surgery is art. Exactly. So, I'm able I'm able to to sculpt the area to make sure that um it's it's not just like a one and one and done thing. Everybody's different.

So, certain parts of the breast need more fat here or there and it's about sculpting and and the results you get are just like the name plan or better. So, uh I would say well it depends what the aesthetic is you're going for. So, I never try to push a certain aesthetic on a patient. Most patients that come to see me want the more natural look. um they don't want really large over like breast that which what is a giveaway that somebody usually has an implant is there's a lot of fullness in the upper pole.

So the top part of the breast is really full. The natural breast doesn't have that shape. It's more of a a natural slope and then fullness on the bottom, bottom, bottom, right? right? right? And that's what fat grafting can achieve. Sometimes it does take more than one round of fat grafting. The reason for that is because unlike an implant, you know, you can put almost any sized implant into into somebody. It's pretty traumatic. You're just shoving this large thing in there. Whereas fat, you're limited. It's like a sponge.

So if you imagine a sponge filling with water, it can only fill with so much water before it just flows out. And the fat in the breast is the same way. You can only put so much fat in before the fat cells don't survive. So the first round of fat grafting, you fill every it's like a 1 to1 ratio. You can double the volume of the breast. Not all of it will survive. Once that fat heals, the stem cells cause all these new blood vessels to grow in.

And then with the second round, you can accommodate even more fat. And so you can get to uh the same size as an implant, but it may take more than one round of fat grafting, but the aesthetic will be different. It's going to look more like a natural shaped breast. Are there any complications or risks or challenges other than just normal surgery, infection, and bleeding? Those are the main ones that we look out for. So infection, bleeding, it's still surgery. So just just like any surgical procedure, those those are common things.

The things that are more important to look out with fat grafting, there's a risk of something called fat necrosis. So if the fat's not properly injected, you get these big globs, some of it will die. it can create an oil cyst and cause cause problems. The thing that I see more commonly is the entry points can get a bit um you can have a bit of scarring around them and that's hard to predict. Not everybody scars the same way but usually the scars heal really well and uh the question I get asked a lot and it's super important is fat grafting doesn't increase the baseline risk of breast cancer.

So patients with fat grafting want to know is this going to change my future risk of breast cancer? The answer is no. is no. is no. And the second thing is it doesn't obscure mammograms. M in the first 6 months it can um it's just important to be aware of if you have any family history of breast cancer but onwards most radiologists are well trained enough to know what calcifications from fat grafting can look like compared to breast cancer. and those breast ultrasound and breast MRI.

So there's other technologies which help. So compared to breast implants, I think the risk profile is much lower, but it's still surgery. So got to be careful, but but it's not the autoimmune issues and the breast implant illness and the cancer risk and all that stuff. It's your own tissue, so you're not dealing with any of of these autoimmune issues and it it it's going to heal. And so so let's say ideally you'd want to be having a little extra body fat and you can use it and then you want to stay at the same weight.

But what if you're like, you know, want an implant and you're a little overweight and then you want to lose 20 lbs. What happens? So the fat that gets transferred is a great question. Fat that gets transferred is just like the fat anywhere else in your body. If you lose weight, gain weight, it'll go in the same direction. The fat cells uh that survive will stay there. It's just their capacity to grow and shrink is what changes as the body weight changes. Usually I recommend patients, it's not um around the time of surgery is not the time to lose weight.

So you want to achieve a weight that you're comfortable with within like like let's say 5 to 10 pounds and then do the surgery and then you want to just try and maintain your weight. If you lose a significant amount of weight afterwards the breast size will decrease and the same for the opposite which is if you gain a lot of weight the breast size will increase and patients will use that to their benefit all the time. Yeah. But if you're really overweight and you want to take ompic and you have a fat a fat a fat transfer ompic and fat transfers do not go well together.

So when I if patients are on any kind of GLP-1, I say we got stop the GLP1 forever. No, not not forever. Just let just reach reach a plateau that you're comfortable being at, being at, being at, stop the ompic or the other GLP1 for 4 weeks. Let the fat fully heal and then you can restart. But the the idea is about maintenance. It's not about going up or down significantly. And then there's new technologies. This is what's been around. This is what works. This is what you're doing right now.

now. now. Yeah. Yeah. Yeah. But we were chatting a little earlier. said there's some newer technologies that are available which are pretty interesting which is using other people's fat. There's an endless supply of that in America, right? It's like you think people give give medical used to make money by giving blood donations. blood donations. blood donations. It's wild. It's wild. It's wild. Or sperm donations. You do like you can do fat donations. Do you see I mean the OMIC thing is really taking off. Apparently the Ompic thing has taken off so much so that airlines are now saving money on fuel.

on fuel. on fuel. Fuel of course. So maybe not for long. We will Emp's good for climate change. Yeah. Yeah. Yeah. Wild. Wild. Wild. That's who knew the side effects. Everybody on Ompic right now. No. Save the planet. Take OPIC. In terms of in terms of the uh the weight, it's it's it's important I think for people understand it's if this is fat tissue and it fluctuates. Um but these new technologies sort of use an endless supply of fat from other donors. So tell us about what that is, what it's called, how it works, what the risks are.

So the big vision is that nobody puts an implant in ever again. I'm putting my stake in the ground maybe 5 to 10 years from now hopefully sooner that we'll just say you know what implants are really not it. You want the FDA to go this is done. Yeah. And they they've done it twice in the 80s they said uh ' 80s or early 90s there's a moratorium placed on breast implants because of these rheatologists that were saying I think implants are making people sick. We need to do more investigation.

Bunch of research was done, questionable about how the studies were funded and what the outcomes were, but they said, "Okay, they're safe. They can come back." And then again, the resurgence, I think in 2018, blackbox warning implants, but they're still out there. And now there's these newer generation implants who are, you know, the whole the whole the whole like trans fats are now ruled they're not safe to eat by the FDA, but they're still a cool whip in the grocery store. Exactly. Or it's like, hey, don't smoke the regular cigarettes, smoke the skinny ones, which is exactly what's happening now with implants.

The implants are getting smaller. There's a whole new design of an implant by certain motiv. But it literally to me I look at it it's like oh it's a safer cigarette. I'm like what are we doing? This is not why do they say it's safe and why do you think it's not safe? Like I don't think it's safe because I've heard I've heard about this one from we have not changed the fundamental laws of biology which is you put in a foreign object it is going to have a reaction.

If it's a less of a reaction great but there's still some percentage of of people that are going to have that reaction. They've done a lot of science. They changed the way that the rough surface of the implant is created. It's no longer abrasive chemicals. It's now a 3D printed surface and it's done even more minimally invasively. But the root cause is still the root cause. People are still smoking silicone. Silicone is there's still silicone in the body. So, and now I I saw some recently a surgeon's putting in 100 cc implant.

That's a third of the size of this. That's small. That's small. That's small. It's not only is it small, you could easily do that with fat. So, it just makes it makes even less sense to me. Yeah. Yeah. Yeah. So, to answer your question, I don't think so. Hopefully implants stop altogether, but that won't happen until there's better technologies out there that fully replace them. And the three technologies that I think are have are making waves and breakthroughs in the world of fat fat transfer, fat grafting.

The first is using your own fat, but doing everything possible on the surgery side and recovery side to improve fat graft retention. graft retention. graft retention. Yeah. I don't want to talk about surgery as a ceremony after what you do that's because you're not just a regular surgeon. We're going to get into all that. So, I'm going to save that. But but there are ways to use various kinds of therapies and treatments to enhance healing. And I' I've recently I had a bike accident and I smashed on my face and I recently had to use it.

I was so amazed at how fast things heal. things heal. things heal. You look great, Mark. Thank you. Thank you. Thank you. So what's the name of this this uh uh fat transfer that you get from other people? Like what is it called? Um Alo Clay. It basically has Alolay is the name of the brand right now. But clay like molding. Yeah. Alo clay. It's aloe means foreign. Correct. Correct. Correct. So aloe from somebody else, clay. It's spelled it's not spelled the same way. It's a L l L O C L A E.

But the the the concept or the medical term for is cataic acellular cataic acellular cataic acellular lipid or fat. It's basically fat from somebody else that's been processed that you can safely inject. And before that it was Reneua, another another brand. But the technology has gotten better that you now have this like pre-processed fat that can be injected from somebody else. I don't use a ton of it just because I still think the best source is your own natural fat. But if there's no other option, if you truly are too thin, BMI is too low, there's not enough fat to harvest to get the results you want.

Dancer, Dancer, Dancer, yeah, it's it's a good alternative, which is you're not using an implant and you're using this other thing. It can be a little bit pricier at times, times, times, and the immune reaction is uh it's it's minimal. Yeah. Some sometimes uh patients can have like there can react and have a bit of redness around it, but it's it's rare. Now, you we also talked about a newer technology that is is kind of interesting to me that you say it's only a year or two off because it involves taking some of your own fat and then growing it in a lab.

So, can you talk about that and what it what what the promise of that is and the risk? So, I I think this will be big in the future which is you can um so it's really I'll I'll I'll go over the four this is the third one that we talked about. The third technology is banking your own taking your own fat getting the stem cells from there and growing Xvivo. So outside the body growing fat cells and I think we'll see that in a few years as a safe alternative.

So you could go to your doctor to get like a quick 5minute procedure cuz you don't need a lot of fat for that. You just take a little bit of fat out, send it to a lab. The lab will grow that fat tissue outside of your body and then whenever you're ready you get a notification on your phone and come back into the office and you get the fat transfer. And how long does it take to grow? I mean fat like most and this has been done this isn't you know this is new but it's been done in many other examples it's done been done for bone it's been done for skin it's been done for for other tissues um 6 to 8 weeks basically you basically you get a little fat sample taken out and it doesn't have to be a lot and then you can you put in a lab and you cook it basically it goes in like a incubator and you grow your own fat cells and you can grow as much as you want yeah it'll be I would say right now it's probably cost prohibitive it's more experimental But like with any technology as it becomes more abundant and scales the the cost goes down.

What's available today and can be done today is you can bank your own fat. So four technology four things we talked about for fat. The first is improving everything possible in the operating room with your own fat. The second is alo clay or using somebody else's fat. else's fat. else's fat. The third is banking uh or or growing your own fat cells your own growing your own fat cells outside your body. And the fourth one which is available today is you take your own fat and save it and freeze it and process it for later.

And so if somebody's undergoing a procedure and wants to do fat grafting but doesn't want to have to have lipo suction every time, they can store their own fat outside their body. And that's good for two things. It's good for as a source of stem cells for any number of things in the future. And two, as as a volume filler, but ultimately you wouldn't need to do the banking if you could just Yeah, if you can just grow it, great. But right now, that's not uh it's not commercially available and it's it it would be extremely expensive.

It's kind of like, you know, with Impossible Meat and all the the lab grown meat. Like lab grown meat's a thing today, but it's do it's $800 burger. It's or I don't know how much it cost now, but that's expensive. expensive. expensive. It's not $800. How far off is this growing your own fat technology for women? women? women? I don't want to put an exact number up, but I'd say at least two to five years. It's it's it's it's like not right around the corner. Two five years.

In terms of the the interest you're saying, the volume because we're talking about, you know, fat transfer, if you're thin, it's hard, but if you have a lot of fat, would you be able to have bigger breasts? breasts? breasts? Yeah. And when I do fat transfers, I I like to have at least 3 to 400 cc's of fat per side. And just for reference, this is a 250 cc ind. So, like double that almost. that almost. that almost. Yeah. And a can of soda is about 330 cc's or something like that.

So it's it's a good amount knowing that not all of it's going to survive. Yeah. Yeah. Yeah. Uh and that's per side. So usually like in a in the best case scenario, you'd harvest about a liter of fat which is which is doable if you treat multiple areas in the body. As people are listening this and wondering, you know, okay, this all sounds like promising. There's actually this alo clay now, which you can do. You can do if you're if you're underweight, if you're if you have plenty of body fat, you can use your own fat.

How do you kind of coach women and explain to women when they're talking about their breast implants and worried about them and taking them out? Cuz that's a big deal. Like I think it's I just want to sort of spend a minute on the psychology of that how you handle that because I deal with this and I feel uncom to be honest uncomfortable like I'm like God you know this is this is a very personal thing. You know I think as a doctor this is affecting your health adversely.

if you want to not have this autoimmune disease, you know, I have this woman who's got breast implants and her platelets are like 10 and I'm like everything is just not moving the needle and I'm just like listen this is the thing I think it's causing it but you know what's the threshold that you kind of say okay you you got to do this. Uh the first place is like you're doing it comes from a place of compassion saying like you know this is a procedure that you had that may be impacting your health and also medically uh it is a diagnosis of exclusion.

So let's check let's do every other possible work up to make sure that it's not something like Lyme disease or your thyroid or this or that. It's like once everything else is ruled out ruled out ruled out we've arrived at the final destination which is I think it's it could be the implants and it's important to do everything else medically. Well that's what I do. I deep dive on every possible other cause from a functional medicine perspective of what could be causing it and I get rid of that and they're still not better.

And the latest research shows that it's actually more of a neuroimmunology probably something closer to fibromyalgia the way that it's approached and and handled. And so I mean imagine all the patients that suffer from fibromyalgia if you could say I think it's this physical thing that's causing it. You've ruled out everything else. Let's remove it and see what happens. what happens. what happens. So the coaching uh or the counseling comes from first compassion. The second, where are you on the implant journey? Because if if patient says like, I heard about this yesterday and I think I have breast implant, I don't think it's a good time to have surgery within a week.

It's there's a lot of uh understanding that needs to happen and about the risks and benefits of expplant also the identity of who you're going to be on the other side because you've become this avatar of yourself over the past however long the implants are there. And it's a lot to dramatically change your appearance if you're not fully sure that the symptoms are caused by the implant or where you're at psychologically to prepare for it. So that process takes time. Usually I I recommend patients wait at least 6 months to a year.

Many patients that come see me have been thinking about this for for years. They've been on message boards. They've talked to other patients. They they've they've really done a lot of their own research to understand what it's going to be like on the other side and they're ready for it. Um, a big mistake is to do a surgery too soon just because a patient feels like they're they're ready. Um, and then then they're unhappy. And there have been situations where it's it's rare, but once or twice patients um, one patient stands out in mine.

She had her expplant, even though she I felt like she was ready for it. She felt like she was ready for it. And then months or about eight months later, she's like, "You know what? I feel better, but I can't handle the way that I I look, and I I really want that look back." And that's and that's part of the journey. So for me it's more about doing everything I can from what I know and hearing what the patient's saying to say like you're really ready for this journey and it takes time.

Also preparing before and after. There are protocols, things that help healing. Um and you know that's that's everything from preparing psychologically for it to physically. Um the amount of modalities out there is amazing to to detoxify afterwards. So, how long how long after women get an expplant surgery do they have to wait before they do some kind of other procedure like a fat transfer? I usually recommend waiting 3 months and it's I always stage it. I don't do the expplant and the fat crafting at the same time.

It's like demolishing and building a house at the same time. Just doesn't make sense. So, let everything heal, adapt, get get comfortable in your body and then we can talk about the next the next step. And that can be done that next surgery could be done either awake or asleep. And I think awake is important because less general anesthesia, less risks of of uh of all those heavy medications. I think for everybody listening, you know, I can say as a as a practicing physician that this is a real phenomena.

The FDA thinks it's a real phenomena that that it can cause a range of symptoms from sort of mild, you know, fatigue and cognitive dysfunction all the way to full-blown autoimmune disease and cancer. And it's not to be taken lightly and it's a serious subject because a lot of women have this. about 5% of women in the country have breast implants. So, it's just a big number. Many people are thinking of having implants. So, I hope you get to listen to this and understand the risks and and kind of wait a minute, pause and and wait, maybe wait for these new technologies or use one of these other possible transfer fat transfer techniques.

You're also, you know, thinking about how to really take care of women in a way that's safe and effective, but your your thinking goes far beyond that. And and I I you're one of the few surgeons that I've ever met that's thinking holistically about surgery. its impact on and I've had surgery many times and it's a very scary thing. There's not a lot of psychological support and there's not a lot of ritual around it. There's not a lot of understanding of how it affects you. I mean, I had massive surgeries like about a year ago and it was a it was a lot, you know, and I I have a pretty good constitution and a pretty stable mind.

So, but I remember like I mean for mine it was you know it was a very severe thing and I could have died and and and I remember going into the operating room and you know just you know you're kind of in the hospital you're in a sterile environment you're you're getting wheeled into the operating room they kind of stick the needle in you they go okay you're going to sleep out you know and I remember this could be my last breath is my last moment of consciousness you know and uh it was kind of scary and you you you've been in the operating room for thousands of hours Okay.

And you understand what the normal approach is and you've created this whole other framework. We you call it surgery as ceremony and I I love that. Um so I I'd love you to unpack that. What what what is that and what do you do that's different? And uh why do you do it like that? So I know this might sound woowoo and a bit out there, but I believe that we've removed a lot of the ceremony from many parts of our lives. the intention behind why we do things, the protocol behind it, the process, the ritual.

And I heard once this, it was it was a US general was giving a talk. He said, "What is a protocol but a process? A process but a ritual. And a ritual but a ceremony." Mhm. Mhm. Mhm. And it it stuck out to me as how many things do we do regularly in our life that are ceremonial nature, but we treat them as a protocol? Think about flying. You know, there's the FAA checklist. Yeah. Yeah. Yeah. which turns into flight school which turns into the ritual of boarding an airplane but the pro I mean the ceremony is like travel travel is amazing experience experience experience but we've we've removed a lot of that and surgery is no different we've taken what used to be um you know it started uh you were there in Egypt we were in Egypt and I was looking at these the walls of I think it was like I can't remember raw or cop the gods yeah but they had all these they had all these hieroglyphs of surgery and pharmacy and things like that.

And I was like, "Wow, even and psychedelic mushrooms." Yeah, of course. It's got part of the experience. So 5,000 years ago, there were these elements of medicine and surgery that were very ritualistic, very ceremonial. You know, they didn't have a sterile clean operating room. They had these altars and things like that. And then if you really break down the nuts and bolts of surgery through a different lens, and I'm not the very first person to think about and talk about it like this, maybe to operationalize it in a way that it's used in my practice, that might be new.

Well, when I was in residency, one of the surgeons used to play the the one of the surgeons used to play the Grateful Dead in the operating room. That was kind of like a ceremony. Music. Music. And I'll talk about this. Music is a huge part of it. Every Friday, I send out something called Mark's Pick. It's where I share the exact supplements, tools, books, and routines that I personally use to optimize my health. If you've ever wondered what I actually do in my own life, well, this is where I share it.

And when you sign up, I'll also send you my free guide, The Inflammation Fix, so you can start feeling better immediately. Just click below to join. If you think about a ceremony, what is a ceremony? Ceremony um it could be meditation, could be a week-long retreat. It could be um sometimes plant medicine experience, but you're you're you're you have this desire to undergo uh a change whether it's psychological or physical. You're looking for an altered state. Again, it could be meditation um quieting the mind, could be some people do it with plant medicine.

And then the third thing is you're you have to go through the journey. You have a guide sometimes that brings you. And then if you look at surgery through that lens, well, you're wanting to undergo this major transformation, whether it's elective or not, and you could have a a broken knee or something. You you want to be fixed. There is an altered state of consciousness, which is the medication that's used in surgery. It's without a doubt 100 million surgeries a year, people are having their consciousness altered for that time period.

Your conscious is being unplugged. All these medications flood your system and then you have to go through the journey, meet yourself on the other side. And very rarely is there psychological support after the surgery to say even before to say like oh your your body's changed but your mind has to catch up with what's happened. And the consensual part of surgery which is I know I'm going to receive this damage from my surgeon which you know it's very carefully done but it's still damaged. It's your the cery things are being burned things are being cut.

You're asleep. asleep. asleep. The shaman once told me that you know your body can't different tell the difference between a samurai sword and a and a surgeon's knife. Exactly. And I was like Yeah, you you are it's exactly the the the thought uh that led led to this which is surgery is a traumatic experience for the body and for unplugging consciousness just before it happens. Even though you knew what you went in for when your body wakes up, it's still having to you know body keeps a score.

It's trying to make sense of what's going on inside. So why not have a system that allows more support for the journey uh for the experience of surgery and that's that can happen before that can happen during surgery and immediately after. So surgery ceremony is a protocol that has three parts. The first part is doing is having psychological support immediately. It's like I call it like surgical psychology. So basically in preparation for your procedure, you have you meet with a therapist to go over the intentions, desire, fear and anxiety that you might have around the surgery.

The protocol that I use uses ketamine as part of the pro um the process. So it's ketamine assisted psychotherapy. Not a big not a big dose. It's a very light dose, but it helps kind of drop the ego defenses so you can get into the discussion with your therapist. The therapist then will uh elicit certain key words, mantras, and you know, Dr. Cat, we've we've worked, she she helped uh craft this protocol. Amazing therapist to work with. We'll help basically pull out little key phrases, mantras, and things to understand that are unique to that patient that I can then use during surgery because patients are generally awake during their procedures to coach and talk them through it.

So, and they're also listening to music during that first part. And this is where the Grateful Dead thing is actually pretty important. The music that sort of like neuro acoustic recall that you hear during this transformative experience where you're dropping into your why you're going to surgery. If that playlist starts playing again during surgery, it it it's it's like a warm it it's it's like a warm hug. Yeah. hug. Yeah. hug. Yeah. You like, I heard this before. I felt pretty good last time. Let me listen to that music again.

And then I also have key phrases and words and intentions that I can say back to the patient of why they're doing this as a reminder. For example, one patient, her mantra was like, "I want to come home to my body." And I could tell during the surgery, as as the medication was coming in, I also used ketamine as a anesthetic during the surgery, I was able to I said those phrases back to her. I said, "You're coming home to your body." And you just smiled and she's like, "Yeah, yeah, yeah, I'm ready." So, the ceremony of the surgery itself is also very important.

So, you talked about having surgery. It's this clean, sterile environment. It's loud. It's noisy. It smells weird. It's like, no, nobody wants to go to a party like that. You want the light to be good. You want the music to be good. You want the vibes to be good. Why can't an O be the same? same? same? So the energy of the the staff that are in there, you know, they're here holding a patient's hand. Tactile sensation, the release release of oxytocin may be the best pain medication we know.

So all those all those things add up. Right music, right lighting, right vibe. Even the bed has to be warm. I use these vibrating pads to help distract patients from the experience, drop them more into a parasympathetic state. The ceremony of the surgeries has a lot of steps to it. Uh but the most important thing is it's it's about removing the things that are uncomfortable at the typical O environment. The last thing is actually afterwards. So it's body work. It's coming home to your body. I work with a great team of lymphat lymphatic therapists that will help you land back in your body as you're integrating everything.

And that's that's just really important. So three parts before surgery psychotherapy, the actual journey of the surgery itself, and then afterwards with body work. And all of those things come together to to to be what I call surgery ceremony. Yeah, it's true. You know, I had I had this massive surgery in my back. And you know, without the people I brought in to help me after, which was not recommended by the surgeon, I don't think I would be where I am. You know, I had lots of body work to get back in my body.

I had, you know, dry needling, acupuncture. I had physical therapy. I had, you know, I had all these things that helped to move the energy and get my body back. And it's it's amazing. I mean, my my neurosurgeon was like, "What are you doing? Like, you we've never seen anybody recover like you. like you're an anomaly. And I'm like, well, this isn't rocket science. It's just, you know, understanding how the body works and and surgeons are great at like cutting and leaving them. It's like boom boom.

You're done. Not anymore. We just And what's really interesting is that, you know, you can ask a surgeon, "What do I do after surgery?" They almost don't even have an answer for you most of the time. And don't lift heavy things or don't do this. It was like all the don'ts. Not what the dos are. Not the dos, but the don'ts. don'ts. don'ts. And I was like, "Wow." Um, you also do other things to advise patients. You mentioned red light therapy and there's other modalities. What else do you use in terms of helping recovery?

And so, it's it's things you can do to your body and things you shouldn't do. And the things you can do, it starts with foods that you eat, uh, actual physical things you can do to your body and some some other parts of the protocol. So, I generally recommend a whole food, mostly plant-based diet, but having a lot of protein because after you have surgery, it's like your body's running a marathon every day. You need a lot of supplementation. supplementation. supplementation. The next thing is I'm a big believer in red light therapy.

The specifically near infrared and infrared light. 650 nm is about the wavelength that really stimulates mitochondria and improves wound healing. wound healing. wound healing. Hyperbaric oxygen is amazing. I know you big big fan of that. Acupuncture and lymphatic therapy is essential. I recommend it for all of my patients. It's it's closing that loop between what's happening in my body and what's happening in my mind. So if if you're anxious, you're going to feel more pain. And if you're feeling more pain, you're probably going to feel more anxious.

And it's just this loop. And those kinds of uh modalities like lymphatic massage, acupuncture, they they cut the loop. You're addressing the mind. Relax, feel less pain. Also feels feels nice to be to held and touched. Yeah. Yeah. Yeah. Um there's other modalities that I think are great now. More and more I'm recommending peptides to my patients. So TB500, BPC-157, thymus and alpha. We have a little peptide protocol that I think is is is more and more important. Up tissue repair, regeneration. Yeah. And to touch on what you said is I think the old paradigm of surgeons just cutting and leaving.

I think it's done. I think that I think the the most cutting edge surgeon or the new the new way is what do we do before and after surgery? How do we how do we curate the whole experience for your wellness, not just cut and done. Yeah. And I think I think this kind of holistic view of surgery ceremony of preparing patients before of how the environment is and how you do it and the posttop care which is quite different is important. But I I just want to touch on something I know you know about and I want to dive in because people don't think about this when it comes to surgery and it's going to sound very crass and you probably heard this in medical school, but you remember those patients you'd operate on and their tissues would just fall apart.

Like you try to like sew them and you're in the op you're in the wound or in a surgical field. field. field. It's like tissue paper and it's like Yeah. You can't grab on to with a with a needle and it'll rip and and we had a terrible saying for it. Do you remember what that is? Tell me. Tell me. Tell me. Piss poor protoplasm. Oh yeah. Oh yeah. Oh yeah. You remember that piss poor protoplasm? It's terrible. But it's kind of what doctors do to sort of deal with the gruesomeness of all the things they have to do is make jokes.

But but it it's it's a real thing. And and I think it has to do with with with uh how your body heals and wounds and and and and the the cause of that in my belief is that it's it's people's overall health and diet and nutritional status because you know if your tissues are bad and you're malnourished and you're eating tons of sugar and you're inflamed and you have insulin resistance which is to some degree over 90% of the population is on the spectrum not of autism but on the spectrum of of insulin dysregul ation blood sugar issues, you know, you're not going to heal as well like if your vitamin A is low or your zinc is low or your protein is low as you said or you have uh lower levels of omega-3s or or or copper like all these all these micronutrients are super important.

Yeah. And so, so I'm curious, you know, what I really found interesting was as I began to do functional medicine, I started to like, you know, use supplements and things 30 years ago. And the one of the only other doctors, two groups of doctors using supplements were plastic surgeons and dermatologists. And I was like, this is fascinating. And they're recommending stuff for wound healing and repair and recovery. And I actually there were supplement companies that had like a pre and posttop supplements, which I thought were amazing that I use a lot of my patients.

Yeah. I I recommend them all the time. what what what should people do to prepare and what should people do after in terms of their diet and and the right supplementation regimen to help them get through surgery? through surgery? through surgery? Great question. So before it's kind of like the dos and don'ts. There's things you should do, things you should definitely not do. So you want avoid anything that might thin the blood. So avoiding omega-3s, ginko, jinseng, garlic, usually anything with a G kind of thins the blood.

Not not forever. Just usually vitamin E. Vitamin E. Yeah. So like in omegas and and um that category, things that we know thin the blood. Avoid those for at least a week before surgery. Of course, consult your doctor to know for sure. Plus aspirin and Advil and everything. Yeah. So, anything that thins the blood and and it's interesting. NSAIDs less less less so now the evidence for them that they they But is there really evidence about the omega-3s? Like is it just a is we just know that it thins the blood.

I I'm I'm a huge proponent of omega-3s, but we know like it's it the risk we don't really have any good data that during surgery it's a problem. We just hypothesize that it might I recommend them afterwards all the time. I just said beforehand just just to stop. Also, with the surgeries I do, the risk of bleeding is so low because there's not really big incisions. So, it's it's less of a risk. But with other surgeries, yeah, for sure. But the things you should do is so I think protein intake is incredibly important.

Creatine, more and more evidence that it's actually important in the wound healing. Um, zinc, copper, vitamin D. And so, there are supplements out there that incorporate all those things. Um, and I I I share a few with my patients. I think they're they're really helpful before and after surgery. I think the things that get slept on the most are arnica and bromelain. So arnica is a a plant derived thing that helps uh with with bruising. And bromelain is a a compound from pineapple that helps with swelling.

Before surgery, you just want to make sure you're in the best shape possible to undergo the stress of surgery. Afterwards, you want to be doing things that are going to nurse the body for the diet. Yeah. It's all Oh, diet's I mean, you know this diet's most diet diet is the most important part. Yeah. So having in general I I think a whole whole food mostly plant-based, but obviously with a good amount of protein can be animal animal based is too. Yeah. We we had we were about to do a study to the the head of orthopedics at uh one of the key orthopedic surgeons at Cleveland Clinic, I think.

And uh he wanted to do a study on knee trans knee transplants like knee replacements. And he was like, "Listen, a lot of our patients bounce back because they're meaning bounce back, they come back to the hospital with complications, infections, problems, and you know, these patients who get knee surgery are usually overweight and they have that's why they have, you know, bad knees because you're putting massive forces of pressure of weight on your knees, which you're not supposed to. I forget the math on that, but it's like it's like a exponential amount of force for every pound and and and they come back with complications." And so we were about to do a study where we put people on a 30-day program to reduce inflammation, to help them lose weight, to improve their metabolic health and nutritional health as a preop strategy to reduce post-op complications.

And then even post-op the same thing. So I think that's really important and I knew for my recovery I just loaded up on protein and inflammatory foods and you know you want just the right amount of inflammation and all the nutritional support you can get. I do I think in the future there will be diets that will be specific for certain surgeries. I mean it already sort of exists with there's these things called early recovery after surgery protocols, irass protocols, a lot of hospitals have them.

But I think with the more information we get about uh specific blood work and uh the type of surgery people are having and what's really good for them and their wound healing. Like if you're having bone surgery, it's probably better to be supplementing things that going to support joints and collagen and things like that more to push that kind of healing more. if you're having more skin surgery, things that are going to, you know, favor more skin healing, brain, like I do think there's there is a world in which we have more organ specific or surgery specific diets afterwards that are tailored toward towards your recovery.

Absolutely. Yeah. I mean, it definitely wasn't the diet that I got served after my back surgery. So, I think, you know, we don't really have this consciousness in medicine, but we will. And I think your work around understanding you know surgery of ceremony around using all these nutritional and lifestyle modalities and psycho psychological supports and you know envir and um posttop healing technologies whether it's you know peptides or red light or hyperbarics lymphatic drainage acupuncture these are all things that should be used as part of standard of care and hopefully they will be because they ultimately reduce costs because they reduce complications they preve recovery they they basically save So, um, John, uh, thanks for enlightening us about the dangers of breast implants, uh, which I think most people need to know about.

And also the hope of, uh, new technologies that are around cuz it's not just all bad news, there's good news, cuz that was the problem before. I was like, you know, okay, you need things out, but like I'm sorry, like there's nothing to do, you know, and and now there is, which is really refreshing. And, uh, where can people find out about your practice, learn more about you, understand what you're doing, go see you? Best place is going to be online. in my Instagram it's @drj.k.

So d rj o n. K. And I'm I I answer most of the message I get and always happy to chat. chat. chat. What's your website for? It's oruraesthetica.com. It's oruraesthetica.com. It's oruraesthetica.com. So that's a r aurathetica. A s h i.com. Okay. Great. Or aesthetica. We'll put a link in the show notes. I can't wait till your book comes out. I don't know when you're writing it, but you better write. write. write. I'm going to need your help. Give me give me some pointers. I definitely need to write a book on this.

I'm thinking busted. Busted. Yeah, Busted. Yeah, Busted. Yeah, that's a good one. Yeah. Something about breast implants not being a thing anymore. Anyway, we'll workshop the title out. Okay. Okay. Well, thanks John for coming over and doing what you do and um being a pioneer and all this and and uh thinking about things differently. I'm so glad to see how well you're doing with it all. Yeah. I appreciate you your friendship, mentorship, and always always good vibes. All right. Thanks. If you love that last video, you're going to love the next one.

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