Breast Implant Illness & Busting the 'En Bloc' Myth

Dr. G (00:00):
So when you take them out, you just have this ptosis at the bottom.

Bri (00:04):
I have zero breast tissue. If I took my implants out, there's no chance I would think they would look good. They'd just be like dead little tube socks on me.

Dr. G (00:15):
You're listening to another episode of All the B's with me, Dr. G and my scrub tech, Bri. Every couple weeks some celebrity needs to tell us about how she's taking her implants out. And as Dr. Killeen pointed out, no one asked.

Bri (00:32):
Yeah, no one asked. Also, I don't ever see these celebrities actually taking their implants out.

Dr. G (00:37):
I feel like one of the ones we're going to talk about today, it makes it seem like she took them out, but I feel like she might've just downsized and I'm like, couldn't you just be a little more clear about what you're doing? It's so odd.

Bri (00:49):
I've been waiting for Jesse James to take her implants out

Dr. G (00:51):
Oh yeah.

Bri (00:52):
Downsize or whatever. I've seen nothing.

Dr. G (00:55):
Yeah. So once this happens, people decide, oh, implants are canceled again, but we know that's not true.

Bri (01:04):
Never. They'll never be canceled.

Dr. G (01:06):
Not canceled. And there's a lot of different reasons people take their implants out. I did just get back from Paris, which is why we -

Bri (01:15):
Yes. First off, tell us how Paris was.

Dr. G (01:17):
It was deliriously? Deliriously. I'm still delirious from the shopping that I did. So I will say my comment on Paris is that there's a lot of really good shopping. I didn't get to do all the shopping I wanted to, but my credit card says otherwise. So I think we're good.

Bri (01:36):
Has a hole in it?

Dr. G (01:37):
Yeah. Burned a little hole. Mostly because benign neglect, I did not bother to look up the Euro conversion. So it was sort of like Monopoly money.

Bri (01:50):
She came back and she was like, I really just don't know how much anything was.

Dr. G (01:55):
It seemed like an awesome good deal. So I would say the least best thing was the Louvre where it was like standing room only and it was just...

Bri (02:08):
I've just heard even the Eiffel Tower. It's just saturated with homeless people.

Dr. G (02:13):
No, around the Eiffel Tower was nice.

Bri (02:17):
Oh, nice.

Dr. G (02:18):
It was really nice. You could walk around the base. We decided not to go up in the Eiffel Tower. I thought that was probably unnecessary. And then the very last night we went back out to a location where you could see it light up, Twinkle, and that was super cool.

Bri (02:34):
Yeah. How many people did you see get proposed to while it was Twinkling?

Dr. G (02:38):
We weren't that close.

Bri (02:39):
Everyone gets down on one knee.

Dr. G (02:41):
It is really lovely. So yeah, it was fun. I would say from an aesthetic standpoint, I mean people do... I was fed so many TikToks about what streets fashion looked like. And I will have to say it was spot on. People do dress nice on the streets. I feel like it's similar to New York City. My daughter and I were laughing that we did not see... I mean, ballet flats are everywhere, which is awesome. I only bought myself one pair while I was there, which I thought was an act of intense restraint.

Bri (03:19):
Because she has so many here.

Dr. G (03:21):
But we did not see one person wearing Uggs, which is such a contrast.

Bri (03:27):
So they were wearing ugs and baggy jeans with a little crop top?

Dr. G (03:30):
No. No uggs and baggy. And I did see-

Bri (03:34):
What did most people wear?

Dr. G (03:36):
Ballet flats, pants or jeans, kind of a basic top, cute purses everywhere and a cigarette.

Bri (03:46):
And a cigarette. The cigarette goes with every outfit. Yeah.

Dr. G (03:48):
The cigarette accessory, which I found disgusting. It's funny because you can't... There's not what they call a takeaway. They don't really have very many coffee shops where you can get your coffee to go and no one's clutching their Stanley as they walk around. So I guess it's not classy to walk and drink there, but you can smoke.

Bri (04:10):
I just don't understand that though. If I had to go sit down and have a cup of coffee, I would never make it anywhere.

Dr. G (04:15):
No, I know. It's definitely a slower pace. And then aesthetics, I think we were like, is there skincare routine stripped down? Because the sink counter space in our hotel was so tiny. There was nowhere to put anything. Everything's just smaller.

Bri (04:32):
I'm like, where did I put my 12 step skincare?

Dr. G (04:34):
Yeah. Everything is just smaller, but I would say that's a no, because the French pharmacies are awesome. There were all these K Beauty popups and K beauty pharmacies on top of that. There are some products that you can buy in French pharmacies without a prescription that are usually prescription based. The SkinMedica stuff is just there. And there are certain forms of retinoic acid that you can buy over the counter. And then if you knew what you were doing with Korean beauty stuff and the masks and everything, that was also... I mean, that was the part of the shopping that I didn't really get to. Anyway, good times. Highly recommend.

Bri (05:17):
A place I'd also love to go.

Dr. G (05:19):
While I'm out of the country, you want to give us an update on what happens?

Bri (05:23):
I plead the fifth. Just kidding. Generally, when she is not in office, I try to not be in office. Unfortunately, I did have a lot of work to do. What did we do? I worked on my general job duties and then I spent a lot of time trying to figure out some outlets that we needed for our new fancy laser.

Dr. G (05:46):
Yeah. So let me just give a shout out to Sciton here. I bought an egregiously expensive laser, like more than a Maybach laser.

Bri (05:55):
Yeah, 100%. You could buy two Maybachs.

Dr. G (05:58):
Yeah. And it shows up, sure, have it show up while I'm out of town. That's fine. We can get it all set up and ready to go and we can do some training when I get back. And oh, it needs a 220 outlet.

Bri (06:09):
Homeboy comes in. Where's the outlet? I was like, "What do you mean?" He's like, "We need a 220 outlet." I was like, "Why wasn't this brought to my attention?"

Dr. G (06:20):
So Bri's texting me. Sorry to upset you in Paris. And I was like, "Oh no, it's fine because it's 10 o'clock and I've had eight glasses of wine so let's go. What's the problem?"

Bri (06:32):
I got back a lot of angry faces, I might kill him. So I'm calling all these electricians trying to get all these quotes because I was hoping to try and get it done while she was out of town. It did not work, but it's getting done in the process now. Yeah.

Dr. G (06:49):
It took us a week, but we're getting it done.

Bri (06:51):
It took us a week, but we're going.

Dr. G (06:53):
Mostly because the first quote was -

Bri (06:56):
They were kind of crazy. So if you guys ever need an outlet, get multiple quotes.

Dr. G (07:02):
Don't pay $9,000, get three quotes.

Bri (07:03):
Yeah. Insane.

Dr. G (07:05):
I mean, I had the converter plug for Europe so I could plug in my charger. Yeah. Can I just bring that and plug the laser in?

Bri (07:15):
I brought that to Tennessee. I was so dumb, instead of bringing the box for my charger, I took the European converter charger and I get there and I'm like, "Oh fuck."

Dr. G (07:26):
Tennessee -

Bri (07:27):
My phone's on 5% the whole weekend.

Dr. G (07:30):
That's awesome. Okay. All right. Let's get to some celebrity news, which I will have to say in doing my research for this podcast yesterday instead of doing, I mentioned this earlier, the legal consulting I was supposed to be doing because it was just deadly boring. So on my Sunday afternoon, I'm like, "Okay, let me look at the celebrity news instead." And this Road Island celebration canceled. It was supposed to happen June 13th and my sister had called yesterday afternoon and I don't know why Taylor Swift came up but it did and we were talking about this and I'm like, "No, no, no, it's not happening in Rhode Island. That's canceled. It was supposed to be June 13th. They've moved on I think because too many people knew about it. " And she's like, "I don't believe you. " I'm like, "No, I literally just read this article about it."

(08:24):
So then we went on to talk about whether Blake Lively was really going to go to whatever event is happening. I don't know. I think it's supposed to be July 3rd because that number means something to Taylor Swift. And I think it's supposed to be at Madison Square Garden, but I don't think that's going to be the wedding.

Bri (08:42):
So Rhode Island got canceled, but Madison Square Garden is on?

Dr. G (08:46):
Is on.

Bri (08:46):
That's so public. Well,

Dr. G (08:48):
It's a closed, they're just buying it out.

Bri (08:51):
I feel like they should have just stuck with Rhode Island.

Dr. G (08:54):
I mean, I would say no one was going to go to Rhode Island to capture the people going in and out, but -

Bri (09:00):
100%. This is the biggest wedding of the century.

Dr. G (09:04):
Yeah. And so everyone wants to know whether Blake Lively is going to this thing or not. I feel like if you're hosting something at Madison Square Garden, I'm thinking there's probably room for Blake.

Bri (09:18):
Yeah, I think so. We can find a corner for Blake to stand in.

Dr. G (09:23):
I don't know. Anyway.

Bri (09:24):
There's no way they're just not friends after that.

Dr. G (09:27):
I know. I mean, just move on.

Bri (09:31):
It's fine.

Dr. G (09:32):
It was what it was. Everyone makes a mistake. I guess if nothing else, it's insurance for Taylor doing something stupid or Travis doing something. You know what? What if somebody in the Kelsey family does something equally dumb? Then what are you going to do? People are human.

Bri (09:50):
Yeah.

Dr. G (09:51):
Move on.

Bri (09:52):
Amen.

Dr. G (09:53):
Anyway, I was vindicated this morning when my sister was like, "Yeah, you're right." The Rhode Island thing was -

Bri (09:58):
You're like, "Thank you. " I was like, "I know I'm right." It's just crazy to plan all that and just cancel it. I just feel like they're in the public eye. Everything they do is going to be public. They're going to be photographed.

Dr. G (10:07):
Maybe they get secretly married.

Bri (10:10):
Yeah, wherever they go.

Dr. G (10:12):
Already married.

Bri (10:13):
That seems kind of more private than...

Dr. G (10:17):
I don't know. I bet the Rhode Island place is sweet. We got the deposit non-refundable and no party, so well done.

Bri (10:25):
Fine.

Dr. G (10:26):
All right, moving on. World Cup. I went and watched the game on Friday afternoon a litle bit of it where US beat Australia was good.

Bri (10:36):
I haven't watched any of it.

Dr. G (10:38):
But I think the tourists are hilarious because I guess they're commenting about America, sort of just how I was like, "Oh, what's different in France?"

Bri (10:46):
Oh, I've seen all these memes about people are smuggling ranch dressing back through TSA and they're like, "Please check your ranch dressing. Don't put it in your carryon because people are loving the condiments here."

Dr. G (11:01):
I can't believe they're going to take ranch back.

Bri (11:03):
No one saw Chick-fil-A sauce or... No. That's crazy.

Dr. G (11:07):
Somebody went to Raising Cane or something. Oh, TSA compliant ranch.

Bri (11:14):
Yeah. It's hilarious. I saw one in this dude had 13 bottles of ranch in his carry-on.

Dr. G (11:20):
That's wild.

Bri (11:22):
Yeah.

Dr. G (11:23):
I'm not that big of a fan.

Bri (11:27):
I just started liking ranch recently. I eat chicken nuggets about three or four times a week for lunch here.

Dr. G (11:33):
Not just chicken nuggets. We get the dino nuggets.

Bri (11:36):
Dino nuggets. Like a fucking adult. Sorry. And I just started mixing ranch with ketchup and it is...

Dr. G (11:43):
That's Thousand Island, isn't it? Oh no, that's mayo and ketchup. It's cool.

Bri (11:46):
I only eat about three to four chicken nuggets, but it's so good.

Dr. G (11:51):
Now you're onto the ranch.

Bri (11:52):
Now I'm onto a ranch kick.

Dr. G (11:54):
Okay. Chick-fil-A sauce is legit though. I'll give you that.

(11:58):
Yeah. They're obsessed with Taco Bell, which also disgusting.

Bri (12:02):
That's disgusting. Absolutely not. I don't care.

Dr. G (12:05):
Waffle House

Bri (12:09):
All of the - What about In and Out? Does nobody go to In-N-Out?

Dr. G (12:12):
I think there's only been one game. So this is all over America, right? And so I mean, In-N-Out's a California thing strictly.

Bri (12:22):
No.

Dr. G (12:22):
Yes. And also if you rolled up to In-N-Out anytime of day, it's a massive line.

Bri (12:27):
And there's In-N-Out in Colorado.

Dr. G (12:30):
Is there?

Bri (12:32):
Please hold.

Dr. G (12:33):
Fact check that.

Bri (12:34):
There's no way. And they just moved to Tennessee.

Dr. G (12:37):
Well, maybe they're expanding, but it's sort of like Krispy Kreme or Dunkin. It used to be very regional.

Bri (12:42):
Is In and Out only in California? No.

Dr. G (12:49):
Okay.

Bri (12:49):
It's in Texas, Arizona, Nevada, Utah, Oregon.

Dr. G (12:53):
Then why are they always so busy here?

Bri (12:56):
Because there's not enough.

Dr. G (12:56):
I'm telling you, my kid always, when we're driving back from volleyball at 3 in the afternoon, we'll be like, "Can we snap in and out on our two hour drive back?" And I'm like, "Sure. Stop at random in and out at 3:00." Massive line. Why? Go at midnight, massive line.

Bri (13:13):
Because you just can't order, you can't DoorDash. You just got to go there and show up. It's crazy.

Dr. G (13:19):
All right. Well, yeah, I don't know why they chose Taco Bell to elevate.

Bri (13:24):
That's disgusting.

Dr. G (13:25):
Anyway. All right. And then we did talk about this in the OR last week, Bunny XO and her jelly roll divorce.

Bri (13:34):
Yeah.

Dr. G (13:34):
Bro loses some weight and then it's over.

Bri (13:36):
All of a sudden he's out. She's doing a podcast.

Dr. G (13:39):
She's always done a podcast.

Bri (13:41):
Tour and was like, "I love her. We're best friends." She's like, "I'm still going to have his baby." I don't know. I'm just so confused.

Dr. G (13:50):
I feel like it's a PR stunt. If you dive deep, he filed for divorce. They're not getting a divorce yet. He just filed for it sort of impulsively after an argument. Maybe they will get divorced, but she's still going to have his kids even though she's not currently pregnant and they're doing it through a surrogate. What?

Bri (14:17):
That doesn't make any sense. I don't know. This is all confusing for me.

Dr. G (14:24):
But she's definitely had some plastic surgery, so we applaud her for that.

Bri (14:28):
Yeah. No, she looks great.

Dr. G (14:31):
I wonder if he's had any plastic surgery to remove all the excess skin.

Bri (14:33):
I feel like you have to. You can't lose that much weight and just not,

Dr. G (14:36):
Yeah, that'd be a lot. Especially if he's in his post-divorce glow up era, he's going to be getting it done.

(14:48):
I don't know. Maybe they're just getting back into -

Bri (14:50):
Yeah. See, they look exactly alike. They should be brothers.

Dr. G (14:56):
Postie.

Bri (14:57):
All right. Okay. Also, is Brittany out of rehab because I saw her post something over the weekend.

Dr. G (15:03):
I don't know. We got to look into that.

Bri (15:06):
Yeah. I'm not sure. We were literally just talking about it and she's like, "What do you mean Brittany's in rehab?" I was like, "I haven't seen her post anything." And then she posted something over the weekend.

Dr. G (15:16):
She back.

Bri (15:17):
She did look like she attended rehab.

Dr. G (15:20):
Oh, she's supposedly out of rehab and expecting... Oh, a deal for her DUI. Perfect. Yeah. I just wonder...

Bri (15:30):
She looks like she went on a bender and needed to go back to rehab.

Dr. G (15:33):
On her post?

Bri (15:34):
Yeah.

Dr. G (15:35):
Was it bad? Because her posts were unhinged for quite some time.

Bri (15:39):
She just doesn't look any different.

Dr. G (15:42):
Yeah. Okay. Well, that's fun for her. What a mess.

Bri (15:47):
Yeah.

Dr. G (15:48):
Okay. Speaking of messes, let's talk about celebrities who had their implants removed and Courtney Stodden, who I feel like Bri doesn't know, but it doesn't matter. She's had her implants removed. I will say in reviewing this article for the podcast, she posts her post-op photo and it's giving the photos that we get submitted sometimes when people are like, they need to post something, not the way she's standing or anything.

Bri (16:19):
That's her post-op photo?

Dr. G (16:20):
Yeah, that's her post-op photo. So girl looks like she still has implants in. But my takeaway from this is when patients submit their photos for pre-consultation, the number of times there's a dog judging in the background is -

Bri (16:36):
There my mom being a hoe again.

Dr. G (16:38):
50%. And we even had some patient be like, "Here are my photos and ignore my dog who's silently judging me in the background." And they're also usually in their bedroom, which they don't bother to clean up. I mean, I get it because you're submitting it to me. And just looking at the photos for a consultation for whatever it is you're considering. But this girl is like social media, this is in US weekly. You don't think you could make the bed or whatever the hell is going on back there. I mean, the dog's fine, whatever.

Bri (17:14):
There's just so much happening in this photo.

Dr. G (17:17):
What is going on? It's so weird.

Bri (17:19):
Stuff on the floor.

Dr. G (17:20):
Angle your leg different. The whole thing is awful. I feel like there's some bad FaceTune or Photoshop or something going on and it did not deliver.

Bri (17:29):
Just seems very out of touch for a post-op photo.

Dr. G (17:33):
Yeah. And also the other thing that -

Bri (17:35):
If you want to post yourself naked, just post yourself naked.

Dr. G (17:38):
Mostly made me unhinged is if don't zoom in, but if you did zoom in, you can clearly see her nipples through the bra. And I think I get sent to Facebook jail routinely for an image of us in the OR or me talking about implants and yet this bitch is allowed to post basically naked and it's acceptable. What how is she not in some sort of Instagram jail -

Bri (18:09):
I have no idea.

Dr. G (18:10):
Shadow banned.

Bri (18:11):
I don't know how the lines are drawn on Instagram, honestly.

Dr. G (18:14):
I hate Meta.

Bri (18:15):
I have just no idea. But it doesn't even look like she got her implants out.

Dr. G (18:19):
No, it does not. So that's why -

Bri (18:21):
Does she have a before picture?

Dr. G (18:22):
No. So then you're like, did she just get them downsized? Because she said she got a breast reduction. The way they toss around breast reduction implants and feeling lighter and then not... I feel like if you actually had the surgery, you should be able to articulate that, but maybe that's where some of the confusion is, right?

Bri (18:44):
Yeah.

Dr. G (18:44):
So she said she got rid of huge implants, but did she get rid of huge implants and trade them in for smaller implants?

Bri (18:51):
Yeah. She was like -

Dr. G (18:52):
I feel like that's what happened. You could be a little clearer, but maybe that's the confusion about all of this and so we'll get to that. But there are a million celebrities who've had their implants out. Famously Chrissy Tegan.

Bri (19:07):
She's had a bunch of lifts. She's been very open. Yeah.

Dr. G (19:10):
She's had a lot of breast surgery. Alyssa Molano, who else was on that long list? There was a lot of people no one cares about. There's Danica Patrick who was one of the early adopters of getting him out and talking about her breast implant illness. So that is on reason. So yeah, we can talk about all the reasons that people get them out. I can't discuss Camille Grammar because she just annoys the shit out of me. And somebody in all this group, I forget which person it wasn't Danica Kapatrick, but was like, "I had all this going on and I felt really horrible and I decided to take my implants out, but also I had three kids under five and my husband was working all the time and I was just tired all the time." I'm like, Okay. Probably not your implants, but it's okay. Maybe it was -

Bri (20:02):
Yeah, it might be the three kids under five.

Dr. G (20:04):
Yeah. So what are we talking about since there is a lot of confusion about whether you're Dana Kilpatrick actually taking your implants out or Courtney Stodden who's just downsizing trying to jump on the implant train or something? I don't know. So there's explant, which is removing implants. There's a breast reduction, which is making your natural breasts smaller. But I think a lot of times people will say," I had a breast reduction and they... "I mean, we've had patients come in ostensibly for a consult about breast reduction. "My breasts are too big. I want a reduction. I'm a Triple D, I want to be a C and then they roll in and they have implants and I'm like... Okay, well that's a different, totally different thing.

(20:53):
Insurance is not going to cover that 99% of the time whereas a breast reduction is more likely to be covered by insurance. So at least if you're talking to plastic surgeons in the plastic surgery world, breast reduction implies that we're reducing your breast tissue, your native breast tissue. Removal of an implant is usually explant or breast implant removal and then downsizing can be implant exchange We call it implant revision. And then if you're going to get your implants removed, not exchanged or revised, there's lots of reasons for it. We see people who should have them removed and choose not to over and over again.

Bri (21:41):
And these women that they're all like 70 and above, not all of them, but I always find it so interesting.

Dr. G (21:48):
Right. I think when we do see patients with implants to generalize a little bit, if you're in your 40s and 50s, a lot of those women, not all of them, but a bigger percentage will be like, " You know what? Just take them out. Because you're no longer 100% attached to them and you're like, for whatever reason I have to replace them, maybe it's a rupture or whatever is going on. If you put new ones in, you're going to get maybe 20 years out of it and then you're going to be 70 and have to do another surgery. So in their mind, they're like, "Uh-uh, I'm done. Just going to hop off. I don't want to have more breast surgery." And I think it's a higher, it depends on how many surgeries you've had up to that point and all that stuff. The ladies in their 70s are like, a lot of them have had them for 40 years and they had one surgery, they

Bri (22:44):
Dinosaur eggs.

Dr. G (22:46):
Way too much time out of them and they're like, "Yeah, no, I want them new ones." And you can confidently say they're probably going to be fine. They'll get buried with them.

Bri (22:57):
That'll be me at 70 though, but I'm committed to my problems. Okay. Just want perky tits at 70.

Dr. G (23:06):
Yeah. And we have a lot of those patients that are like, "You know what? This is what I want. " Certainly many are like, "Nope, I'm done. Let's get them out. And it can be because there's a problem with the implant. You can have anything from capsular contracture where the implant has hardened, that can be due to a rupture or just bad luck or the age of the implant. You can have a rupture where the silicone is ruptured or patients who had saline implants in the 90s are now starting to show up with one implant ruptured. So then they need to do something. And then you can have what we call breast implant illness, which is these sort of chronic symptoms that are not related to any other medical diagnosis. We want to make sure that all the other things have been ruled out and you generally just don't feel well and you want to have your implants removed. I would say in our practice, that's not our biggest category. Most people are just like, "Fuck it, I'm over it."

Bri (24:15):
Yeah, just want them out.

Dr. G (24:17):
Yeah. What are some symptoms of breast implant illness?

Bri (24:22):
Fatigue.

Dr. G (24:23):
Fatigue.

Bri (24:24):
I have seen quite the list. The symptoms are literally everything. So I don't really know medically what actual an actual symptom of BII is because I literally did a H&P for somebody who was getting them out with another doctor and there was probably like 45 symptoms and it was just general how I feel every day. How we feel? Yes. Tired itchy skin allergies. I feel like anything can be a symptom, I don't know. Anything can just be your implants.

Dr. G (25:02):
Yeah. So fatigue, mental fog, itchy, rashes, trouble sleeping. I do feel like depending on your age, it can be sort of weirdly the same as perimenopausal symptoms, losing your hair, skin changes. It's all very nonspecific. And so we don't have a test for it and it's kind of what we call a diagnosis of exclusion, meaning that we have to rule everything else out and if everything else is fine and you still feel like garbage, then okay, maybe it's a foreign body reaction to your implants and you can take the implants out. The good news actually though is that the overwhelming majority, like 80% of women who fall into that category where they're attributing their symptoms to breast implant illness get better when you take them out.

(26:00):
So I think as long as you're willing to accept whatever the changes are that come with having your implants out, it's the smart move. And if you're really committed to feeling better and you're not so focused on what that's going to look like when you have them removed, then you're a good candidate and you'll probably feel better and you're not going to regret having them removed. I've had two patients come back and have implants put back in. I think part of some of my issues with breast implant illness is that if everything's a bell curve, right? So like I said, the majority of people who attribute their symptoms to the breast implants are going to get better after having them removed. And then there's always going to be a small group of patients that don't feel better and those patients I feel get left out in the cold a little bit because there's the group of really, really, really hardcore BI advocates that are intent on convincing them that if you didn't get better after getting your implants removed that somebody did something wrong, you didn't have your capsule removed for which there's no science to back.

(27:21):
You still need to go through a detox program. The thing that's never suggested is that, girl, maybe it wasn't your implants.That's A possibility. And so if you can't have that perspective that perhaps it wasn't your implants, then I don't think you should be guiding patients in their journey. So nobody knows, so nobody knows. I can't say that you're going to get better, but I can say the studies have shown that you'll probably get better and I can't promise you that. And if you don't get better, it's not because one cell of capsule got left behind, it's because that wasn't the root cause of your problem. I think it's weird because there's other things you can focus on and people get hyper focused on mold in your house or I don't know. What if you have a pacemaker and that's a foreign body? Are you going to have a reaction to that or your hip implant?

Bri (28:30):
Yeah.

Dr. G (28:30):
I don't know, your dental implant. There's other things that are implanted and we roll with it. What about, I don't know, the fridge cigarettes we drink all day our Diet Coke.

Bri (28:40):
I literally got a car air freshener that said Fridge cigarette over the weekend and it's a Diet Coke.

Dr. G (28:47):
I had to buy some shampoo. Shout out to Ashley, our old front desk person.

(28:51):
We're still charging her aesthetician account for salon Centric.

Bri (28:55):
Your California esthetician license is expired, but it lets me order. Okay. So I ordered my fancy shampoo and then they had a Diet Coke wetbrush.

(29:07):
Stop.

Dr. G (29:08):
Yeah. Had to have it and Diet Coke, those little clips that hold

Bri (29:11):
Oh, that is so cute.

Dr. G (29:14):
Limited supply.

Bri (29:15):
Going to have to get some.

Dr. G (29:17):
There we go. Anyway, I mean, maybe it's all the other toxic shit we put in our bodies. Who knows, right?

Bri (29:25):
Yeah.

Dr. G (29:27):
Is it my implants? Is it the Diet Coke I drink?

Bri (29:30):
Is it the peptides? Is it the... Just kidding.

Dr. G (29:33):
Right, right.

Bri (29:34):
Yeah. I've seen the greatest peptides memes lately and it's no shame in it. We've all tried them. I love them, but it's like they're just so funny. I can't even... One girl's coughing up her own blood. She's like, "It's fine. It's just the peptides. It wants me to rejuvenate my blood so I just spit out a little and it makes more cells." And it was, "It's so funny." Nobody knows honestly. And we put so many other things we don't know about in our bodies. I mean, you would really... I don't know. I'm sure there's a medically correct way to answer that, but I just don't. I can't believe that. It's all my implants. It might be the half a bottle of wine I drink every night or it's making me tired the next day.

Dr. G (30:22):
I know. I tried the fake wine, the non-alcoholic stuff. It is truly awful.

Bri (30:27):
Yeah, it's not worth it. I had a non-alcoholic beer at dinner the other day.

Dr. G (30:31):
Oh, also awful.

Bri (30:32):
Yeah. I don't drink to feel nothing. You know what I mean? I want to feel something.

Dr. G (30:39):
Shots, Shots,

Bri (30:39):
Shots. I want the wine to let me relax. I don't want non-alcoholic.

Dr. G (30:46):
Yeah. No, I know, right? I don't want a non-alcoholic drink because I like the taste.

Bri (30:53):
Yeah.

Dr. G (30:53):
Exactly. Okay. All right. So anyway, let's talk about taking your body back, which was Stauden's gist, which I do feel like is a common thread. I'm taking my body back, but it just depends on what your origin story is for why you got implants. If you were too young or impulsive -

Bri (31:16):
Which is the most common thing you hear. I was too young or the doctor went too big and I didn't know about it.

Dr. G (31:24):
Right.

Bri (31:25):
Which I find very hard to believe.

Dr. G (31:26):
But I think, yeah.

Bri (31:28):
I know there are doctors that probably just laminates a lot, but I just can't imagine going somewhere and not knowing what size implants I was going to get in.

Dr. G (31:37):
Right. But it happens. And not as often today as it used to, but it used to be more of a thing like we're just going to pick the implant for you. Now patients come in, they want a specific brand, they know the profile. I mean, people are super educated about what they want in. But yeah, back then I think people were like saline silicone and I'm going to pick something that's good for your body.

Bri (32:00):
Yeah.

Dr. G (32:01):
And then maybe like 15 years ago my friend who practices up in Beverly Hills was operating out of a surgery center and there was a guy who was famous for doing an 11 minute aug, which is awful. That's insane. So he would do the surgery in 11 minutes. He told me he walked into his OR just to take a peek and he's like, "He just slams the same implants in everybody." And I was like -

Bri (32:27):
That's crazy.

Dr. G (32:28):
No. Yeah.

Bri (32:30):
11 minutes.

Dr. G (32:32):
500 ccs, boom, next. And I'm like, oh my God.

Bri (32:35):
Are these under the muscle or like -

Dr. G (32:38):
i think this is back under the muscle days. Put them to sleep, slam them in, go.

Bri (32:42):
Slice, dice, slam.

Dr. G (32:45):
Yeah. Hemostasis. No bleeding.

Bri (32:47):
No hemostasis.

Dr. G (32:49):
The implants holding the spot.

Bri (32:51):
Yeah. Staple, staple. Just kidding.

Dr. G (32:54):
Staple, staple. Yeah. So I think yes, it was more frequent to not have a say in the implant size and trying to figure out what was really going to work for you and all that stuff. I guess when a patient comes in, I have the category of patients that know they want their implants back in so we make those choices and people who definitely know they want them out and then the people who are somewhere in the middle and they don't know. And when we have those patients, I usually have a really long conversation about both options and then have them come back once they've decided because both pathways can take you down different rabbit holes. And honestly, I think if you're not sure if you want to revise or just take them out, it really depends on what you're starting with and what you expect your breasts to look like.

(33:46):
And I have had people who just are so convinced if you're really convinced they're making you sick and you want them out, but you're also really attached to the aesthetics of the breast, that's a hard conversation to have because the implants have changed your breasts, time has changed your breasts and you have to be realistic about what that's going to look like when you take them out. I think if you're not ready for that, maybe don't take them out.

Bri (34:18):
I feel like a lot of people think that it's going to go right back to how their boobs were before.

Dr. G (34:22):
Right. And if they like their breasts before, then they're happy. If they didn't like their breasts before, then we got a whole new sort of problems that I don't know because I didn't see them when their implants weren't there. If you had some sort of constricted breast problem or like really weird asymmetry or something like that, that's probably going to come right back and now your breasts are stretched out. Usually the upper pole, like either the upper part of your breast is stretched out, which when you take them out, gives you that very scooped outlook or the implants have been weighed heavily and the lower pole is stretched. That's also very common. So when you take them out, you just have this ptosis at the bottom.

Bri (35:07):
I have zero breast tissue. If I took my implants out, there's no chance I would think they would look good. They'd just be like, dead little tube socks on me. You know what I mean? There's no chance.

Dr. G (35:20):
Yeah. And they have not been made better from being stretched. There is some rebound effects. We do have a lot of patients that take them out under local, right? So we do that pretty frequently. Probably a couple times, I don't know, probably three or four times a month. We'll do it on Friday. I'll numb up the incision that you already had to put the implants in, make an incision, get down to the capsule, open up the capsule, take the implant out and then close everything. No capsule is removed. Patients feel better anyway Despite that some patients look actually really good after they take them out and you just need to give it some time because the breast tissue has been on stretch and so it rebounds a little bit once it implants out and the breast tissue can fluff up a little bit.

(36:09):
It just takes time. I tell patients the other big concern is like where are my nipples going to end up after I take them out? And I can say with confidence they're not going to fall down to the ground. They just kind of fall back. So wherever they are, they're going to fall back. If they're super low and they've been sliding off the implant for years, they're going to stay down there. They're not going to spring up. If they're in a good position, then they just fall back. They're not going to fall off either. So that's like a helpful information when you're looking and trying to decide what kind of stuff you want to do. And if you do decide to take them out and kind of let your body recover and then come back and do something, that's acceptable too. So you really have a lot of options, but it is a detailed conversation.

Bri (37:02):
Okay. En Bloc removal. Is that the gold standard for removing implants?

Dr. G (37:13):
In a word, no. I know it's offered. I think I tell patients, again, it's your body. So if you choose to have an end bloc removal, it's your choice. Is it medically indicated? No. There is currently no data or science that says you need your implant and all of your capsule removed in one giant block, which is generally reserved for a cancer operation unless you have breast implant associated lymphoma. So ALCL is the indication some sort of cancer is the indication to do an En Bloc and that is not being done as a cosmetic procedure. It's done in a hospital. You need scans and like a workup and a diagnosis and all this other stuff. So the studies have shown that you can take your implant out, you can take some of the capsule out, you can take all of the capsule out, you can take the capsule out separate from the implant altogether.

(38:23):
All of those things, you will still feel better. If your implant is ruptured, it's sometimes helpful to get the capsule out so that you're not mucking around with the implant. Although we have the vac thing now that's Hella awesome to take the implant out if it's ruptured. If you have a dinosaur egg, which we've talked about, so the capsule is like this calcified rock then obviously -

Bri (38:50):
Rock solid.

Dr. G (38:51):
Yeah. Can cut it in half, make an ashtray, those things can like that needs to come out. We don't want to leave that in there. Your body is never, ever going to break that down, but you have normal breast -

Bri (39:04):
Textured recalled implants. We'll usually try and take most of the capsule.

Dr. G (39:08):
Try to take the capsule out. Yeah. I think those are the main reasons, but other than that, you don't really need to. And so sometimes if you have a normal capsule, which is thin, filmy, like one cell layer, you're doing a lot of damage to try and carve out all that capsule. Also, the incision has to be made bigger to do that, like way bigger. I used to try to do it through a small incision. I no longer -

Bri (39:36):
She's not allowed to do that anymore.

Dr. G (39:39):
It's torture. It takes forever and no one's happy. So just, if you really want all the capsule out, I'm going to make a big incision and that's...

Bri (39:49):
You really just have to commit to it if that's what you want. Yeah.

Dr. G (39:55):
And you can do it. I always talk about this in my consultations. If you get diagnosed with breast cancer, you have the option to do a lumpectomy and radiation or a mastectomy. You can even do a double mastectomy. That's like a wide range of options, right? You can just take the little cancer out and then radiate and hold onto both breasts, or you can take both breasts off, which is kind of extreme. You have to be comfortable with that decision process because we're telling you that those things are equal. And so if you choose to do the big surgery, that's fine. If you choose to do the small surgery, are you going to be somebody who lies awake at night worrying about breast cancer in the other breast or the remaining breast tissue or... You know what I mean? If that's you, then do the double mastectomy.

(40:47):
So the same thing goes for breast implant illness. If you feel sick and you're attributing it to your implants and you want them out and we're going to take them out and then you're going to lie awake wondering, "Ugh, I don't feel better. Should I have I taken the capsule out? " You get on these Facebook groups where they tell you absolutely you should have, even though they're not doctors and can't offer medical advice, then just do it. Just take the capsules out. It's your choice. I'm not going to tell you you can't, but I'm not getting on a podcast or Instagram and telling everybody that they have to have an explant that involves an En Bloc and that's the only way to do it. That's definitely not my... It's not my prerogative. Again, it's part of informed decision making. I have to give you the information and then you can kind of decide based on that.

Bri (41:39):
What you're going to do.

Dr. G (41:41):
It's when people ask me what would I do? I don't know.

Bri (41:45):
Yeah.

Dr. G (41:46):
I'm not taking them out and I'm not doing an En Bloc. Absolutely not. I'm fine with keeping my implants in. But there's millions of women with implants and a small percentage who feel sick after it. We could spend a whole other podcast talking about what your options are after taking them out, but you can do a lift, you can do a fat transfer, you could do nothing, you can do both. I usually say a lift is going to reshape, not necessarily lift the nipples if that's not the problem, but reshape the tissue you have and fat transfer will restore some volume. The one thing you're never going to restore is that upper pole fullness. If that's something you had with implants, that is impossible without implants and you're bound to be smaller. I mean, it's just -

Bri (42:38):
Something you have to live with and be mindful of. Don't expect to have the same size boobs with a fat transfer and a lift that you do within an implant.

Dr. G (42:47):
No, especially if your implants are large. I do have a patient who had, I mean, they weren't large implants. They were like 350cc implants, but she's a small person and she eventually wants to get them out and she did a novel approach where she downsized her implants to like 200s and so he breast is accommodating to that and she had like a weird bottoming out problem too. So now they're smaller and she likes them and then in five or 10 years, her plan is to just take them out, which is in her case is like a reasonable option. It's just surgery, but there's a million ways to approach it. I would say if you're considering getting implants now, the on take home is that they're not lifetime devices and most likely, unless you're 70, you're going to need another set at some point or some other surgery, whether it's to take them out, to exchange them, something.

Bri (43:47):
So would you suggest if somebody wanted to take out their implants, would you suggest that they all in one surgery take them out, get a lift, try fat transfer? Or would you suggest they take them out, see how their breast tissue naturally evolves or -

Dr. G (44:03):
It depends on the patient

Bri (44:04):
On the patient.

Dr. G (44:05):
Yeah. I think the most important factor in that is what I refer to as the breast implant to breast tissue ratio. And so people who are mostly implant and very little breast tissue usually need to do something because I've seen enough patients that if you're not a good candidate to just take them out, then I will let you know because sometimes that can leave you more distorted and weird looking, certainly with a drain in and everything looking crazy and then that's really hard to undo. Most people are fine and can do something down the road, but if I'm looking at you and I know you need a lift, there is really not a lot of reason to not just do it because I can tell you're going to... If you need a lift with the implants in, then you're going to need a lift with the implants out and unless you're okay with it, you're going to want to do that all at one time.

(45:00):
And then the same thing with the volume restoration. A lot of times I can tell whether you're absolutely going to need it. It's the people who are sort of in the middle have smallish implants and some breast tissue and not a lot of ptosis. Those patients can go either way and it's kind of like a personal choice and I'll often say, "Hey, if you're one of those people who wants everything done just in one shot, then we can do that. " If you're financially considering your options or you want a faster recovery, those all factor in too, then let's just take them out because I think you'll probably be fine. The people who have the easiest are the people with saline implants because they can deflate.

Bri (45:37):
Yeah.

Dr. G (45:37):
We deflate them in office and then this is what you get. So this is going to be what you're going to end up with. What do you think?

Bri (45:45):
And then you're like, "Oh wait, I do actually need a lift."

Dr. G (45:48):
Yeah, I want all the things. Unfortunately, I can't do that for silicone.

Bri (45:55):
Right. All right. Rapid fire. Breast implant illness is officially recognized as a medical disease.

Dr. G (46:03):
It's not.

Bri (46:04):
Removing your implants is guaranteed to cure systemic symptoms.

Dr. G (46:08):
Also not.

Bri (46:09):
You have to replace your implants every 10 years no matter what.

Dr. G (46:12):
Oh my gosh, no.

Bri (46:14):
A silicone implant can rupture without you feeling a thing.

Dr. G (46:17):
Absolutely can.

Bri (46:18):
En Bloc removal is always medically necessary.

Dr. G (46:21):
Absolutely not.

Bri (46:22):
Going smaller or flat means you'll always look deflated.

Dr. G (46:25):
No.

Bri (46:26):
Saline implants are safer than silicone when it comes to BII.

Dr. G (46:29):
Nope.

Bri (46:31):
You heard it here first folks.

Dr. G (46:33):
Those are a lot of myths.

Bri (46:35):
I know. No reality.

Dr. G (46:38):
There was no reality there. All right. So if you're listening, you have questions or maybe listening to this raised more questions, reach out and hopefully we can guide you through your journey of dealing with your implants.

Bri (46:51):
Yes. Whether it's a reduction, a revision, a downsize and upsize.

Dr. G (46:56):
Yep. Yeah, we see less upsizes, but yeah, same size as an option.

Bri (47:01):
Yeah. If they're 40 years old, I'll give you an office next door to call. Just kidding.

Dr. G (47:09):
All right. Thanks for listening and we're going to scrub in.

Bri (47:13):
And scrub out.

Dr. G (47:14):
If you're listening today and have questions, need info about scheduling, financing, reviews or photos, check out the show notes for links. Restore SD Plastic Surgery is located in La Jolla, California. To learn more about us, go to restorestplasticsurgery.com or follow us on Instagram @RestoreSDPlasticSurgery. If you enjoyed this episode, please share it and subscribe to All the B's on YouTube, Apple Podcasts, Spotify, or wherever you like to listen to podcasts.