July 30, 2025 • 40 mins
What happens when your body changes—but your implants don’t?
In this powerful episode of Plastic Surgery Uncensored, Dr. Rady Rahban sits down with his patient and friend, Raina, to explore a deeply personal and increasingly common question: What if you’re not sure whether to keep your implants or remove them? From breast augmentation and capsular contracture to animation deformity and the decision to explant—Raina opens up about the physical, emotional, and psychological toll of living in “the in-between.” Not quite loving your implants. Not quite hating them. Just feeling... off. This episode pulls back the curtain on:
👍 Love the show? Please subscribe, leave a review, and share it with someone who needs to hear this before their next cosmetic procedure.
📲 Follow Dr. Rady Rahban on social media for expert insights and behind-the-scenes content:
In this powerful episode of Plastic Surgery Uncensored, Dr. Rady Rahban sits down with his patient and friend, Raina, to explore a deeply personal and increasingly common question: What if you’re not sure whether to keep your implants or remove them? From breast augmentation and capsular contracture to animation deformity and the decision to explant—Raina opens up about the physical, emotional, and psychological toll of living in “the in-between.” Not quite loving your implants. Not quite hating them. Just feeling... off. This episode pulls back the curtain on:
- What breast implant illness (BII) might really mean
- The truth about fat transfer during explantation
- Why honesty and surgical flexibility matter more than ever
- And what it’s like to finally feel like yourself again
👍 Love the show? Please subscribe, leave a review, and share it with someone who needs to hear this before their next cosmetic procedure.
📲 Follow Dr. Rady Rahban on social media for expert insights and behind-the-scenes content:
- Instagram: @drradyrahban
- TikTok: @radyrahbanmd
- YouTube: Dr. Rady Rahban
- Website: www.drradyrahban.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:11):
Welcome to another I have to set a plastic surgery
on centent. I'm your host, Doctor rober Raybond, and I
am super excited about our show today. As always, the
show is only interesting if we have someone, a patient,
a dear friend, who will help us through this journey.
We are blessed to have a dear friend and patient
of mine who is going to help us navigate the
idea of explantation. It's a super hot topic. Anyone who's
(00:34):
considering contemplating breast augmentation has heard of things like BII
explantation cap selecting me and these are terms that are
very confusing, breastlist fat transfer. Well, we're going to address
all of that today, but this time through the eyes
and the experience of our patient, Rainer. So welcome to
the show, Rainer, and thank you for coming. We appreciate it.
(00:56):
I'm very excited that you're here because and grateful because
shows don't exist without you. I mean literally, anyone who
knows anything about me knows that I can just talk
about anything at any time. True, but that's not as
exciting as having this banter and dialogue. Not only because
you're interesting to talk to, but you had this experience,
and through your willingness and vulnerability, we're going to discover
(01:17):
a lot of information and I think people are going
to really appreciate. So let's go ahead and start with
your journey. Tell us that basically, when was the first
time that you had breast surgery, and if you can
take us through what it is that you ended up
doing and why you ended up doing it in the
first place.
Speaker 2 (01:32):
Well, as you know, I have two sons nineteen and
fourteen now, but my younger son I breastfed for seventeen
months and I was left with basically the equivalent of
two empty bean bags that you would play a game
of cornhole with. There just wasn't much to my breast
any longer, and they hung low, and they felt like
(01:53):
they didn't belong to me anymore.
Speaker 1 (01:55):
And you're obviously really fit, very thin. You've always been
very lean, so I imagine you didn't have much press
to shoe prior to breastfeeding, let alone afterwards.
Speaker 2 (02:03):
Right now, I certainly didn't, okay, but I decided to
explore what are my options a BREASTLFT. I really didn't know,
so I met with a few surgeons in Los Angeles.
There's a lot of great surgeons here, and I decided
on one, and I was informed that I could have
a breastlift, but probably wouldn't have the volume in the
(02:26):
upper portion of my bra and I should probably consider
a small implant. I was fine with it. My husband
was over the moon rocket.
Speaker 1 (02:34):
And we're talking this was fourteen years ago.
Speaker 2 (02:38):
No, this was eleven years ago, right, eleven years ago.
And I decided to do it and had the lift,
had the small implant put in, and went on my way.
And once I was cleared to start exercising again, I
you know, I did a lot of yoga back then.
At any time I would go into any position that
would engage my pectoral muscles. I noticed that my left
(03:01):
breast drifted. I watched it drifted to the left anytime
I engaged my arms, and it was disturbing and kind
of weird, and I was a little scared. Went back
to the surgeon and was informed that I could be
taken care of with some sort of a piece of mesh.
And I said, okay, And I underwent another surgery and
(03:24):
healed from that, started exercising again, and the same thing
happened sure, and I just I was done. I don't
want anyone to touch me anymore, touch my body anymore.
I was fine, you get what you get, you don't
get upset, and that was it. I went about my
life and fast forward, I would say probably nine years later.
(03:46):
I go for an annual mammogram and ultrasound because with
breast implants, I was told you just want that extra
layer of protection when you're looking for breast cancer. And
during my last mammogram, which was a little under a
year ago, I was informed that one of my breast
implants had encapsulated and a capsulature.
Speaker 1 (04:09):
I thought, you've got cops capsure, contracture.
Speaker 2 (04:11):
And so it Visually it looked like my right breast
was maybe an inch and a half higher, and it
was up into my upper chest air just just not
where they're supposed to be right exactly. There was nothing
natural about it. And you could look at me from
one side you're like, hey, that looks great, and you
look from the other side and it looks like I
(04:32):
just swallowed something and it was bizarre. Additionally, I was
at risk for rupturing, which is scary. There's sublicone. I
don't want that to happen. So I decided to explore
my options.
Speaker 1 (04:45):
Okay, so let's go back into a couple of things.
So the first thing that we want to touch on
is the idea that you about needing or not being
in the implant. I don't think that the individual as
long as you were informed about it. I think the
key is to have the inform So I would have
advised you probably the same, which is here, you are
a lovely, beautiful lady coming to me with two issues
(05:07):
at hand. One is my breasts have sort of lost volume,
and the other is they've also started to sag. And
the sag part is addressed with the lift aka removing
the excess skin, and the volume part can only really
be addressed by adding volume. We're gonna forget about fat
transfer because everyone loves the concept. You're not even a
candidate because you're so lean. But the idea is that
I have to add volume. So if you have a patient,
(05:29):
then you would be that patient who doesn't have a
lot of their own volume. If you do a LYFT,
it's going to be incredibly underwhelming, so much so that
you'll probably wish you didn't have the lyft because now
I still have basically nothing, except now I have a
bunch of scars in exchange, and granted your breast will
sit a little better, you'll have essentially no volume to
your breast such that you will look fuller in any way.
(05:52):
The assumption is if I'm looking fuller porn start. No,
we have one hundred and forty CC implants. They're that big.
They're literally the size of a small doughnut. So it
doesn't mean that you need to be huge. And I
think the idea of doing the lift with an implant
was a correct one. Whether or not that's executed correctly,
that's a whole different animal. The second thing you were
talking about, which was when I would activate these implant,
(06:15):
especially the one on the left, would shift all the
way to the right. That's called something called animation deformity,
and a small amount of it is normal. Right. The
implant's use should go under the muscle. So therefore, when
you fire your muscle, especially downward dog bench press flies,
that muscle will fire. That muscle will then tighten, and
(06:37):
that implant will then move. That's normal. But what you
were experiencing is more than just animation deformity. When you
were experiences that pocket was not correctly dissected, and so
when it would move, it would bulge abnormally in certain
places more than others. So that's the second thing. The
third thing is this idea of capture contraction, which unfortunately
(06:58):
still is sort of the art nemesis of breast implants.
And essentially what it is is that, for whatever reasons,
every person who has an implant in their body makes
scar tishe around it. It doesn't matter what the implant is, prosthetic, knee, heart, valve, pacemaker.
Your body's going to say, oh, this thing doesn't belong
here and make a shell around it and protect you
from it. And that shell is normally thin, and you
(07:19):
don't care, and you go live your life. Some people
and some bodies tend to start making a thicker, more
voracious scar tissue, which is not dangerous. It's not going
to kill you. It's just going to annoy you because
it's going to start changing the shape of this perfectly
round structure. And they first tend to notice is like,
holy shit, this one's all the way up here. How
(07:40):
did you get up here? And then hmm, this is
so much harder than this one, And that's because of
the squeezing effect of that capsule. When did you start
noticing that when you looked in the mirror and you're like, WHOA,
this doesn't look right. When did just that start happening?
Speaker 2 (07:54):
It was gradual. I mean there were many years. I
was extraordinarily happy with the Great implants.
Speaker 1 (07:59):
I really was.
Speaker 2 (08:00):
I lived with the animation deformity, and I just sort
of went back. But I mean I was happy. I
was definitely happy. I felt the volume. I felt very feminine.
I would say probably eight and a half nine years in.
Speaker 1 (08:13):
Great So it was towards the end that that that
started happening. All right, So now we fast forward. Here
you are. You did your ultrasound, you did your mammogram
to telling you that it might be ruptured. Maybe not.
In addition, just flat out you're looking at yourself and
you're like, now there's a decent amount of asymmetry, and
it's very hard to hide asymmetry. Yes, that is the
number one complaint that I have when people come to
(08:34):
my practice. It isn't even so much that it's hard
or I don't like the shape. It's I can't conceal
this asymmetry. And so you didn't then decideed have to
do something about it. Your sort of hand was forced
to do something. I'llbe around ten to fifteen years. You
probably should have changed the implants anyways, So you got
a you got a good lungevycast at first. You've got
(08:55):
a good run. Okay. So now you are here, you
are you have to go about it. So take me
through what you do now with these three things in place, animation, deformity,
right capture, cantracture, and breast asymmetry. So tell me what
you do.
Speaker 2 (09:10):
Still living in Los Angeles, I have access to amazing
surgeons everywhere. I started asking around, did some research, and
I met with two other very reputable surgeons, one of
whom specializes in breast reconstruction. So I thought, this has
got to be the way to go. And it was
a woman, so that was a different even level of
(09:33):
understanding and empathy. And the response I got from both
of these surgeons separately was very similar, which was no problem.
You've got a capsular contraction. We can explant your implants
and fix the capsule. As far as the animation, we
can put some mesh in there and I don't even
(09:54):
know how I'll say described it, and then we can
put new implants back in and off you go. That
was an ideal for me, not because I was against implants,
but because, well, if I already created a capsule, was,
why wouldn't I just do it again? Sure, and maybe
this time sooner, and I just don't want to do that.
So my end goal was, in addition to feeling good
(10:18):
and keeping my body healthy and safe, was to not
necessarily have to have implants.
Speaker 1 (10:23):
Right, So let's talk about size in general. So there's
the issues associated with the implants, which you're you eloquently said.
It's like, hey, I made this capsule before, what's to
say I won't make it again? And the truth of
the matter is that there is nothing to say that
you won't make it again. It is a risk, and
albeit it took eight years or so, you could develop
it again. But let's just talk about sheer size. Do
(10:45):
you remember what size implant was there originally?
Speaker 2 (10:47):
Well, okay, so I had two separate sizes because it
had naturally symmetry to begin with. I want to say
it was like a one eighty and a two ten.
Speaker 1 (10:54):
Ag so one eighty two to ten it sounds about right,
And in general, those are very small implants. However, it's
all relative and on your tiny little frame, which is
very thin and you don't have a lot of volume
on your chest. One eight, two, ten, may seem much
larger than perhaps even what you liked. So if you
take size alone, forget about all the other issues. My
(11:16):
understanding is that you wanted to be smaller in general.
You liked that look of just smaller.
Speaker 2 (11:22):
Yes, yes, I like that liko smaller. And also because
of where my implants sat in my body, not just
the one that was encapsulated, it looked messy, like if
I were t hanged top. I just you know, I
felt very self conscious.
Speaker 1 (11:37):
So okay, so then you and I me, and you
come to see me. The things that I picked up
on when I met you, I think the biggest element
of all the things that you're talking about for me
was the asymmetry. It wasn't that they were big, wasn't
that they were small. It wasn't even that both breasts
were high. It was that your right and left breast
were far enough separated in terms of differences in the
(11:59):
way they look that I could imagine that it would
become very cumbersome to dress and you always dress elegant,
and you couldn't. I can only imagine trying to conceal that.
So to me, that was the biggest element. So we
chatted right and we talked and what did I tell
you regarding the idea? What did? What did? What did
I tell you? What did we decide?
Speaker 2 (12:18):
So, first of all, when I met you, it was
the most refreshing thing because I didn't I didn't yet
know we had a dear friend in common. But you
had said to me, I can't make any promises that
you're going to walk out of here and look perfect.
That is that is I can promise you that I
am going to tell you what I can do. And
(12:40):
you were so honest with me, and you looked at me.
You told me exactly medically what was going on, capsular contracture,
animated deformity, and that you would go in, we do
a lift, you'd fix the capsule, and you know, there's
a chance we'd do implants again, and otherwise, if I
can solve it to a breast tissue you have, I'll
(13:01):
try to do that too.
Speaker 1 (13:02):
You're very honest.
Speaker 2 (13:03):
It was sort of like, let's just get in there
and see. And that gave me an addition to giving
me a lot of comfort, because you were just very,
very honest. It gave me some hope too, which was
an exciting feeling, just to know that there's a chance
that I could get away with having the look that
(13:24):
I wanted overall, which was not necessarily anti implant, but
just smaller, more petite, and more fitting of my bust.
Speaker 1 (13:32):
Sure, So the way I approach so XPLIN is a
tough topic for me as a surgeon, and it's a
hot topic now because we have this, we have this
EBB and flows in plastic surgery and plastics and implants
and plastic surgery are a buzzword. They're a hot topic
because there's a really strong divide and there is a large,
(13:52):
large subset of individuals. They don't make up a large
number of individuals, but they make up a very focal
number of individuals who have issues with implants. Just like
people have issues with hip prosti prostheasis. My wife had
issues with their spine hardware. There are implants, there are
foreign devices, and there's a large substantial number of people
who have a general condition called BII or breast implant
(14:16):
illness and essentially what that is, and nobody knows yet
and maybe in five years and ten years and twenty
years will know exactly what that is. But the way
I see it is as follows. When an implant goes
into your body, your body knows it doesn't belong there.
It knows that that's not a human tissue, and it
will separate that tissue from your body and protect you
(14:36):
from it and wall it off and make scar tissue
around it. And that's the capsule that every human being has.
In the overwhelming majority of people, that process is finite.
It makes the scar tissue and then it calls it
a day. But I believe in that people who have
BII their bodies are continuously trying to manage this thing.
(14:57):
It's like it's constantly set in the troops, and like
a computer, the hard drive is an overdrive, and therefore
things are running slow in the background. So they're developing
symptoms like fatigue, hair loss, muscle joint pain, and things
of that nature, which we would call constitutional symptoms. They
(15:19):
don't feel well. So that's not a new topic. That's
been around for a long time and then it kind
of disappeared and now it's come up again. And social
media is a very big driving force. So what's happening
now in plastic surgery is we're having a sizeable number
of people coming to us saying, hey, I want my
implants out, no problem, I have no problem with that.
But simultaneously they want to look good. And so the
(15:43):
problem that at least I'm facing is I want to
honor the patient's wishes of wanting the explant. It's not
my body. You can do a mastectomy if you want.
At the same time, I know as the surgeon, I
know as the artist, I know as a person that's
in surgery that they may not have sufficient breast issue
to create anything that would be arguably attractive. And that's
(16:08):
a real problem because I believe that they may not
fully understand what they're asking for. Now. My sister had
breast cancer. My sister had a double masstec. To me,
just you had to like, you have no breas, you
have no breast, you do because you were dying of
this disease. And if your illness is so strong that
you don't care what you look like, I understand. But
(16:29):
in the milieu of people coming in asking for explans,
there are a lot of women who don't really have
BII and they're sort of just getting swept into this.
The current of implants are bad, mind you. Now, the
overwhelming majority of people in the world who have implants
love their breast implants. So this is a small subset.
(16:51):
So my concern with you, and the reason why I
was so honest with you, is because you are so lean,
you are so fit, And what was I worried about.
I was worried that I got your tube rest implants.
I do the capsulect me fix da da da da da,
And then I would go to do a lift and
be like, wow, there's nothing here or not sufficient here
whereby which I feel and at the end of the
(17:13):
day you're asleep that you would feel comfortable attractive Because
if I told you I'll fix everything, but you get
a mass stect to me, would you sign up for that? Now?
You wouldn't You just wouldn't sign up for it. Yes,
I don't like this asymmetry. Yes I don't like anything
about this, but this is better than a mastectomy. So
I try to fight that fight on behalf of patients.
(17:33):
And what I always offer them is which what I
would want someone to offer my wife is I'm gonna
go in and I'm gonna definitely die trying and if
I can if I feel like it's acceptable that you
understand it's not going to look like a supermodel, but
it's acceptable. I absolutely will explain to you. However, if
I take out the implant and I'm like, wow, that
(17:55):
doesn't look good at all, what do you want me
to do? You want me to leave you like that?
And most patient who are not in the true biid
category illness wise or like well, I want the smallest
implant you can give me because they are concern is
that they don't want to live that lifestyle they used to.
They've outgrown it. Implants was great then, but not now.
So we're going to take a quick break. We're gonna
(18:16):
come back and then let's talk about what we did
end up doing. Absolutely, and then we're going to talk
a little bit about what your advice is moving forward
on how to navigate this. If you are at home
listening and you are in that, I consider it three categories.
I love my breast implants, I have BII and I
don't give a shit. I want them out, and I'm
in the middle, and I think I want to go smaller.
I want to get rid of them, but I don't know.
(18:36):
So I want you you and I going to talk
to those people in the middle here. Let's take a
quick break. We'll be right back with the second half
of plastic surgery on sensor. Welcome back to the second
half of plastic surgery on censored. All right, So Ray
now and I are digging in, and I know all
of you been at the edge of your seat. So
Ray now, you go into surgery, you go to sleep,
(18:58):
you wake up, and what happened. Wow.
Speaker 2 (19:02):
First of all, this is one of my favorite parts
of this whole experience I had with you. So you know,
I didn't see you after. I know the surgery went well.
I was told I don't remember much.
Speaker 1 (19:13):
I go home.
Speaker 2 (19:14):
Recovery wasn't that bad. The pain wasn't that bad. One
thing you made extraordinarily clear to me prior to surgery,
which was do not push pull anything larger, bigger, heavier
than five pounds for six weeks. I was lily relative,
So I really followed your directions. And when I saw
(19:35):
you for the first follow up appointment, I had bandages,
I had a special brawl. I couldn't shower. That was rough.
I saw you a week later.
Speaker 1 (19:45):
I come in.
Speaker 2 (19:46):
You took off the bra you took off the bandages.
You asked me to stand and read of the mirror,
and I remember looking and I was blown away. They
were pretty damn symmetrical, I have to say. I mean,
I was extraordinarily impressed. They were lifted, they were shaped
like a breast. I mean, they were just they looked
(20:07):
from each side. One wasn't significantly higher or harder than
the other. And you looked at me. By the way,
I had no idea, and you looked at me and
you said, I didn't think we'd be able to do it.
But I got in there and you had enough breast
to shoe. At this point, I did not know I
(20:27):
didn't have an implant, so I was wet, and you
said yeah. And I don't even know if you thought
I knew, but I didn't know.
Speaker 1 (20:38):
I did not. I did not know.
Speaker 2 (20:42):
So I was extraordinarily happy. I left here, still couldn't drive,
and I standing right outside waiting for my husband. I
called him and I said, you're not I don't want
to curse, and I don't think I'm allowed to curse, but if.
Speaker 1 (20:54):
I were, there would be allowed.
Speaker 2 (20:59):
Because censored. And I call my husband. His name is David,
I said, David. One you're not fucking gonna believe this.
And he's like, what I said, I don't have an
implant because long pause, Yes, did he forget? And I'm like, no,
I didn't forget. And when he was just he was
so happy because he knew my goal was not necessarily
(21:22):
not to have implants, but to have a look that
fit my body. And the fact that it was achieved
without an implant.
Speaker 1 (21:28):
Even better, even better. Absolutely, absolutely, I was thrilled. He
was surprised.
Speaker 2 (21:34):
It was pretty funny, the overall experience, but I was
so happy. I was happy with the look. I was
happy with the feel. I already felt better even wearing
you know, the cotton bra that has eleven snaps in
the front, but with a tank top, I didn't have
to worry about concealing what I always did. Sure, those
Turblenicks went to the back of my mind.
Speaker 1 (21:56):
Yeah, And for me, the most powerful part of that
was the idea that you know, here, you are this
beautiful lady. You always dress elegant every time I see you,
And then when I would see you in the office
and I saw that what you were managing, it always
I have this sort of a man. I'm not a woman,
so you know, but my wife is an elegant woman,
(22:18):
likes to dress. She seeks so much joy at being
able to adorn herself with a clothing that represents what
she likes. And when you are, when you're dealing with
this thing underneath that no one knows, and I can
only imagine how many of your girlfriends actually knew what
your breasts looked like towards the end, and sort of
the asymmetries and what it's like during intimacy and all
(22:38):
those things. That's for me a very powerful feeling, even
though I'm a man, because I know that for women,
as like for men, their hair is a very big
symbol of who they are, and when you lose it,
it's a really big deal. And for women, their breast
is a very big symbol of their own femininity and
how they connect to their own sexuality. And so it
(22:59):
was a great feeling to be able to not only
create breasts that were like beautiful and symmetrical and all
those things, but one that was congruent with what you
thought would look good on you, right, not what I thought,
or your husband did or whatever, but you did. And
the trith matter is as interesting as it is you
had gained some breast tissue, which is not the case
then prior, because you know some women as they get
(23:21):
older they lose breast issue, and some women in your instance,
as a result of I think as your second child,
gained some breast tissue. So you had not a lot,
but you had something there and so nothing makes me happier.
But the key to this was that you were open
to the possibility of if I need it, then find
you what you need to do. And for me, as
a surgeon, that's the only patient I'm going to operate on.
(23:43):
Because had you said to me, no, no, no, I
don't want an implant under any circumstances, but they got
to look pretty, I wouldn't do your surge because you
didn't create a scenario that's not winnable. I have done
the surgery, and I have told patients they well not
look pretty, and they have signed a consent that's I
understand that my breast will not look attractive. And I'm
happy to help you in your journey. But if you
(24:05):
want me to do your surgery and then you're gonna
hold me accountable for the way they look, and you're
not letting me do what I need to do well,
then we can't do this dance. So you allowed us
to do that journey. And your openness was very very
important because some people are very abstinent about their wants
and they just think that plastic surgery is magic and
it's not. So not that you're in your How long
(24:27):
ago was our surgery? It was March five, two twenty three.
We're talking about six months, so you're well into the
rhythm of your life. Yeah, absolutely right. You get to
buy aware what you want, You're going to the gym.
You are now this new person, right, and you recall
it just six months ago not being that person. How
(24:48):
has this impacted your life in the different categories? Wow?
Speaker 2 (24:54):
Well, in addition to being able to not have to
plan out when I'm gonna wear, which was very typical
occurrence for me, I just I felt like obscene looking
before I or anything that was not even low cut
because I don't order low cut, but anything that was
too form fitting. I was very self conscious, and I mean,
(25:15):
I feel great. I feel like I don't have to
think about it, is the truth. I don't there's there's
no planning, so I don't think about it, right, right?
Speaker 1 (25:23):
That is a very powerful statement, which is I stopped
thinking about my breast. My life then doesn't revolve around
my press anymore. Yeah, and the instance of intimacy, was
there ever an issue recouting that I felt? Well that
in your camp, Well that's all that matters. Mental. I
can't talk about this every single con Men don't care.
They care when you care.
Speaker 2 (25:43):
Yes, because that comes through right in how you relate
sexually and how you feel about your sexuality. Yeah, I
was self conscious. I would definitely, you know, try to
wear something or and then if my husband were to
remove that, I'd be.
Speaker 1 (25:57):
Like, excuse me, so right?
Speaker 2 (25:59):
Or I didn't want to necessarily you know, certain positions
if I were laying flat, I was really self conscious.
Speaker 1 (26:07):
Sound is I'm assuming that you don't think about it.
They're either during individy.
Speaker 2 (26:12):
I don't know. Definitely.
Speaker 1 (26:14):
I think that's like, that's fucking amazing critical moment in
our being. Intimacy is one of those little areas where
you're in a very special space in life when you're
into it with someone. And to be fully free during
intimacy versus conscious during intimacy is like two different experiences altogether.
So that I think is just says it all, and
(26:36):
it's so phenomenal. So if I'm at home and i'm
you know, as I said to you, there's three categories.
There's people who have no issue with implants. Great, okay, fine.
There's people who, under no circumstances, want to implant if
they have it, they want it out, they don't care
what they look like. Fine, But then there's a large
subset of individuals who are living in this sort of limbo.
That limbo is I'm neither here nor there. I don't
(26:58):
love my breast, I don't hate my implants. I'm just
sort of not happy with my breast, and that breast
then bleed into my intimacy, what I wear, and so
on and so forth. So if I'm a woman and I'm
listening and I'm that middle category, what are some of
the advices, then suggestions and your experience they like, Wow,
(27:18):
if I could have done this earlier. What are the
things that you think of when you're advising friends now
regarding their middle where they're stuck in the middle.
Speaker 2 (27:26):
Well, first of all, I just want to say to you,
I do agree that the voices that tend to be
the loudest are our people with grievances you know about.
And I also I believe in, you know, breast implant illness,
but I also think that typically, and I don't know
if this is always true, but there's some sort of
(27:47):
autoimmune issue going on just in general. And so I
think that when, if and when or if you believe
you have breast implant illness, that's something that you should
explore first and see if you actually have any sort
of on immune issues going on, because that's if you've
been okay for a really, really long time with your implants.
I don't know if it necessarily comes out of nowhere.
Speaker 1 (28:09):
I don't. I don't, and the truth is that we don't.
The reality is that we don't know enough to know now.
And all I know is if you feel adamant that
you want tom out, knock yourself out. Just like there
are people now getting mastectomists who want to transition into
being a math. I'm not here to question you or
judge you, but there are that middle group of people
who don't hate their implants because they're too implants right,
(28:31):
but then are stock and they're not happy with the
way they look, and then they're afraid of moving that direction.
So what do you what do you What would you suggest?
Speaker 2 (28:40):
I would suggest first figuring out for yourself what's important
are what are my goals?
Speaker 1 (28:45):
Are my goals to just at any cost sort of.
Speaker 2 (28:52):
Have them removed and or fixed so that you don't
have to even think about any sort of potential rupture
and or anything. But aesthetically is what they look like
is not as important. I just think you have to
figure out what your goals are. In my case, I did.
I wanted them to look feminine and sexy and like me.
(29:13):
So once I knew that, once I had that established
and I met with different surgeons, I think you need
to ask that question. And I think, honestly, there's only
one answer. There's no definitive answer. There's one answer, which is, well,
let's wait and see. You cannot tell. I don't think
how much rest tissue person actually has what you'll be
(29:34):
left with until you're in there, And so that kind
of trust between you and your physician is really important.
Speaker 1 (29:40):
Yeah, and I think you hit it on the head.
I mean, I think that the reality is that you
know what I've experienced because I've done this a lot,
is that I tend to operate on the people who
are just like you, which is, hey, he are my wants?
What's your wants? My once is I want them to
be more more. Notice the word more symmetrical and not
the word symmetrical. Right, you're it's an anomal We got
you as symmetrical as we did because you started out
(30:02):
so asymmetrical. But the goal was to get you asymmetrical
as possible. I'd like to be smaller, and I'd like
not to have an implant if I can. And the
if is predicated around, well, if you the surge and
the person i'd feel that it's ugly, please put it
in the implant that would make me still look feminine.
But why don't I want it to be no bigger
(30:24):
than this. And when a patient is open to that,
then I can go in and do what I need
to do, because then I know that I have wiggle room.
And so to me, I think that that's really critical
and that you have to as a patient be sure
that you pick aside, which you can't do. When I've
reiterated on many occasions, it insists that you want the
implants out because you're just over it, and then demand
(30:45):
that at the same time you want it to look
beautiful and feminine because there's a misunderstanding. The misunderstanding is
that a breast lift, and now even worsened by the
fact the fat transfer, a breast lift in and of
itself is going to do the math. No, it will not.
If you have no breast tissue, no breast lift on
the planet is going to do shit. Furthermore, and worsened
(31:09):
by the situation is this concept of fat transfer. So
I'm going to just take a moment here. The idea
is that we take out an implant two hundred CC's.
That is a small implant, but it is two hundred
ccxact times two four hundred CC's, and I'm going to
take out that implant and then I'm going to replace
(31:30):
that implant with some degree of fat. First question, where
the hell am I getting it from? Where? Oh? I
don't know. They'll get it from my back, my arms,
my inner thise, my love handles, and my abs in it. Okay, great.
So if you need four hundred ccs volume, know that
about fifty percent of it dies. So now I need
eight hundred CC's. Know that if you have eight hundred CC's,
(31:52):
that means that when you aspirate and you suck out
half of it is fluid. Now I need sixteen hundred CC's,
so all of a sudden, you need a load of
life suction. And the problem I have with high volume
fat transfer butt and or face, I mean butt and
or breast, not face, is that you cause damage in
(32:13):
the areas you borrow to fix the breast. It's stealing
from Paul to pay Peter. And when you're done, Paul
is core. Now I don't even think Peter's rich. I
don't even think the breasts look good after you've done
all these hoops. So you I'm not a believer of
fat transfer to the breast, especially during explantation. You have
to be okay with looking whatever you do. Do not
(32:35):
be fooled by doctors who will mislead you that they're
gonna take out your implants and you're gonna win win,
and they're gonna do light boat and you're gonna get
fat transfer. Holy shit, this is the most common misconception today,
and doctors are making Listen. Doctors are not stupid. They're
very smart people. When there's a trend explantation, they're gonna
get on that wave. And that wave now is oh,
I'm an expert in explanting. Oh, I implants are poison,
(33:00):
and then they're going to play on your insecurity regarding
your implants, and then they're going to create an answer
that is going to be so perfect. So let me
understand this ex plant lift, fat transfer, and I get
lip of the areas that I dislike. Sign me up.
Yesterday you were really clear.
Speaker 2 (33:19):
In fact, I remember asking about transfer, which I failed
to mention earlier, but you said no, no, and you
shut it down because well, A, you didn't think I
had enough places to borrow, but also you had mentioned
that if all of that is done at the same time,
a good portion of that fat is syst absorbed by
the body, so it doesn't be say and there is
(33:41):
it going to go?
Speaker 1 (33:42):
So what's all? What's appointing? Right? That whole space that
the implant comes out of, You can't put fat in there,
there's nothing there. You have to put the fat in
the tissue to fill it in the tissue. It has
to go into the live area, not the empty hole
that's left. It's appie in the sky that plastic surgeons
are doing because so many people want explant and we
(34:03):
don't want to lose them. So for every ten patients
to call us, maybe one will come because I'm like,
I'm not sure I can explain you, and they don't
want to hear that right now. But there are guys
that are advertising left, right and center explan fat transfer
liight boat, sign me up, and you will see patient
after patient after patients so dissatisfied with the esthetic outcome.
They got the implant out. That part alone will make
(34:26):
you happy. But esthetically they do not look feminine. They
do not look attractive. They are not girly, and I
think they didn't expect that. And had you expected that, Okay,
no problem, great, you got your implants out. It's as
good as it is, no problem. But that's not what
they went in being told. And I think that's my
biggest fear for patients, is this sort of trend of explantation.
(34:48):
And then the thing is, I've actually had two patients
come back to me asking me to put the implants back. Sorry,
no go. It's never the same. Once you take that
implant out, it isn't like, oh shit, my bad, you
just put it. Get that pocket collapses, the space gets obliterated.
They've now done a lift. It's a different animal. So
it really is an irreversible decision you're making. And so
(35:11):
all we wanted to do and the reason why I'm
so grateful that you're here, said, I wanted to highlight
this idea because you're in that middle category, and that
middle category actually tends to be the majority. Very few
people want an implant. Can you sign me up? I
wanted to they need an implant for a look. So
(35:34):
when given the opportunity to get rid of the implant
and sold the idea that they can have the look, shit,
absolutely not gonna happen. So all right, Well, any parting
information to anybody who's listening that you're like, God, now
that I did this, whether that's from what you did
from the beginning, from the minute you decided on this
journey back way back when to now that you're sitting here,
(35:57):
if you're best friend, your sister wanted to you any
of this stuff, what would be some of the nuggets
Because you've now had three surgeries regarding your breast, which
is not crazy. My wife's had six spine surgeries, but
you've kind of gone through a very long emotional journey
in those three surgeries. It isn't like I've had three surgeries,
and I just wanted to reach change and replace my breast.
(36:18):
But I've loved them all along, but I've had a
long period of time in which you've been very dissatisfied.
What pieces of nugget would you impart to anyone who's listening, I.
Speaker 2 (36:28):
Would honestly just say that you need to be open
to multiple paths to get to where you want to go,
because there isn't only one option, and that you can't
be too married to an idea of what you're going
to come out looking like. You need to be very realistic.
(36:48):
You need to ideally work with a physician that shares
that and that you trust.
Speaker 1 (36:55):
Yeah, yeah, I agree with I think the problem is
that social media is really fucked things up. Well, that's
what you say. The reason why I say to you
that is because you're saying you want to have realistic expectations.
What when was the last time you looked on social
media and you saw anything but perfection.
Speaker 2 (37:11):
Realism doesn't sell. Realism isn't enough to motivate people to
necessarily go under the knife. But I am happy to
disclose this. I was so excited and happy and grateful
for the work that you did with me that I
trusted you with my most cherished possession was my son. Yes,
(37:32):
and you did accepta rhyinoplasty for him, and it looks extraordinary.
But one thing you said to him, and he was
already you know, he's on late nineteen, you looked at
him and you said, listen, don't don't think that I'm
the guide that you can come in and I'm going
to show you some pictures of what your nose is
going to look like on a piece of software. I
(37:54):
won't do that. And if you meet anyone that's going
to do that, you better run. You were just honest.
You're like, I'm going to get your breathing better, I'm
going to get illus straight as I can, and I'm
going to make you feel a lot better. But I'm
not going to give you a perfect note. Sure, and
guess what I mean.
Speaker 1 (38:11):
You did.
Speaker 2 (38:12):
You gave him a perfect nose, but you gave him
a really great mindset going into it and therefore coming
at it.
Speaker 1 (38:20):
Yeah. No, And I think that's our responsibility, right. I mean,
it is our job as the professional. It's your lawyer's
job as a professional, it's your accountantump. That's why we
call them professions to educate, guide and show patients the
path to their outcome. And that path is not clean
(38:41):
and straightforward. It's a little messy. It's surgery. But I
do think that when you have the right patient and
the right doctor, and you seele liket the right procedure
and you do the execute it, there's nothing more powerful
than the plastic surgery that I do. Nothing. I mean
from your son's experience in that young man's trajectory and
being able to breathe and do exercise and now feel
confident and get married and all that to your journey
(39:02):
of now getting feeling whole again. I mean, that's stratosphere
of experiences of interpersonal relationships. There's nothing like it. So
it's pretty spectacular. And a testimony to that is that
you're here. You came on a Sunday to spend and
share and be exposed and be vulnerable, and we really,
really gratefully appreciate that. So with that, that's going to
wrap up this show of plastic surgery and centered as always,
(39:24):
I'm going to ask you two things. One, if you
like our show, if you love our show, please write
something pleasant. I think that people underestimate the power of
positivity in terms of words. There's a lot of people involved,
the camera crew, the producers, etc. So instead of writing
negative things about how much you hated the hotel and
the food sucked at this restaurant, go write something and
(39:46):
positive about the show. And secondly, you have no idea
who needs this information because by the time you realize
that so and so who's dear to you when and
had something done, it's too late. So if you know,
share this podcast with the people you love because you
want them to listen. Everyone is inclined to the aesthetic world.
(40:07):
It's as small as boatoks to as great as a
mommy makeover, and you're going to want to make sure
that the people you love have access to our show
prior to having done so. So share, download, and subscribe.
As always, thank you very much, Thank you, my dear.
We look forward to seeing you and your son at
your follow ups and more importantly just socially around because
you become a very dear friend. And as always we
(40:30):
uh we appreciate your time. Thanks you all right, guys,
That wraps up another show of classic surgery on Censor
Welcome to another I have to set a plastic surgery
on centent. I'm your host, Doctor rober Raybond, and I
am super excited about our show today. As always, the
show is only interesting if we have someone, a patient,
a dear friend, who will help us through this journey.
We are blessed to have a dear friend and patient
of mine who is going to help us navigate the
idea of explantation. It's a super hot topic. Anyone who's
(00:34):
considering contemplating breast augmentation has heard of things like BII
explantation cap selecting me and these are terms that are
very confusing, breastlist fat transfer. Well, we're going to address
all of that today, but this time through the eyes
and the experience of our patient, Rainer. So welcome to
the show, Rainer, and thank you for coming. We appreciate it.
(00:56):
I'm very excited that you're here because and grateful because
shows don't exist without you. I mean literally, anyone who
knows anything about me knows that I can just talk
about anything at any time. True, but that's not as
exciting as having this banter and dialogue. Not only because
you're interesting to talk to, but you had this experience,
and through your willingness and vulnerability, we're going to discover
(01:17):
a lot of information and I think people are going
to really appreciate. So let's go ahead and start with
your journey. Tell us that basically, when was the first
time that you had breast surgery, and if you can
take us through what it is that you ended up
doing and why you ended up doing it in the
first place.
Speaker 2 (01:32):
Well, as you know, I have two sons nineteen and
fourteen now, but my younger son I breastfed for seventeen
months and I was left with basically the equivalent of
two empty bean bags that you would play a game
of cornhole with. There just wasn't much to my breast
any longer, and they hung low, and they felt like
(01:53):
they didn't belong to me anymore.
Speaker 1 (01:55):
And you're obviously really fit, very thin. You've always been
very lean, so I imagine you didn't have much press
to shoe prior to breastfeeding, let alone afterwards.
Speaker 2 (02:03):
Right now, I certainly didn't, okay, but I decided to
explore what are my options a BREASTLFT. I really didn't know,
so I met with a few surgeons in Los Angeles.
There's a lot of great surgeons here, and I decided
on one, and I was informed that I could have
a breastlift, but probably wouldn't have the volume in the
(02:26):
upper portion of my bra and I should probably consider
a small implant. I was fine with it. My husband
was over the moon rocket.
Speaker 1 (02:34):
And we're talking this was fourteen years ago.
Speaker 2 (02:38):
No, this was eleven years ago, right, eleven years ago.
And I decided to do it and had the lift,
had the small implant put in, and went on my way.
And once I was cleared to start exercising again, I
you know, I did a lot of yoga back then.
At any time I would go into any position that
would engage my pectoral muscles. I noticed that my left
(03:01):
breast drifted. I watched it drifted to the left anytime
I engaged my arms, and it was disturbing and kind
of weird, and I was a little scared. Went back
to the surgeon and was informed that I could be
taken care of with some sort of a piece of mesh.
And I said, okay, And I underwent another surgery and
(03:24):
healed from that, started exercising again, and the same thing
happened sure, and I just I was done. I don't
want anyone to touch me anymore, touch my body anymore.
I was fine, you get what you get, you don't
get upset, and that was it. I went about my
life and fast forward, I would say probably nine years later.
(03:46):
I go for an annual mammogram and ultrasound because with
breast implants, I was told you just want that extra
layer of protection when you're looking for breast cancer. And
during my last mammogram, which was a little under a
year ago, I was informed that one of my breast
implants had encapsulated and a capsulature.
Speaker 1 (04:09):
I thought, you've got cops capsure, contracture.
Speaker 2 (04:11):
And so it Visually it looked like my right breast
was maybe an inch and a half higher, and it
was up into my upper chest air just just not
where they're supposed to be right exactly. There was nothing
natural about it. And you could look at me from
one side you're like, hey, that looks great, and you
look from the other side and it looks like I
(04:32):
just swallowed something and it was bizarre. Additionally, I was
at risk for rupturing, which is scary. There's sublicone. I
don't want that to happen. So I decided to explore
my options.
Speaker 1 (04:45):
Okay, so let's go back into a couple of things.
So the first thing that we want to touch on
is the idea that you about needing or not being
in the implant. I don't think that the individual as
long as you were informed about it. I think the
key is to have the inform So I would have
advised you probably the same, which is here, you are
a lovely, beautiful lady coming to me with two issues
(05:07):
at hand. One is my breasts have sort of lost volume,
and the other is they've also started to sag. And
the sag part is addressed with the lift aka removing
the excess skin, and the volume part can only really
be addressed by adding volume. We're gonna forget about fat
transfer because everyone loves the concept. You're not even a
candidate because you're so lean. But the idea is that
I have to add volume. So if you have a patient,
(05:29):
then you would be that patient who doesn't have a
lot of their own volume. If you do a LYFT,
it's going to be incredibly underwhelming, so much so that
you'll probably wish you didn't have the lyft because now
I still have basically nothing, except now I have a
bunch of scars in exchange, and granted your breast will
sit a little better, you'll have essentially no volume to
your breast such that you will look fuller in any way.
(05:52):
The assumption is if I'm looking fuller porn start. No,
we have one hundred and forty CC implants. They're that big.
They're literally the size of a small doughnut. So it
doesn't mean that you need to be huge. And I
think the idea of doing the lift with an implant
was a correct one. Whether or not that's executed correctly,
that's a whole different animal. The second thing you were
talking about, which was when I would activate these implant,
(06:15):
especially the one on the left, would shift all the
way to the right. That's called something called animation deformity,
and a small amount of it is normal. Right. The
implant's use should go under the muscle. So therefore, when
you fire your muscle, especially downward dog bench press flies,
that muscle will fire. That muscle will then tighten, and
(06:37):
that implant will then move. That's normal. But what you
were experiencing is more than just animation deformity. When you
were experiences that pocket was not correctly dissected, and so
when it would move, it would bulge abnormally in certain
places more than others. So that's the second thing. The
third thing is this idea of capture contraction, which unfortunately
(06:58):
still is sort of the art nemesis of breast implants.
And essentially what it is is that, for whatever reasons,
every person who has an implant in their body makes
scar tishe around it. It doesn't matter what the implant is, prosthetic, knee, heart, valve, pacemaker.
Your body's going to say, oh, this thing doesn't belong
here and make a shell around it and protect you
from it. And that shell is normally thin, and you
(07:19):
don't care, and you go live your life. Some people
and some bodies tend to start making a thicker, more
voracious scar tissue, which is not dangerous. It's not going
to kill you. It's just going to annoy you because
it's going to start changing the shape of this perfectly
round structure. And they first tend to notice is like,
holy shit, this one's all the way up here. How
(07:40):
did you get up here? And then hmm, this is
so much harder than this one, And that's because of
the squeezing effect of that capsule. When did you start
noticing that when you looked in the mirror and you're like, WHOA,
this doesn't look right. When did just that start happening?
Speaker 2 (07:54):
It was gradual. I mean there were many years. I
was extraordinarily happy with the Great implants.
Speaker 1 (07:59):
I really was.
Speaker 2 (08:00):
I lived with the animation deformity, and I just sort
of went back. But I mean I was happy. I
was definitely happy. I felt the volume. I felt very feminine.
I would say probably eight and a half nine years in.
Speaker 1 (08:13):
Great So it was towards the end that that that
started happening. All right, So now we fast forward. Here
you are. You did your ultrasound, you did your mammogram
to telling you that it might be ruptured. Maybe not.
In addition, just flat out you're looking at yourself and
you're like, now there's a decent amount of asymmetry, and
it's very hard to hide asymmetry. Yes, that is the
number one complaint that I have when people come to
(08:34):
my practice. It isn't even so much that it's hard
or I don't like the shape. It's I can't conceal
this asymmetry. And so you didn't then decideed have to
do something about it. Your sort of hand was forced
to do something. I'llbe around ten to fifteen years. You
probably should have changed the implants anyways, So you got
a you got a good lungevycast at first. You've got
(08:55):
a good run. Okay. So now you are here, you
are you have to go about it. So take me
through what you do now with these three things in place, animation, deformity,
right capture, cantracture, and breast asymmetry. So tell me what
you do.
Speaker 2 (09:10):
Still living in Los Angeles, I have access to amazing
surgeons everywhere. I started asking around, did some research, and
I met with two other very reputable surgeons, one of
whom specializes in breast reconstruction. So I thought, this has
got to be the way to go. And it was
a woman, so that was a different even level of
(09:33):
understanding and empathy. And the response I got from both
of these surgeons separately was very similar, which was no problem.
You've got a capsular contraction. We can explant your implants
and fix the capsule. As far as the animation, we
can put some mesh in there and I don't even
(09:54):
know how I'll say described it, and then we can
put new implants back in and off you go. That
was an ideal for me, not because I was against implants,
but because, well, if I already created a capsule, was,
why wouldn't I just do it again? Sure, and maybe
this time sooner, and I just don't want to do that.
So my end goal was, in addition to feeling good
(10:18):
and keeping my body healthy and safe, was to not
necessarily have to have implants.
Speaker 1 (10:23):
Right, So let's talk about size in general. So there's
the issues associated with the implants, which you're you eloquently said.
It's like, hey, I made this capsule before, what's to
say I won't make it again? And the truth of
the matter is that there is nothing to say that
you won't make it again. It is a risk, and
albeit it took eight years or so, you could develop
it again. But let's just talk about sheer size. Do
(10:45):
you remember what size implant was there originally?
Speaker 2 (10:47):
Well, okay, so I had two separate sizes because it
had naturally symmetry to begin with. I want to say
it was like a one eighty and a two ten.
Speaker 1 (10:54):
Ag so one eighty two to ten it sounds about right,
And in general, those are very small implants. However, it's
all relative and on your tiny little frame, which is
very thin and you don't have a lot of volume
on your chest. One eight, two, ten, may seem much
larger than perhaps even what you liked. So if you
take size alone, forget about all the other issues. My
(11:16):
understanding is that you wanted to be smaller in general.
You liked that look of just smaller.
Speaker 2 (11:22):
Yes, yes, I like that liko smaller. And also because
of where my implants sat in my body, not just
the one that was encapsulated, it looked messy, like if
I were t hanged top. I just you know, I
felt very self conscious.
Speaker 1 (11:37):
So okay, so then you and I me, and you
come to see me. The things that I picked up
on when I met you, I think the biggest element
of all the things that you're talking about for me
was the asymmetry. It wasn't that they were big, wasn't
that they were small. It wasn't even that both breasts
were high. It was that your right and left breast
were far enough separated in terms of differences in the
(11:59):
way they look that I could imagine that it would
become very cumbersome to dress and you always dress elegant,
and you couldn't. I can only imagine trying to conceal that.
So to me, that was the biggest element. So we
chatted right and we talked and what did I tell
you regarding the idea? What did? What did? What did
I tell you? What did we decide?
Speaker 2 (12:18):
So, first of all, when I met you, it was
the most refreshing thing because I didn't I didn't yet
know we had a dear friend in common. But you
had said to me, I can't make any promises that
you're going to walk out of here and look perfect.
That is that is I can promise you that I
am going to tell you what I can do. And
(12:40):
you were so honest with me, and you looked at me.
You told me exactly medically what was going on, capsular contracture,
animated deformity, and that you would go in, we do
a lift, you'd fix the capsule, and you know, there's
a chance we'd do implants again, and otherwise, if I
can solve it to a breast tissue you have, I'll
(13:01):
try to do that too.
Speaker 1 (13:02):
You're very honest.
Speaker 2 (13:03):
It was sort of like, let's just get in there
and see. And that gave me an addition to giving
me a lot of comfort, because you were just very,
very honest. It gave me some hope too, which was
an exciting feeling, just to know that there's a chance
that I could get away with having the look that
(13:24):
I wanted overall, which was not necessarily anti implant, but
just smaller, more petite, and more fitting of my bust.
Speaker 1 (13:32):
Sure, So the way I approach so XPLIN is a
tough topic for me as a surgeon, and it's a
hot topic now because we have this, we have this
EBB and flows in plastic surgery and plastics and implants
and plastic surgery are a buzzword. They're a hot topic
because there's a really strong divide and there is a large,
(13:52):
large subset of individuals. They don't make up a large
number of individuals, but they make up a very focal
number of individuals who have issues with implants. Just like
people have issues with hip prosti prostheasis. My wife had
issues with their spine hardware. There are implants, there are
foreign devices, and there's a large substantial number of people
who have a general condition called BII or breast implant
(14:16):
illness and essentially what that is, and nobody knows yet
and maybe in five years and ten years and twenty
years will know exactly what that is. But the way
I see it is as follows. When an implant goes
into your body, your body knows it doesn't belong there.
It knows that that's not a human tissue, and it
will separate that tissue from your body and protect you
(14:36):
from it and wall it off and make scar tissue
around it. And that's the capsule that every human being has.
In the overwhelming majority of people, that process is finite.
It makes the scar tissue and then it calls it
a day. But I believe in that people who have
BII their bodies are continuously trying to manage this thing.
(14:57):
It's like it's constantly set in the troops, and like
a computer, the hard drive is an overdrive, and therefore
things are running slow in the background. So they're developing
symptoms like fatigue, hair loss, muscle joint pain, and things
of that nature, which we would call constitutional symptoms. They
(15:19):
don't feel well. So that's not a new topic. That's
been around for a long time and then it kind
of disappeared and now it's come up again. And social
media is a very big driving force. So what's happening
now in plastic surgery is we're having a sizeable number
of people coming to us saying, hey, I want my
implants out, no problem, I have no problem with that.
But simultaneously they want to look good. And so the
(15:43):
problem that at least I'm facing is I want to
honor the patient's wishes of wanting the explant. It's not
my body. You can do a mastectomy if you want.
At the same time, I know as the surgeon, I
know as the artist, I know as a person that's
in surgery that they may not have sufficient breast issue
to create anything that would be arguably attractive. And that's
(16:08):
a real problem because I believe that they may not
fully understand what they're asking for. Now. My sister had
breast cancer. My sister had a double masstec. To me,
just you had to like, you have no breas, you
have no breast, you do because you were dying of
this disease. And if your illness is so strong that
you don't care what you look like, I understand. But
(16:29):
in the milieu of people coming in asking for explans,
there are a lot of women who don't really have
BII and they're sort of just getting swept into this.
The current of implants are bad, mind you. Now, the
overwhelming majority of people in the world who have implants
love their breast implants. So this is a small subset.
(16:51):
So my concern with you, and the reason why I
was so honest with you, is because you are so lean,
you are so fit, And what was I worried about.
I was worried that I got your tube rest implants.
I do the capsulect me fix da da da da da,
And then I would go to do a lift and
be like, wow, there's nothing here or not sufficient here
whereby which I feel and at the end of the
(17:13):
day you're asleep that you would feel comfortable attractive Because
if I told you I'll fix everything, but you get
a mass stect to me, would you sign up for that? Now?
You wouldn't You just wouldn't sign up for it. Yes,
I don't like this asymmetry. Yes I don't like anything
about this, but this is better than a mastectomy. So
I try to fight that fight on behalf of patients.
(17:33):
And what I always offer them is which what I
would want someone to offer my wife is I'm gonna
go in and I'm gonna definitely die trying and if
I can if I feel like it's acceptable that you
understand it's not going to look like a supermodel, but
it's acceptable. I absolutely will explain to you. However, if
I take out the implant and I'm like, wow, that
(17:55):
doesn't look good at all, what do you want me
to do? You want me to leave you like that?
And most patient who are not in the true biid
category illness wise or like well, I want the smallest
implant you can give me because they are concern is
that they don't want to live that lifestyle they used to.
They've outgrown it. Implants was great then, but not now.
So we're going to take a quick break. We're gonna
(18:16):
come back and then let's talk about what we did
end up doing. Absolutely, and then we're going to talk
a little bit about what your advice is moving forward
on how to navigate this. If you are at home
listening and you are in that, I consider it three categories.
I love my breast implants, I have BII and I
don't give a shit. I want them out, and I'm
in the middle, and I think I want to go smaller.
I want to get rid of them, but I don't know.
(18:36):
So I want you you and I going to talk
to those people in the middle here. Let's take a
quick break. We'll be right back with the second half
of plastic surgery on sensor. Welcome back to the second
half of plastic surgery on censored. All right, So Ray
now and I are digging in, and I know all
of you been at the edge of your seat. So
Ray now, you go into surgery, you go to sleep,
(18:58):
you wake up, and what happened. Wow.
Speaker 2 (19:02):
First of all, this is one of my favorite parts
of this whole experience I had with you. So you know,
I didn't see you after. I know the surgery went well.
I was told I don't remember much.
Speaker 1 (19:13):
I go home.
Speaker 2 (19:14):
Recovery wasn't that bad. The pain wasn't that bad. One
thing you made extraordinarily clear to me prior to surgery,
which was do not push pull anything larger, bigger, heavier
than five pounds for six weeks. I was lily relative,
So I really followed your directions. And when I saw
(19:35):
you for the first follow up appointment, I had bandages,
I had a special brawl. I couldn't shower. That was rough.
I saw you a week later.
Speaker 1 (19:45):
I come in.
Speaker 2 (19:46):
You took off the bra you took off the bandages.
You asked me to stand and read of the mirror,
and I remember looking and I was blown away. They
were pretty damn symmetrical, I have to say. I mean,
I was extraordinarily impressed. They were lifted, they were shaped
like a breast. I mean, they were just they looked
(20:07):
from each side. One wasn't significantly higher or harder than
the other. And you looked at me. By the way,
I had no idea, and you looked at me and
you said, I didn't think we'd be able to do it.
But I got in there and you had enough breast
to shoe. At this point, I did not know I
(20:27):
didn't have an implant, so I was wet, and you
said yeah. And I don't even know if you thought
I knew, but I didn't know.
Speaker 1 (20:38):
I did not. I did not know.
Speaker 2 (20:42):
So I was extraordinarily happy. I left here, still couldn't drive,
and I standing right outside waiting for my husband. I
called him and I said, you're not I don't want
to curse, and I don't think I'm allowed to curse, but if.
Speaker 1 (20:54):
I were, there would be allowed.
Speaker 2 (20:59):
Because censored. And I call my husband. His name is David,
I said, David. One you're not fucking gonna believe this.
And he's like, what I said, I don't have an
implant because long pause, Yes, did he forget? And I'm like, no,
I didn't forget. And when he was just he was
so happy because he knew my goal was not necessarily
(21:22):
not to have implants, but to have a look that
fit my body. And the fact that it was achieved
without an implant.
Speaker 1 (21:28):
Even better, even better. Absolutely, absolutely, I was thrilled. He
was surprised.
Speaker 2 (21:34):
It was pretty funny, the overall experience, but I was
so happy. I was happy with the look. I was
happy with the feel. I already felt better even wearing
you know, the cotton bra that has eleven snaps in
the front, but with a tank top, I didn't have
to worry about concealing what I always did. Sure, those
Turblenicks went to the back of my mind.
Speaker 1 (21:56):
Yeah, And for me, the most powerful part of that
was the idea that you know, here, you are this
beautiful lady. You always dress elegant every time I see you,
And then when I would see you in the office
and I saw that what you were managing, it always
I have this sort of a man. I'm not a woman,
so you know, but my wife is an elegant woman,
(22:18):
likes to dress. She seeks so much joy at being
able to adorn herself with a clothing that represents what
she likes. And when you are, when you're dealing with
this thing underneath that no one knows, and I can
only imagine how many of your girlfriends actually knew what
your breasts looked like towards the end, and sort of
the asymmetries and what it's like during intimacy and all
(22:38):
those things. That's for me a very powerful feeling, even
though I'm a man, because I know that for women,
as like for men, their hair is a very big
symbol of who they are, and when you lose it,
it's a really big deal. And for women, their breast
is a very big symbol of their own femininity and
how they connect to their own sexuality. And so it
(22:59):
was a great feeling to be able to not only
create breasts that were like beautiful and symmetrical and all
those things, but one that was congruent with what you
thought would look good on you, right, not what I thought,
or your husband did or whatever, but you did. And
the trith matter is as interesting as it is you
had gained some breast tissue, which is not the case
then prior, because you know some women as they get
(23:21):
older they lose breast issue, and some women in your instance,
as a result of I think as your second child,
gained some breast tissue. So you had not a lot,
but you had something there and so nothing makes me happier.
But the key to this was that you were open
to the possibility of if I need it, then find
you what you need to do. And for me, as
a surgeon, that's the only patient I'm going to operate on.
(23:43):
Because had you said to me, no, no, no, I
don't want an implant under any circumstances, but they got
to look pretty, I wouldn't do your surge because you
didn't create a scenario that's not winnable. I have done
the surgery, and I have told patients they well not
look pretty, and they have signed a consent that's I
understand that my breast will not look attractive. And I'm
happy to help you in your journey. But if you
(24:05):
want me to do your surgery and then you're gonna
hold me accountable for the way they look, and you're
not letting me do what I need to do well,
then we can't do this dance. So you allowed us
to do that journey. And your openness was very very
important because some people are very abstinent about their wants
and they just think that plastic surgery is magic and
it's not. So not that you're in your How long
(24:27):
ago was our surgery? It was March five, two twenty three.
We're talking about six months, so you're well into the
rhythm of your life. Yeah, absolutely right. You get to
buy aware what you want, You're going to the gym.
You are now this new person, right, and you recall
it just six months ago not being that person. How
(24:48):
has this impacted your life in the different categories? Wow?
Speaker 2 (24:54):
Well, in addition to being able to not have to
plan out when I'm gonna wear, which was very typical
occurrence for me, I just I felt like obscene looking
before I or anything that was not even low cut
because I don't order low cut, but anything that was
too form fitting. I was very self conscious, and I mean,
(25:15):
I feel great. I feel like I don't have to
think about it, is the truth. I don't there's there's
no planning, so I don't think about it, right, right?
Speaker 1 (25:23):
That is a very powerful statement, which is I stopped
thinking about my breast. My life then doesn't revolve around
my press anymore. Yeah, and the instance of intimacy, was
there ever an issue recouting that I felt? Well that
in your camp, Well that's all that matters. Mental. I
can't talk about this every single con Men don't care.
They care when you care.
Speaker 2 (25:43):
Yes, because that comes through right in how you relate
sexually and how you feel about your sexuality. Yeah, I
was self conscious. I would definitely, you know, try to
wear something or and then if my husband were to
remove that, I'd be.
Speaker 1 (25:57):
Like, excuse me, so right?
Speaker 2 (25:59):
Or I didn't want to necessarily you know, certain positions
if I were laying flat, I was really self conscious.
Speaker 1 (26:07):
Sound is I'm assuming that you don't think about it.
They're either during individy.
Speaker 2 (26:12):
I don't know. Definitely.
Speaker 1 (26:14):
I think that's like, that's fucking amazing critical moment in
our being. Intimacy is one of those little areas where
you're in a very special space in life when you're
into it with someone. And to be fully free during
intimacy versus conscious during intimacy is like two different experiences altogether.
So that I think is just says it all, and
(26:36):
it's so phenomenal. So if I'm at home and i'm
you know, as I said to you, there's three categories.
There's people who have no issue with implants. Great, okay, fine.
There's people who, under no circumstances, want to implant if
they have it, they want it out, they don't care
what they look like. Fine, But then there's a large
subset of individuals who are living in this sort of limbo.
That limbo is I'm neither here nor there. I don't
(26:58):
love my breast, I don't hate my implants. I'm just
sort of not happy with my breast, and that breast
then bleed into my intimacy, what I wear, and so
on and so forth. So if I'm a woman and I'm
listening and I'm that middle category, what are some of
the advices, then suggestions and your experience they like, Wow,
(27:18):
if I could have done this earlier. What are the
things that you think of when you're advising friends now
regarding their middle where they're stuck in the middle.
Speaker 2 (27:26):
Well, first of all, I just want to say to you,
I do agree that the voices that tend to be
the loudest are our people with grievances you know about.
And I also I believe in, you know, breast implant illness,
but I also think that typically, and I don't know
if this is always true, but there's some sort of
(27:47):
autoimmune issue going on just in general. And so I
think that when, if and when or if you believe
you have breast implant illness, that's something that you should
explore first and see if you actually have any sort
of on immune issues going on, because that's if you've
been okay for a really, really long time with your implants.
I don't know if it necessarily comes out of nowhere.
Speaker 1 (28:09):
I don't. I don't, and the truth is that we don't.
The reality is that we don't know enough to know now.
And all I know is if you feel adamant that
you want tom out, knock yourself out. Just like there
are people now getting mastectomists who want to transition into
being a math. I'm not here to question you or
judge you, but there are that middle group of people
who don't hate their implants because they're too implants right,
(28:31):
but then are stock and they're not happy with the
way they look, and then they're afraid of moving that direction.
So what do you what do you What would you suggest?
Speaker 2 (28:40):
I would suggest first figuring out for yourself what's important
are what are my goals?
Speaker 1 (28:45):
Are my goals to just at any cost sort of.
Speaker 2 (28:52):
Have them removed and or fixed so that you don't
have to even think about any sort of potential rupture
and or anything. But aesthetically is what they look like
is not as important. I just think you have to
figure out what your goals are. In my case, I did.
I wanted them to look feminine and sexy and like me.
(29:13):
So once I knew that, once I had that established
and I met with different surgeons, I think you need
to ask that question. And I think, honestly, there's only
one answer. There's no definitive answer. There's one answer, which is, well,
let's wait and see. You cannot tell. I don't think
how much rest tissue person actually has what you'll be
(29:34):
left with until you're in there, And so that kind
of trust between you and your physician is really important.
Speaker 1 (29:40):
Yeah, and I think you hit it on the head.
I mean, I think that the reality is that you
know what I've experienced because I've done this a lot,
is that I tend to operate on the people who
are just like you, which is, hey, he are my wants?
What's your wants? My once is I want them to
be more more. Notice the word more symmetrical and not
the word symmetrical. Right, you're it's an anomal We got
you as symmetrical as we did because you started out
(30:02):
so asymmetrical. But the goal was to get you asymmetrical
as possible. I'd like to be smaller, and I'd like
not to have an implant if I can. And the
if is predicated around, well, if you the surge and
the person i'd feel that it's ugly, please put it
in the implant that would make me still look feminine.
But why don't I want it to be no bigger
(30:24):
than this. And when a patient is open to that,
then I can go in and do what I need
to do, because then I know that I have wiggle room.
And so to me, I think that that's really critical
and that you have to as a patient be sure
that you pick aside, which you can't do. When I've
reiterated on many occasions, it insists that you want the
implants out because you're just over it, and then demand
(30:45):
that at the same time you want it to look
beautiful and feminine because there's a misunderstanding. The misunderstanding is
that a breast lift, and now even worsened by the
fact the fat transfer, a breast lift in and of
itself is going to do the math. No, it will not.
If you have no breast tissue, no breast lift on
the planet is going to do shit. Furthermore, and worsened
(31:09):
by the situation is this concept of fat transfer. So
I'm going to just take a moment here. The idea
is that we take out an implant two hundred CC's.
That is a small implant, but it is two hundred
ccxact times two four hundred CC's, and I'm going to
take out that implant and then I'm going to replace
(31:30):
that implant with some degree of fat. First question, where
the hell am I getting it from? Where? Oh? I
don't know. They'll get it from my back, my arms,
my inner thise, my love handles, and my abs in it. Okay, great.
So if you need four hundred ccs volume, know that
about fifty percent of it dies. So now I need
eight hundred CC's. Know that if you have eight hundred CC's,
(31:52):
that means that when you aspirate and you suck out
half of it is fluid. Now I need sixteen hundred CC's,
so all of a sudden, you need a load of
life suction. And the problem I have with high volume
fat transfer butt and or face, I mean butt and
or breast, not face, is that you cause damage in
(32:13):
the areas you borrow to fix the breast. It's stealing
from Paul to pay Peter. And when you're done, Paul
is core. Now I don't even think Peter's rich. I
don't even think the breasts look good after you've done
all these hoops. So you I'm not a believer of
fat transfer to the breast, especially during explantation. You have
to be okay with looking whatever you do. Do not
(32:35):
be fooled by doctors who will mislead you that they're
gonna take out your implants and you're gonna win win,
and they're gonna do light boat and you're gonna get
fat transfer. Holy shit, this is the most common misconception today,
and doctors are making Listen. Doctors are not stupid. They're
very smart people. When there's a trend explantation, they're gonna
get on that wave. And that wave now is oh,
I'm an expert in explanting. Oh, I implants are poison,
(33:00):
and then they're going to play on your insecurity regarding
your implants, and then they're going to create an answer
that is going to be so perfect. So let me
understand this ex plant lift, fat transfer, and I get
lip of the areas that I dislike. Sign me up.
Yesterday you were really clear.
Speaker 2 (33:19):
In fact, I remember asking about transfer, which I failed
to mention earlier, but you said no, no, and you
shut it down because well, A, you didn't think I
had enough places to borrow, but also you had mentioned
that if all of that is done at the same time,
a good portion of that fat is syst absorbed by
the body, so it doesn't be say and there is
(33:41):
it going to go?
Speaker 1 (33:42):
So what's all? What's appointing? Right? That whole space that
the implant comes out of, You can't put fat in there,
there's nothing there. You have to put the fat in
the tissue to fill it in the tissue. It has
to go into the live area, not the empty hole
that's left. It's appie in the sky that plastic surgeons
are doing because so many people want explant and we
(34:03):
don't want to lose them. So for every ten patients
to call us, maybe one will come because I'm like,
I'm not sure I can explain you, and they don't
want to hear that right now. But there are guys
that are advertising left, right and center explan fat transfer
liight boat, sign me up, and you will see patient
after patient after patients so dissatisfied with the esthetic outcome.
They got the implant out. That part alone will make
(34:26):
you happy. But esthetically they do not look feminine. They
do not look attractive. They are not girly, and I
think they didn't expect that. And had you expected that, Okay,
no problem, great, you got your implants out. It's as
good as it is, no problem. But that's not what
they went in being told. And I think that's my
biggest fear for patients, is this sort of trend of explantation.
(34:48):
And then the thing is, I've actually had two patients
come back to me asking me to put the implants back. Sorry,
no go. It's never the same. Once you take that
implant out, it isn't like, oh shit, my bad, you
just put it. Get that pocket collapses, the space gets obliterated.
They've now done a lift. It's a different animal. So
it really is an irreversible decision you're making. And so
(35:11):
all we wanted to do and the reason why I'm
so grateful that you're here, said, I wanted to highlight
this idea because you're in that middle category, and that
middle category actually tends to be the majority. Very few
people want an implant. Can you sign me up? I
wanted to they need an implant for a look. So
(35:34):
when given the opportunity to get rid of the implant
and sold the idea that they can have the look, shit,
absolutely not gonna happen. So all right, Well, any parting
information to anybody who's listening that you're like, God, now
that I did this, whether that's from what you did
from the beginning, from the minute you decided on this
journey back way back when to now that you're sitting here,
(35:57):
if you're best friend, your sister wanted to you any
of this stuff, what would be some of the nuggets
Because you've now had three surgeries regarding your breast, which
is not crazy. My wife's had six spine surgeries, but
you've kind of gone through a very long emotional journey
in those three surgeries. It isn't like I've had three surgeries,
and I just wanted to reach change and replace my breast.
(36:18):
But I've loved them all along, but I've had a
long period of time in which you've been very dissatisfied.
What pieces of nugget would you impart to anyone who's listening, I.
Speaker 2 (36:28):
Would honestly just say that you need to be open
to multiple paths to get to where you want to go,
because there isn't only one option, and that you can't
be too married to an idea of what you're going
to come out looking like. You need to be very realistic.
(36:48):
You need to ideally work with a physician that shares
that and that you trust.
Speaker 1 (36:55):
Yeah, yeah, I agree with I think the problem is
that social media is really fucked things up. Well, that's
what you say. The reason why I say to you
that is because you're saying you want to have realistic expectations.
What when was the last time you looked on social
media and you saw anything but perfection.
Speaker 2 (37:11):
Realism doesn't sell. Realism isn't enough to motivate people to
necessarily go under the knife. But I am happy to
disclose this. I was so excited and happy and grateful
for the work that you did with me that I
trusted you with my most cherished possession was my son. Yes,
(37:32):
and you did accepta rhyinoplasty for him, and it looks extraordinary.
But one thing you said to him, and he was
already you know, he's on late nineteen, you looked at
him and you said, listen, don't don't think that I'm
the guide that you can come in and I'm going
to show you some pictures of what your nose is
going to look like on a piece of software. I
(37:54):
won't do that. And if you meet anyone that's going
to do that, you better run. You were just honest.
You're like, I'm going to get your breathing better, I'm
going to get illus straight as I can, and I'm
going to make you feel a lot better. But I'm
not going to give you a perfect note. Sure, and
guess what I mean.
Speaker 1 (38:11):
You did.
Speaker 2 (38:12):
You gave him a perfect nose, but you gave him
a really great mindset going into it and therefore coming
at it.
Speaker 1 (38:20):
Yeah. No, And I think that's our responsibility, right. I mean,
it is our job as the professional. It's your lawyer's
job as a professional, it's your accountantump. That's why we
call them professions to educate, guide and show patients the
path to their outcome. And that path is not clean
(38:41):
and straightforward. It's a little messy. It's surgery. But I
do think that when you have the right patient and
the right doctor, and you seele liket the right procedure
and you do the execute it, there's nothing more powerful
than the plastic surgery that I do. Nothing. I mean
from your son's experience in that young man's trajectory and
being able to breathe and do exercise and now feel
confident and get married and all that to your journey
(39:02):
of now getting feeling whole again. I mean, that's stratosphere
of experiences of interpersonal relationships. There's nothing like it. So
it's pretty spectacular. And a testimony to that is that
you're here. You came on a Sunday to spend and
share and be exposed and be vulnerable, and we really,
really gratefully appreciate that. So with that, that's going to
wrap up this show of plastic surgery and centered as always,
(39:24):
I'm going to ask you two things. One, if you
like our show, if you love our show, please write
something pleasant. I think that people underestimate the power of
positivity in terms of words. There's a lot of people involved,
the camera crew, the producers, etc. So instead of writing
negative things about how much you hated the hotel and
the food sucked at this restaurant, go write something and
(39:46):
positive about the show. And secondly, you have no idea
who needs this information because by the time you realize
that so and so who's dear to you when and
had something done, it's too late. So if you know,
share this podcast with the people you love because you
want them to listen. Everyone is inclined to the aesthetic world.
(40:07):
It's as small as boatoks to as great as a
mommy makeover, and you're going to want to make sure
that the people you love have access to our show
prior to having done so. So share, download, and subscribe.
As always, thank you very much, Thank you, my dear.
We look forward to seeing you and your son at
your follow ups and more importantly just socially around because
you become a very dear friend. And as always we
(40:30):
uh we appreciate your time. Thanks you all right, guys,
That wraps up another show of classic surgery on Censor
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