Navigating Breast Implant Surgery Risks with Dr. Thomas Chung

Breast implants are said to be a transformative solution for individuals seeking aesthetic enhancement or breast reconstruction. However, beneath their promise of confidence and beauty lie potential risks that are often overlooked. Breast Implant Illness (BII) underscores the importance of thorough patient education and informed consent, highlighting the complexities and implications associated with implants. That is why there is a need for us to raise more awareness about the realities of breast implant surgery, ensuring that patients are fully informed about the risks and potential consequences.

I'm thrilled to introduce our guest for today's episode – Dr. Thomas Chung. We share a similar background in terms of experience and training, which initially intrigued me since he has a clear and insightful understanding of breast implant illness, and we'll delve into that throughout this episode.

Plastic surgery career, including microsurgery and breast reconstruction

What struck me about Dr. Chung is his extensive experience in microsurgery, a field in which we've both worked. Dr. Chung's journey began with his training in the Navy, where he completed his internship and general surgery residency at Walter Reed, then part of the National Naval Medical Center consortium in DC. During his residency, he managed numerous casualties from conflicts like Fallujah, serving as chief of the trauma service with a daily census of 30 to 40 injured veterans. After finishing his general surgery training, he pursued a fellowship at Johns Hopkins, launching his plastic surgery career before returning to Walter Reed to handle more trauma cases.

His work involved extensive microsurgery, such as reconstructing an entire abdominal wall for a survivor of a suicide bombing and performing numerous extremity-free flaps and breast reconstructions using deep inferior epigastric perforator (DIEP) flaps. Over the first seven to eight years, Dr. Chung climbed the Navy's ranks, taking on leadership roles like Chief of Surgery, Chair of the Medical Executive Committee, and ultimately Chief Medical Officer for the San Diego region.

Dr. Chung remains passionate about plastic and aesthetic surgery despite his executive responsibilities. Notably, he performs many explant surgeries for patients experiencing issues after long-term breast implant use.

Immunosuppression in organ transplants and chronic inflammation

In my previous episodes, I've extensively discussed breast implant illness and Dr. Chung agrees that implants may cause more than just localized pain or discomfort. He believes there's something inherently toxic about implants that science can explain and this understanding aligns with groundbreaking surgical advancements by the Nobel Prize winner, Dr. Joseph Murray. Dr. Murray's work on organ transplants demonstrates the need for immunosuppression to prevent rejection.
In transplants, immunosuppression is crucial to avoid rejection, but this concept can also apply to implants. Patients often react negatively to treatments like steroids or methotrexate, fearing the medications rather than understanding their role in managing symptoms.

We see chronic inflammation in patients with implants, similar to organ rejection. In both scenarios, if the initial post-surgery period goes well, complications are less likely. However, issues during this time can lead to significant problems. For cancer patients undergoing reconstruction, immunosuppression can exacerbate complications, demonstrating the delicate balance required to manage immune responses.

Transplant rejection and the use of splint analogy to explain the concept

Using analogies from organ transplants helps patients understand that their bodies might be "rejecting" implants, causing chronic inflammation. This perspective can help them grasp the need for proper management and treatment strategies, even if those include higher doses of immunosuppressants like prednisone to manage their symptoms effectively.

When it comes to resolving issues with breast implants, focusing on the concept of explants and the importance of addressing capsules surrounding the implants is vital. We use the splinter analogy to explain the body's reaction to foreign objects. Just as a splinter in your finger causes pain and inflammation until it's removed, so does the body react to implants, leading to discomfort and potential toxicity. Removing the splinter provides immediate relief, compared to the relief patients might experience after explant surgery.

Dr. Chung appreciates the simplicity of this analogy, which helps patients understand the body's rejection response. He relates it to his experience on transplant rotations, where managing immune responses to transplanted organs was crucial. He emphasizes the importance of detailed procedures in removing implants, akin to meticulous methods used in cancer surgeries to reduce recurrence risks.

Breast implant illness, implant removal, and fat transfers as an alternative

Both Dr. Chung and I have extensive experience dealing with complications from implants, whether in cancer patients or veterans needing reconstructive surgery. We emphasize that implants can be a necessary part of treatment but also come with risks that must be clearly communicated to patients.

Dr. Chung admitted that he initially didn’t know much about implant-related issues despite performing many breast augmentations. He often dealt with patients who had capsular contracture, a condition where the scar tissue around the implant tightens and causes pain or deformity. In these cases, he would remove the implant and the capsule and then insert a new implant, only for the problem to eventually recur.

I would like to highlight fat transfers as a viable alternative to implants. Fat transfers can help refine and improve reconstructive results by adding volume, achieving a natural look without the risks associated with implants. Dr. Chung supports this approach, noting that while fat transfers don’t create the same pressure as implants, they offer a safe and effective option for many patients.

Fat transfer vs implant for breast augmentation, with pros and cons for each method

Implants provide more projection and pressure, pushing out the skin envelope, especially beneficial for patients with tighter skin or certain deformities like tuberous breasts. Fat transfers, on the other hand, follow the natural curvature of the breast, adding volume and creating a natural look without the risks associated with implants.

Fat transfers are particularly effective for patients who have more lax skin, often due to previous pregnancies, breastfeeding, or prior implants, which act like tissue expanders. While fat transfers don’t provide the same upper pole fullness or projection as implants, they can achieve a satisfactory result by filling out the skin and providing a natural appearance. The success rate of fat transfers is generally high, especially in younger patients with adequate fat, countering any misconceptions that they don't work well. This method is also frequently used in oncologic reconstruction to refine and improve outcomes.

The success of fat transfers is influenced by various factors, each playing a significant role in determining the outcome of the procedure. One crucial factor is the age of the patient. Younger individuals, typically those in their 20s, often experience better outcomes from fat transfers. This is attributed to their more favorable hormone levels and metabolism, which contribute to enhanced tissue regeneration and integration of the transferred fat. Additionally, younger patients tend to have healthier skin with better elasticity, allowing for more seamless integration of the injected fat and resulting in a more natural appearance.

Conversely, older patients, particularly those over the age of 35, may encounter challenges that can affect the success of fat transfers. Hormonal imbalances, a common occurrence with age, can impact the body's ability to heal and regenerate tissue effectively. Metabolic issues, such as slower metabolism or insulin resistance, can also hinder the body's ability to process and integrate the transferred fat. Furthermore, poor diet and nutritional deficiencies prevalent in some older individuals can compromise tissue health and overall healing capacity, leading to suboptimal outcomes from fat transfer procedures.

On the technical aspects of fat transfer, there is about 20-30% of the injected fat that typically gets absorbed by the body. This process is influenced by the patient's skin condition, with factors like previous pregnancies, weight changes, and age affecting skin expansion and the overall success of the procedure.

It's essential for patients and surgeons to recognize these factors and consider them when planning and performing fat transfer procedures. Tailoring the approach to address specific challenges associated with age can help optimize outcomes and ensure patient satisfaction. Moreover, implementing comprehensive preoperative assessments and postoperative care regimens that address hormonal balance, metabolic health, and nutritional status can further enhance the success of fat transfer procedures in older patients.

We want to emphasize that the technical process of fat transfer—harvesting, processing, and reinjecting fat—is not the issue. Instead, the patient's overall health and wellness play a critical role in the success and maintenance of the results. That’s why I developed a comprehensive program that addresses genetics, detoxification, toxicity issues, gut health, food sensitivities, and hormone balance to optimize recovery and maintain results.

Visit our website at https://drrobssolutions.com/ to explore our range of solutions, including high-grade supplements, medical-grade skincare, lab testing, and expert advice. Whether you're recovering from surgery or seeking to enhance your overall wellness, Dr. Rob's Solutions provides the resources and support you need to achieve your goals.

Don't let uncertainty hold you back. Trust the experts at Dr. Rob's Solutions to guide you on your journey to healing and wellness.

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About Dr. Rob

Dr. Robert Whitfield (https://www.drrobertwhitfield.com/dr-whitfield-2/)
In 2012, Dr. Whitfield came to Austin and became renowned for his breast surgery expertise. He set up his own practice in 2017. Here, he offers the men and women of Austin a full range of cosmetic procedures, both surgical and non-surgical, addressing the full array of breast, body and face.

Born and bred in Las Vegas, Austin plastic surgeon Dr. Whitfield received his medical degree from the University of Las Vegas School of Medicine. This was followed by six years of surgical training, as well as his plastic surgery residency at Indiana University Medical Center. He returned to Nevada for a one year microsurgery fellowship before settling down to practice and teach at the Medical College of Wisconsin for seven years.

Board-certified by the American Board of Plastic Surgery, Dr. Whitfield’s approach to medicine has really been shaped by both his upbringing and his education. As a child of the “wild west,” he was born with an adventurous spirit. One of the reasons that he was drawn to plastic surgery is the constant innovation. In the field of plastic surgery, with innovative techniques and technologies developed each year, there are simply issues for which a solution has yet to be invented. Dr. Whitfield tempers his intrepid attitude with Midwestern pragmatism. It makes for a pretty winning combination.