Transcription:

Maggie McKay (Host): There's been a lot in the news through the years about breast implant illness. But what is the latest on symptoms, risks, and treatment options, and the silent danger of this illness? Today, we'll get the facts from Dr. Shaher Khan, surgeon at Executive Plastic Surgery.

Host: This is Top Docs Podcast. I'm Maggie McKay. What a pleasure to have you here today, Dr. Kahn. Will you please introduce yourself?

Shaher Khan, MD: Yes. This is Dr. Shaher Khan. I'm a board-certified general surgeon, and I'm also a board-certified plastic surgeon, board-certified by the American Society of Plastic Surgeons, the one and only board that authenticates and certifies plastic surgeons, given the many aspects of plastic surgery.

Host: And let's just start right off with what are the symptoms of breast implant illness?

Shaher Khan, MD: So, breast implant only is a constellation of signs and symptoms that the patients suffer as a direct result of the silicone toxicity. The silicone leeches from both silicone implants and certainly saline implants and then basically touches all aspects of the human body, all the different organ systems. So, the patients complain of the most common complaint being fatigue; psychological effects from anxiety, depression; believe it or not, suicidal ideations; neck and back pain, for example; problems with changes in vision, hair follicles; and I'm going to go top down, neck and back pain, like I mentioned earlier; rheumatological joint problems, which are the hallmark features of what is breast implant illness, cardiac issues, arrhythmias, funny heartbeats. You have patients with blood pressure issues. You have patients with GI disturbances, basically endocrine issues, autoimmune issues being very common, along with the many other endocrine issues as well. So as you will see, the many complaints that the patients come in.

And one way for me to gauge the symptoms that the patient comes in with is the breast implant illness symptom questionnaire where they have a list of 55 symptoms that they check off. For example, vertigo, which is the spinning or tinnitus, which is the ringing in the ears, amongst the many other signs and symptoms. So that way, I can gauge the severity of the illness. And as you will see, there is no imaging modality. There is no lab workup that will diagnose a patient. This is essentially a diagnosis of exclusion, which basically means that the patients, as you will see, they have gone to their primary care doctors and they have ruled out rheumatoid arthritis, lupus, diabetes, thyroid problems. And now, all the fingers point towards what would be breast implant illness because what would be these many symptoms that are affecting a young lady or old with the many symptoms of breast implant illness until proven otherwise. And as you will see, and we get into the detail, it becomes evident with time that when more and more of the workup is negative, more and more of the fingers point towards what is breast implant illness.

Host: And Dr. Khan, if somebody thinks they may have breast implant illness, how do they confirm? How do they know for sure, because that's a long list of symptoms?

Shaher Khan, MD: Yes. So, this is someone kind of an extension of the first question. So, for example, someone goes to their primary care doctor and they're complaining of fatigue, you want to make sure that the thyroid levels are good; the joint pain, it's not underlying rheumatoid arthritis. You don't have pseudogout for example or gout for example, there's two elements of the joint. And you have rheumatological problems, so you get the GI workup. Sometimes, the GI disturbances may be due to, say, a colon mass, for example, so one may end up getting a workup for that, be it young or old. Now, this is ultimately determined by your primary care doctor and your subspecialized doctor. Most of the patients end up going, for example, to an allergist immunologist or to a rheumatologist or GI doctor, for example, or an ophthalmologist.

Now, once all those symptoms are ruled out and the patient still continues to complain of these symptoms, then we know with good certainty that it is breast implant illness. Now, ultimately, there's no way to tell. The ultimate way to tell is to remove the implant, the capsule, plus all of that inflamed tissue. And then in the post-operative period, you have well over 90% of the patient that all of a sudden as dictated by the FDA, they basically reclaim their good health back and now they're back to feeling better, healthier, more energetic, minus the neck and back pain, the joint problems and the many symptoms that they came in with. These are young ladies in their mid-20s who take no medication, for example, and they don't have any other illnesses, and this is by definition a diagnosis of exclusion.

Host: So, the goal of the explant surgery is?

Shaher Khan, MD: The goal of the explant surgery is that the entire implant plus the capsule, plus all of the inflamed tissue that is around that capsule into which there is leaching of the silicone is removed, definitively, certainly directly off of the rib or above the muscle, in that case, the fascia of the pectoralis and all associated inflamed tissue. And that when it is removed definitively, it is also checked for lymphoma, which is the breast implant-associated anaplastic large cell lymphoma, squamous cell cancer, among other problems that are associated with the capsules. After that postoperatively, one can say including certainly the surgeon who believes wholeheartedly that breast implant illness exists and that postoperatively the patient is free of the implant, the capsule, and all that inflamed tissue, and the patient now has a postoperative recovery minus these toxins. And ultimately, that will yield to a better good health minus the silicon toxicity.

So, that is the goal where the surgeon, him or herself, has to accept the fact that the implant is certainly the culprit, but the associated tissue that is around the implant, that needs to be removed, which includes the capsule certainly and all the inflamed tissue. And we know this for two reasons. Number one, if you look at the many pathology reports of the capsules that were sent to pathology, you will see the silica giant cell reaction, the refractal light, which is the foreign material within the capsule that was picked up on analysis. And most importantly, you'll see the many patients that have had incomplete removal of the implant, where the capsule was left behind. And only when these patients went back to another surgeon or the same surgeon and the residual capsule was removed, then only do you find these patients bouncing back to a normal state of good health because all of that silicone in the periphery was removed along with the capsule definitively, which should have been and should be and must be done the first time around.

Host: Which brings me to the question, can any plastic surgeon do this removal surgery?

Shaher Khan, MD: Yeah. So, this is a very good question. Now, breast implant illness in the vast majority of the plastic surgeons, they do not believe that it even exists. So first of all, you have to seek a surgeon who believes that there is such an entity called breast implant illness, again, as highlighted by the FDA and well accepted, and you look at and listen to the many patients.

The second thing is you have to see and ask the patient. The patient must ask the surgeon directly, not the physician assistant, not the nurse practitioner. The patient must ask the surgeon as to what is his approach or her approach into explantation, what is the goal of the surgery. And as I quoted earlier, it must be, and this is the take home message, the implant plus the capsule, plus all inflamed tissue must be removed definitively, especially off of the rib, which is the hardest part of the case. And it takes time. On average, it takes me four hours to remove the implant capsule, plus all of the inflamed tissue definitively in a very nice, delicate, sophisticated manner such that no capsule remains behind.

So, your surgeon should have a track record in today's world and age, a social media presence where the many other patients are attesting to the fact that the surgeon definitively does indeed believe in breast implant illness and that he's committed to truly removing the whole implant capsule and all the inflamed tissue. And there is no other better way to gauge and certify this than to talk to the surgeon and, number two, to have this be written down clearly on the consent form where it is clearly stated en block removal, which is the removal of the entire implant capsule plus, or what is a hundred percent total capsulectomy, and that should be dictated and literally spelled out on the consent form.

And most importantly, in today's world and age, where breast implant illness is so prevalent, the plastic surgeon must not ideally be putting in implants because how can you go to a surgeon who's putting an implant and, at the same time, believes in breast implant illness? Because now, you kind of have a contradictory practice. You either believe in it or you do not. And as you have heard me say this before, breast implants are not meant to be in the body forever and that breast implant illness will ultimately afflict everyone, be it in a couple of months or be it 20, 30 years later because the implants do rupture and they absolutely do. They have a certain lifespan. And if you listen to the FDA, the FDA mentions 10 to 15 years. I say from my practice, seven to 10 years. So, that is where the patient has to do her homework into looking for the surgeon who will do the job right the first time around definitively, sincerely, and is truly committed into removing the whole capsule. Because if that's not done, the last thing you want as a patient is to undergo a second surgery where residual capsule is now removed because the first surgery was incomplete.

Host: Wow. I had no idea that that happened, that people go in for it and the job is not complete. So, how do you find a good surgeon who specializes in this?

Shaher Khan, MD: So, look at the surgeon, look at the videos, look at the many discussions. Any good, reputable plastic surgeon who explants will be actively discussing, such as awareness like this where we are, I am bringing forth to the community and to the many patients who are hurting and they're not sure if this is the breast implant illness or not.

Now, you as a patient needs to do your homework because the general convention is, "So what if the implants are ruptured?" This is not safe, you know, if you have silicone that is actively extravasating in the chest, this is not safe at all. I heard this from a patient who sought two plastic surgery consults, and this is what was echoed back to the patient. Vast majority of the patients do not get an MRI looking for a silent rupture.

Now, I say this to the patients, "Don't listen to me, listen to the FDA." Let's go ahead and highlight what the FDA says. And you can see on my website, you can type in on Google, the first thing that the FDA mentions here is the breast implants are not considered lifetime devices. The longer people have them, the greater the chances that they will rupture. Number two, this is the FDA warning, the breast implants have been associated with the development of cancer of the immune system called breast implant-associated anaplastic large cell lymphoma. They have also been associated, as highlighted by the FDA, to squamous cell cancer. And the third thing, which is very important, I'm going to read line by line. It says, "Patients receiving breast implants have reported a variety of systemic symptoms such as joint pain, muscle aches, confusion, chronic fatigue, autoimmune diseases, and others. Individual patient risk for developing these symptoms has not been well established. Some patients report complete resolution of symptoms when the implants are removed without replacement." So, this is a big deal. This warning came out in '21. Now, this is one warning that your surgeon needs to have had discussed with you before he even put them in. Now, this is the many ladies, millions of them, who have implants and they're hurting and they do not know. So, this is not my words. This is the words of the FDA.

Now, the other thing here is I want to highlight how you pick your surgeon and what is it that you need to do, if I can extend that question. Let's go ahead and look at this journal. This is the number one journal that is read on earth by plastic surgeons, which highlights the many studies that are being done. Now, let's go ahead and look at the advertisement for Natrelle, which is a major manufacturer of implants, exquisite from every angle. And I'm going to read here verbatim. We'll put this on the website and we have it on the website: "Breast implants should not be performed in women with active infection anywhere in their body. Women with existing cancer or pre-cancer of their breasts who have not received adequate treatment for those conditions. Women who are currently pregnant or nursing." Now, how many ladies have implants and then they get pregnant and nurse, right? So, this is contradictory, right?

Now, let's go ahead and look at: Safety and effectiveness have not been established in patients with the following: autoimmune diseases, lupus and scleroderma, a compromised immune system, currently receiving immunosuppressive therapy. How many patients do I know who get chemotherapy who have implants because they had stage III or stage IV breast cancer, right? So, this is contradictory there. Planned chemotherapy, planned radiation, conditions or medications that interfere with wound healing and blood clotting, reduced blood supply to the breast tissue. One of my patients that I know had a kidney transplant, she's not a candidate. She got breast implants after her kidney transplant, which is against the recommendations of the manufacturer. People who are diabetics, patients who are elderly, for example, in their 60s and 70s. I had a 68-year-old lady who got implants, then she has peripheral vascular disease, which is decreased blood supply.

Again, precautions and I'm quoting: "Clinical diagnosis of depression or other mental health disorders, including body dysmorphic disorder and eating disorders. Please discuss any history of mental health disorders prior to surgery." This is a big deal. How many? I would say millions of patients who have implants, who have anxiety, depression, worsening anxiety, depression, and possible suicidal ideations. And then as you will see, key adverse events or re-operation, implant removal with or without replacement, implant rupture with silicon-filled implants, implant deflation with saline-filled implants and capsular contracture, Baker's classification." And again, I'm reading verbatim. This is not my words. These are the words of the manufacturer. Other potential adverse events include: "asymmetry, breast pain, breast skin sensation changes, capsular calcifications, delayed wound healing, hematoma, hypertrophic scarring, scarring, implant extrusion, implant malposition, implant palpability, visibility, infection, nipple complications, redness, seroma, swelling, tissue skin necrosis, wrinkling, and rippling." Now, this is one implant. Now, this is a very nice commonly used implant that's used.

Now if you look at another manufacturer, which is Mentor, which is the number one manufacturer, if you look at their advertisement again in the journal that we read at the back, they write down natural feel, I put down danger as you can see sarcastically. If you look at their instructions, they highlight the same problems that they're not meant to be in the body forever. They're associated with lymphoma and squamous cell cancer, that you have complete resolutions. And then, they mention, "the most common complications for breast augmentation with memory gel implants include any reoperation, capsular contracture, nipple sensation changes, and implant removal with or without replacement." And then they mentioned, "the health consequences of a ruptured silicone implants have not been fully established. MRI screenings are recommended three years after initial implant surgery, and then every two years after to detect silent rupture."

Now, whatever I just read in the last few minutes, three to five minutes, the FDA is raising this awareness, lymphoma, they're not meant to be in the body forever, and you have all these problems that I mentioned, fatigue, joint pain. Then, you have the manufacturers highlighting all these problems. And remember if a young lady in 20s, for example, 22, she gets implants and the average life span is 10, 15 years, let's say 10 years, she's going to, in her lifetime, at least have six surgeries along with potentially all these other complications.

So, my take home message to you is this, do not listen to me. Listen to what the FDA's saying. Listen to what the manufacturer, Mentor and Allergan, are saying. And most importantly, listen to the many patients, the many celebrities, the many other hundreds of thousands of patients who are hurting. And when they do explant, you can see, in vast majority, well over 90% regain their life, their health back, and their quality of life where they're free of the pain, the chest pain, and amongst the many other problems, including a rupture.

I did a case where a lady had a rupture five years into her augmentation. And the point I'm trying to make here is you don't want to get a device that is replete with problems. Yes, you may have a nice initial "good period" where you will enjoy the benefits of augmentation. But ultimately, there is a big hefty price that you might have to pay with those, silicon rupture, pain, cancer, death. People have died from this lymphoma. And the other sad part about this lymphoma is it is underreported because not everyone is checking for it. So, the plastic surgery community has been alerted by the FDA to be on the lookout because these numbers are a lot higher than what they're reported to be.

Host: Wow. And Dr. Khan, what is recovery like?

Shaher Khan, MD: So, basically, majority of the times the implants are placed below the muscle. And what that means is because the dissection is done underneath the muscle directly on top of the rib, you are looking at approximately six weeks of recovery before you gently start working up. Now, majority of my patients do not have a drain. I do not do a lift because that is too invasive of surgery at the time where the explants, which takes four hours to do. And within three to five days, I would say a good two-thirds of my patients are off the pain meds. Within a week, I would say 90% of my patients are driving. If they have a desk job, they're back to work, I would say a vast majority of them at week three. Now, if someone is an ICU nurse, for example, where she has to lift 200-pound patients, she has to use all her upper extremity muscles, I wouldn't recommend that she go back at least until eight or 10 weeks because I don't want her to go back. And remember the area underneath the muscle where it's resting and settling, you don't want her to be overly exerting and potentially hurt herself or cause problems. So as you will see, the patients themselves over a period of time recover and they're able to function very safely, very effectively. As you can see, let's say if I did operate on a patient today, she could be back at her work at three weeks easily if she has a desk job.

Host: And you say you don't do lifts while you're doing the explant because it's too much. Do women need to come back for a lift? And what do you say to them when they ask you if they're going to look good after a surgery?

Shaher Khan, MD: Right. That's a very good question. Remember, these are the same ladies that were very concerned about how they looked. Now, remember majority of the times, as you just saw from the complications, patients have malposition of the implant, they have potential rupture, capsular contracture. It's not the same. They bottom out and down, meaning the implants are so heavy that they literally break through the muscle. So, what happens is just the explant procedure in itself, when I do it from my experience, a good number of the patients, 80% of them do not need a lift at all.

Now, remember, I'm at the level of the rib, if you will, the basement of the house, that's where I'm doing the surgery. The entire lift operation is done at the roof level, which is a separate surgery in itself. Yes, certainly it's the same area, but the lift surgery is at the level of the nipple areola. Now, you don't want to do, number one, unnecessary surgery where you're doing a lift and, look, 80% of my patients don't need one. Number two, you don't want to be doing a surgery where the patient is on the operating room table more than the four hours because the lift in itself can be a three-hour operation. Because remember, it's a lot of cutting around the nipple areola. And then, what you are left with is the lollipop anchor incision, and you don't want to be prolonging the patient on the OR table, the risk for clot, bleeding infections, the anesthesia issues among others. Now, some patients certainly do require if they have a 800 cc implant and they have, for example, a lot of redundant skin given their age, that's 65, those patients, certainly you can tell. But the vast majority of the patients in their 20s, 30s, 40, even 50s, as you will see, if you go to my private breast implant support group page and even the public one you'll see on my website, a lot of patients are actually very happy minus the many risks associated with cutting around the nipple areola, including the decreased sensation, nipple skin necrosis where it initially looks good where the lift was done, but then a few months later, you see the nipple areola points upward because the skin retracted or the breast tissue retracted. And it is not advised to do surgery on an area such as the breast where there is a lot of inflammation present from the silicon toxicity and a surgery, like I mentioned earlier, that may not be even required.

Host: Dr. Khan, is there anything else you'd like to add about breast implant illness that we should know?

Shaher Khan, MD: Yeah. So, let's look at the facts. So, we looked at hard facts on the FDA, we looked at hard facts on the manufacturers. Most importantly, look at what the celebrities and the patients are saying on the many Facebook group pages and how they have improved. Look, you are hearing the manufacturer's complete resolution, right? So, this is what they're telling you, that's the complete resolution.

Now, if you look at the history of breast implant illness, 1992 silicone implants were banned, the older generation, for the same reason, because of the silicon toxicity. Now, we are seeing the history repeat itself that many ladies are not talking. They're saying, "Well, I'm not better. My doctor's putting me on psych meds. I have chest pain. My doctor is giving me pain medications." That's like a bandaid phenomenon, right? Now, you have to correct the root underlying cause of the problem. You look at the pathology, you look at the patients, you will see that the history is repeating itself. With an open mind, you talk to your surgeon. You want to get the definitive surgery. If I believed in breast implant illness 99%, and I did not believe in breast implant illness 1%, I would be augmenting because it is the number one plastic surgery procedure because of the financial reward. In one hour, you can put in basically a set of implants and it doesn't take much to put in two implants, a set of implants on a patient. It is a lot harder to remove. And once it's removed, as you will see how I do it, the current procedure without the need for a lift, without the need for the drains, what is twilight anesthesia. Number four, I send the capsules off to pathology to rule out the lymphoma, malignancy, any problems. Number five, I take cultures for aerobic, anerobic, and fungal. I take pictures and videos of the chest showing complete removal, so there's complete transparency. And last but not least, you will have the implants back, so you can see what was inside your body and that you have mental and psychological closure as to the bad, i.e., implants that were inside your body so that you can see the ruptured implant and you can see what was the status of the implant when it came out.

Host: That's a lot of valuable resources, Dr. Khan. I'm sure it is so helpful to your patients to be able to talk to other patients. And like you said, they need to do their homework. So again, thank you for sharing your expertise with us and getting us up-to-date on this topic, because there's a lot of new information that I'm sure many people don't know. So if someone would like to find out more or make an appointment with you, where would they go?

Shaher Khan, MD: Yes. I request my listeners and viewers to please go to executiveplasticsurgeon.com. You can certainly join and highly recommend it, the Private Breast Implant Illness Support Group page by Dr. Khan. You can go to my YouTube channel, Executive Plastic Surgeon. You can go to my Twitter, also my TikTok and my Instagram account, and you will have a whole resource of connections through my main webpage executiveplasticsurgeon.com, so you can connect in a very safe environment with the many other patients and learn about what is breast implant illness.

Host: Thank you so much. Again, that is Dr. Shaher Khan. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Top Docs Podcast. I'm Maggie McKay. Thanks for listening.

Shaher Khan, MD: Thank you very much. I appreciate it.