Dr. Mark Hyman (4:09)

John welcome to podcast.

Dr. Jonathan Kanefsky (4:10)

Thank You.

Dr. Mark Hyman (4:11)

You know, we've been friends for quite a while and talked a lot about regenerative medicine and health and functional medicine. But you come from the perspective of a surgeon. I deal more with the kind of biology stuff. Well, you do, too, but in a different way. We've had many conversations about the topic of breast implants. And as a doctor seeing patients, for now, close to 40 years, and if you include medical school, it's. I don't know what the math is. 43 years. I would say that I have seen many, many, many cases of women with severe illness, chronic disease, who've had breast implants. And it seems to be correlated, can't say caused, but correlated with their implants. And what's even more impressive is when they take them out, they get better. And there's something in medicine called Dr. Years, which is like, how many years of medical practice does it take to see X, Y, or Z condition? Like, we both learned about ophiochromocytoma in medical school, which is a rare adrenal tumor. I've never seen one in 40 years. I'm assuming you've never seen one.

Dr. Jonathan Kanefsky (5:16)

It's always on the differential, but I've never seen one.

Dr. Mark Hyman (5:19)

And it's basically like a rare tumor. So it means, like, it doesn't happen very often, but if you see something over and over, and I'm just one doctor, and I see it over and over and over, in fact, I'm dealing with a patient right now with a really severe autoimmune disease that's really resistant to treatment. Tried everything. I don't start with removing your breast implants, but I'm like, listen, if everything else works that we do in functional medicine and we can't get you better, then we've got to assume there's something that's toxic, that's affecting you. And we know that the silicone in breast implants is definitely linked to adverse health outcomes. So you've spent your life training as a plastic surgeon. You went to McGill. You trained in California for your fellowship. You really are an expert in this field. And, you know, you're kind of a heretic because you're going against the orthodoxy of plastic and aesthetic surgery. We'll talk about the difference there. But you're basically saying that women are being gaslit by the medical profession about breast implants. Can you kind of unpack that for us?

Dr. Jonathan Kanefsky (6:18)

So thank you, first of all, for having me on so we can talk about this. It's such an important topic. And the way that you dive into it is going to be just so helpful. So this journey into questioning implants started about a decade ago. A plastic surgeon by the name of Gary Brody was, I remember still, I think it might have been 2010. So even more than 10 years ago, he presented on something called B I, A L, C L, Breast implant associated anaplastic large cell lymphoma. And I saw that for the first time in a conference in Vancouver.

Dr. Mark Hyman (6:47)

And that's basically an immune tumor cancer.

Dr. Jonathan Kanefsky (6:50)

It's a cancer that's associated with the implant. And so this very rare type of cancer associated with implants was the first thing that sparked my curiosity. I was like, there's something potentially wrong with these implants that patients are reporting very rare. Turns out it's more common now associated with implants. Then fast forward a few more years. Implants still are not banned or there's no major warnings about them. As this information is coming out.

Dr. Mark Hyman (7:20)

The FDA still approves them.

Dr. Jonathan Kanefsky (7:21)

It still approves them now with a black box warning on all implants about a specific type of implant. But fast forward to. I'm in the last year of my fellowship and in one day I had close. There's about three patients that came in all saying, I'm concerned about my implants making me sick. I think my implants are making me sick. And I just, I just heard that over and over again.

Dr. Mark Hyman (7:43)

Yeah.

Dr. Jonathan Kanefsky (7:43)

And up until that point, the medical community or the positivity community by and large was saying, you know, it's. It. These symptoms are so vague. They're kind of this constellation of autoimmune symptoms, like everything from fatigue to hair loss to joint pain, dry eyes, is really fitting the constellation of autoimmune symptoms, but with no specific, easily diagnosable symptoms. Rash signs.

Dr. Mark Hyman (8:05)

Yeah, even nervous system symptoms.

Dr. Jonathan Kanefsky (8:06)

Oh, just, just everywhere. I mean there's anxiety, depression, you know, just, just this. The, the constellation symptoms are so large and at times vague that it's hard to say, oh yeah, this is for.

Dr. Mark Hyman (8:15)

Called bii, right. Plant illness. But there's so much more than that.

Dr. Jonathan Kanefsky (8:19)

But yeah, and it's even before that it was asia, it was auto adjuvant Silicon associated autoimmune problem. And then it's since been recategorized as sspi, Systemic Syndrome associated with breast Implants. Anyway, bunch of acronyms. But the, the etiology is the same. Something about the implant is causing a physical problem. I decided at that point, until I could predict accurately who's going to have an adverse reaction to breast implants, it seemed completely nonsensical. It Seemed unethical to be putting implants in for an elective procedure.

Dr. Mark Hyman (8:50)

Yeah.

Dr. Jonathan Kanefsky (8:50)

That have potentially up to a 30% chance of a complication.

Dr. Mark Hyman (8:53)

Yeah. It's not like you're getting a heart transplant because you need a heart.

Dr. Jonathan Kanefsky (8:56)

Yeah. So it's just like, this is strange. Until I can predict who's gonna have these problems and why, I'm just gonna stop using breast implants and focus on a safer alternative. And that was what launched me into this exploration of no more implants. Let's remove the implants and focus on a safer, natural alternative like fat grafting.

Dr. Mark Hyman (9:13)

So there's more to talk about and unpack about this. But the gaslighting is essentially saying to women, don't worry about it, or these symptoms are all in your head, or take some Prozac, you'll be fine. And it's beyond just, you know, I kind of looked it up when I was preparing for the podcast. But up to 10 to 25% of women have some type of complication. That's 1 in 10 to 1 in 4 women have a complication. And it's everything from capsular contracture. Right. And you can talk about that to autoimmune and inflammatory issues. You mentioned to this. The AASIA that you talked about, this autoimmune inflammatory thing, the breast implant illness and the cancerous. You mentioned this lymphoma. Even just local sort of endocrine effects as the silicone migrates and neurologic effects, cognitive effects, psychological effects. So can you kind of unpack a lot of that and just kind of talk us through each one of those? Because it's a lot of stuff and it's not just one thing that it causes.

Dr. Jonathan Kanefsky (10:07)

The complication rate is actually higher. If you look at all of the potential complications associated with implants, it's closer to 30%. So 30% of women after receiving, after breast implants will either have a complication such as capsular contracture, breast implant illness, or the more rare side effect is the cancer ALCL associated with breast implants. Plus, of course, less common complications, but hematoma, like bleeding, infection, things like that. But the three big ones that are known and make up most at 30% is capsular contractor BII. And the ALCL capsular contractor is essentially

Dr. Mark Hyman (10:42)

that's the autoimmune or that's the cancer that's. But what about the autoimmune? That's a.

Dr. Jonathan Kanefsky (10:46)

That's the biggest category, but the one that's hardest to diagnose. It's really a diagnosis of exclusion so the other two have very clear, we know why they happen and they're very easily diagnosed. So capsular contractor is basically the capsule that forms around the implant. So a foreign body anytime.

Dr. Mark Hyman (11:00)

Yeah, yeah.

Dr. Jonathan Kanefsky (11:01)

Here you go, you got the implant.

Dr. Mark Hyman (11:02)

Tell us about. Here you go.

Dr. Jonathan Kanefsky (11:02)

So this is a fourth or fifth

Dr. Mark Hyman (11:05)

generation, which for those listening, we're showing a silicone breast implant, which you can't see if you're driving. But anyway, this is the only place

Dr. Jonathan Kanefsky (11:10)

the implant should be which is outside the body. This is a newer generation of implant. Even if it's newer generation, it's essentially the same technology repeated with slight variation. So silicone shell with a silicone gel inside. It's a silicone gel polymer. If I was to cut this open, it's kind of like a gut. It would, it wouldn't leak out like liquid. It's a gummy bear.

Dr. Mark Hyman (11:29)

Just, just to be clear, silicone petroleum. Right. So this is a petrochemical industrial product. And we know that these petrochemicals have massive effects on human health. Like any other, quote, toxins, they affect endocrine function or endocrine disruptors, they can cause autoimmunity, they can cause obesity, they can cause cancer. I mean, the range of effects of toxins is huge. And this is a, you know, when you say polymer, that doesn't sound like something should be in your body.

Dr. Jonathan Kanefsky (11:59)

And silicone, it's is one of hundreds of ingredients that are usually used in the process of making a implants. I brought one that's smooth. The ones that are really causing the problem are textured implants. And there's a whole science behind why they're textured. But basically some sort of abrasive chemical process is used to rough up the implant. So it doesn't spin or move around as much in the body and it prevents capsular contractor. So capsular contractor, this foreign body goes inside. The same exact thing happens if you get, if you accidentally get a piece of lead in your fingertip or, you know, thorn from a bush, the body encapsulates it. It's going to make that fibroblast covering around. It's going to cover it with scar tissue. This is a really, this is a fairly large surface area of something to be covered in immune reactive tissue trying to wall it off from the body. And so when a capsular contractor occurs, the body makes this little jail around the implant of immune cells. And if you look at the pathology, like up close, the histopathology of these capsules, it's got four layers and they're rich in immune cells. It's got all these white blood cells that are reacting to the implant. And in some cases nothing happens. And that's great. The body's not having a super strong reaction to it. In other cases, the capsule will continuously contract. Like any scar that contracts, it'll contract on the implant and it'll get really hard. And that's what caps are concerned.

Dr. Mark Hyman (13:09)

So they're like hard balls, like a baseball. Yeah.

Dr. Jonathan Kanefsky (13:12)

And so at that point, the capsule needs to be removed and adjusted. But it's not considered medically dangerous. It's just, it can be very painful for the patient and look uncomfortable. So that's, that's capsular contractor. The other bucket is alcl, the cancer associated with implants. And that's also caused by the immune reaction continuously. It's a type of lymphoma. And then the third category is bii. Breast implant illness or.

Dr. Mark Hyman (13:35)

Yeah. Which is way more common than way more common.

Dr. Jonathan Kanefsky (13:37)

Harder to diagnose. It's the diagnosis of exclusion.

Dr. Mark Hyman (13:40)

And there can be autoimmune illnesses like Sjogren's syndrome, rheumatoid arthritis, systemic sclerosis, mixed kinetic tissue disease, Hashimoto's. I mean, one in five women have hypothyroidism. That's 20% of women.

Dr. Jonathan Kanefsky (13:52)

What's been noticed is if you have a predisposition to any kind of autoimmune illness, any family history, personal history, there's a higher likelihood that getting a silicone implant or a silicone gel or shell implant is going to be what could push you over the edge to go from no symptoms to symptoms. So if your immune system's already kind of upgraded and wired, something like that acts as an adjuvant and it'll upregulate the immune system.

Dr. Mark Hyman (14:17)

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

Dr. Jonathan Kanefsky (14:44)

So in my experience, the majority of women do get better, but there is, it's, it's important to acknowledge how much the mind and body is connected in this experience, that there's a very clear physiology that we know that there's something that's causing this in the body, but there's also the way the mind associates to it. And I believe that's part of the reason why not everybody gets better. Some of the symptoms that patients feel, they'll get better right after the implant's removed or shortly thereafter, especially if they follow certain protocols. But not everybody gets better. And that's a question. There's an incredibly large growing body of research in this field. And before I said the plastic surgery community was. Felt like it was kind of gaslighting women over the years. But since then, the attention has really turned inwards. There's a lot more research being done, good, high quality research to understand the effects of what's actually going on. So removing the implant with or without the capsule can improve symptoms. The majority of women who seem to be experiencing better symptom relief, it may have to do with a capsule removal. The most recent study showed that removing the capsule or not doesn't, it doesn't dramatically change the difference, but there is a strong psychological association and relationship to what it means to have the capsule and the implant remain. So it's important.

Dr. Mark Hyman (15:58)

Why would the capsule remain? Why don't you take the whole thing out? Because it's stuck.

Dr. Jonathan Kanefsky (16:01)

It's a dangerous surgery. It's not easy because it's stuck in it. It's stuck. Yeah. There's a risk of pneumothorax. So you could puncture the lung while removing it because the, the implants now live. The implants that were placed between the pec muscle and the chest wall. So it's, and, and there's this, you know, the technique that was developed that the surgeons are doing for a while is called on block capsulectomy. So it's like trying to remove this implant with its capsule as a whole without, without rupturing the, the implant or the capsule. So it's, it's technically challenging because you're operating in a small space, trying to get all the way around it 360 degrees and then deliver the implant whole with the implant intact, with the capsule intact. Sometimes it's easy. Other times it can be very challenging, Especially if the capsule stuck to the chest wall. You can get into a place that shouldn't be like a lungs.

Dr. Mark Hyman (16:42)

Yeah, yeah.

Dr. Jonathan Kanefsky (16:43)

So it's, it's, it's a much more technically challenging. And for that reason, unless there's a very clear indication to remove the capsule, I will, I'll remove as much of it as I can, but not all, all the time. It's a risk, risk, benefit, harm we just do no harm.

Dr. Mark Hyman (16:56)

And you don't think the capsule remaining still has silicone in it and it's

Dr. Jonathan Kanefsky (16:59)

going to cause issues or it's still reactive inflammatory tissue. So anytime I can remove the capsule safely, I do. If I think it's going to potentially put the patient at more risk, obviously I wouldn't, I wouldn't remove it. And it all has to do with I, I screen the patient to see what are the symptoms you're experiencing. You know, if a patient says, I don't have symptoms, I just want the implants out.

Dr. Mark Hyman (17:16)

We won't, we won't go there, there.

Podcast Host / Announcer (17:20)

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Dr. Mark Hyman (19:46)

But what's interesting is the explant studies because you know, it's one thing to say, well, you know, can you prove by cause and effect, because they're not going to do like a randomized trial where they, you know, give a thousand women implants and then give another thousand or ten thousand women another ten thousand implants and they follow them for twenty years and see who gets sick. You know, that's, that's a really tough study to do. But the, the follow up studies where they take the implant out and they follow people for a while and they see what happens. The data is pretty compelling. It shows like 50 to 80% of women see improvement.

Dr. Jonathan Kanefsky (20:19)

I mean, you're removing this thing that's full of silicone that's causing this chronic inflammatory reaction. So I think just, just from the etiology, it just makes sense. You just take out the thing that's causing the problem and you, you have less of a reaction. There's a plastic surgeon, her name is Patricia McGuire. She's done probably the most research on explant capsules, things like that. And she, what she found was that removing the implant helps, but the capsule, removing the capsule doesn't always create improvement in symptoms. So I still think the source of the problem is what needs to be removed. The implant is prime.

Dr. Mark Hyman (20:55)

Yeah, I mean that's sort of classic functional medicine. Someone's sick, you take out all the bad stuff until you see what happens because you don't know. And the truth is that many people have autoimmune diseases or issues for many reasons. And so the way I think about toxins is it's sort of like a cup that overflows you kind of, your body can handle it to a certain extent moment, and then your toxic load gets so high that it tips over into a disease. And so, you know, there may be other factors and other toxins that are affecting you. There may be other things in your microbiome, there may be dietary factors, there may be late infections. So there's a lot of reasons for all those symptoms that relate to immune activation and inflammation and autoimmunity and microbiome issues even. There's heavy metals right in the silicone,

Dr. Jonathan Kanefsky (21:39)

in the things that are used to process the implants. They all sorts of heavy metals. You know, the dose for amalgam is probably what is the most important question. But they are present.

Dr. Mark Hyman (21:48)

Yeah, it's small, but it's a cumulative effect of all this. And so I think that we're now in an era, we're beginning to understand that toxins play a role in human health. Doctors have been really notoriously bad at thinking about that or assessing it. And unless you have an acute poisoning, they don't think toxins are a problem because your body can handle it. It just thinks you're fine. And so what's really unfortunate is that, you know, doctors, because women wanted this, you know, developed a way to help women, you know, with their body image or get breast implants. But the, the dark side of it is it's, it's problematic and it has created a whole string of. Of issues that are concerning and that have, you know, a lot of metabolic effects and cellular effects and cognitive effects. I mean, it's not just autoimmunity. You can get neuroinflammation and brain fog. You've said some of the know, neuropathies, headaches, pots, things like that.

Podcast Host / Announcer (22:42)

So it's a concern. So I think that what I really

Dr. Mark Hyman (22:45)

kind of want to dive into now is kind of the work you're doing and what you've discovered. Because, you know, after listening this, I'm sure many women who are listening either who want breast implants are disappointed or have implants are freaked out, like, going, what do I do now? I don't want to get sick. Or if I am sick, do I have to take these things out? And what am I going to do? Because, you know, I. It's going to affect how I look and how I feel about myself. And, you know, it's, it's a big deal. It's not just like, oh, geez, you've got a wart, take it off and big deal. Like, you know, because I'm dealing, I deal with this regularly because I treat a lot of patients who have autoimmune disease who are sick, who have breast implants. And it's always like, it's always the hardest thing for me to say, Listen, I think we tried everything, and I think it's time you really explore this, because this could be a factor, and there's no way to prove it. Although there was a lab in Germany that was actually testing for immune reactivity to silicone and other things. So, you know, there are ways of potentially actually doing immunological testing to see. There's, there's. There's ways to check how your, how your white blood cells react to silicone or your antibodies. There's two different kinds of, of immune reactions. One is your white cells fight it, and the other is your antibodies fight it. But you can actually start to test that. So I think, you know, until we get better at that, it's gonna be hard to know. And the question is, there are women who are listening to this and in despair right now, or husbands who are worried about their wives or, or partners. What actually is available now? Because you're pioneering a whole new field of surgical interventions around safe and effective breast augmentation surgery that doesn't involve foreign toxic material. So walk us through what you do, what you've been doing, and what's coming.

Dr. Jonathan Kanefsky (24:23)

So there's two ways that I think about this. The first is, for anybody listening, if you do have breast implants and you're concerned, there is an ample amount of ways that you can explore what is safe to be done. The first thing that I notice among my patients is it takes an average of about three years from the time of thinking or being concerned about your implants to going through the whole journey of explant removing the breast implants. So wherever you're at on that journey, whether you're just curious about it or you think you might actually follow through with it, there's an abundance of support groups and information and ways to think about it. And surgeons are getting better and better at the technique of removing the implant and all the surgery around it. It is a big undertaking, though, because psychologically, it's a lot to have. Have undergone a surgery to change a part of your image to, you know, that might impact your identity to then probably anywhere from 5, 10, 15 years later. Think about now, removing the implants and reclaiming that identity. So it's, it's a lot of the body, but it's also, you know, how do I, how do I accept this new part of myself without implants. What does that look like? And so the second category is wanting to change a part of your body. Wanting to, whether it's after, you know, know, cancer, breast reconstruction, or as a primary augmentation to increase or change the shape and size of the breast, fat crafting is a safe option. It may not achieve.

Dr. Mark Hyman (25:37)

What is that?

Dr. Jonathan Kanefsky (25:38)

Yeah. So fat grafting is taking fat from one part of your body, processing it, and then using it as a sculpting medium. So literally changing the shape and volume somewhere else.

Dr. Mark Hyman (25:45)

All these women are saying, how do I get rid of my belly fat?

Dr. Jonathan Kanefsky (25:48)

So it's, this is a two for a, two for. Right, two for one experience. You can, you can shape and sculpt one part of the body and also use it as a medium. And I, I, I think it's the most natural way to do something because the, the breast tiss is a combination of fat and gland. And so we're just putting, putting fat where it's supposed to be. Fat grafting has, there's a lot of myth around it over the past, you know, it's been around for a long time. Over a hundred years.

Dr. Mark Hyman (26:10)

It has, yeah.

Dr. Jonathan Kanefsky (26:11)

Yeah. Fat graphing has been around for a long time.

Dr. Mark Hyman (26:12)

Amazing.

Dr. Jonathan Kanefsky (26:13)

The initial, what was it used for? The very first case was a case of liposuction that was done in like the 1800s. It did not go well. This is an experimental procedure at the time, but using transplanting a piece of fat actually for breast implant. As a, as a breast implant.

Podcast Host / Announcer (26:26)

Wow.

Dr. Mark Hyman (26:27)

Wait, wait. In the 1800s, they didn't have anesthesia.

Dr. Jonathan Kanefsky (26:29)

So no, this is, this was like late 1800s. The story is it was, it was a, I believe it was a ballerina. I can't remember, but it was exactly, don't quote me on this, but they actually took like a lipoma and transplanted this lipoma as a breast implant.

Dr. Mark Hyman (26:39)

Yeah.

Dr. Jonathan Kanefsky (26:40)

So like a ball of fat put somewhere else. Of course it didn't survive. We know a lot more about how tissue grows and regenerates now. And you can't just take a blob of fat and put it somewhere else in the body. Expect to survive.

Dr. Mark Hyman (26:49)

Oh, what do you do?

Dr. Jonathan Kanefsky (26:50)

Well, the technology has gotten a lot better. The myth used to be, well, you transplant fat, it doesn't survive. That's kind of true, but not entirely true. So 50 to 80% of the fat that gets transferred will survive. It's literally like planting stem cells. And you know, you know all about this. You take these little adipose derived stem cel cells you plant them like seeds, and then all these new blood vessels grow in and then that tissue grafts and it lives in this new place. There's many things that have been done to improve the fat graft survival and some things I do in my own practice and everything from red light therapy to treating the fat with something called surfactant. It's like a little soap molecule that will help preserve the fat cells after they've been removed. And it has a lot to do with technique. The way that it's injected, you inject these little micro droplets, so not these big globs of fat, these tiny little fats with special tools. That is like planting little droplets, little seeds in a garden versus just like throwing a big handful of them. So fat grafting became popular around the time that breast cancer surgery was really also being developed. So women would have breast cancer, have a mastectomy, have an implant placed, and then have radiotherapy. And radiotherapy would completely just damage the tissue. It'd become really thick and tough and leathery because of the radiation therapy. So fat grafting was used as a way to regenerate the tissue. So fat would be injected. The stem cells in the fat would so in the skin and also have the benefit of creating more, more of a contour. Ironically, fat grafting became popular because of breast cancer to the breast.

Dr. Mark Hyman (28:15)

And that's what most breast cancer surgeons would do, would.

Dr. Jonathan Kanefsky (28:18)

Then they'll do a combination of an implant because still if there's, if a lot of breast volume is removed still, in many cases the best option is a breast implant or a bigger surgery called a free flap. So taking like a big block of tissue for one part of the body to sculpt, sculpt and make the breast. But fat grafting is used throughout as a modality and it's getting better and better.

Dr. Mark Hyman (28:37)

So that's what you do, right? So kind of walk us through, you know, how, how it works and what a woman can expect and what kind of different options there are in terms of sizes and stuff. Because I think, you know, you kind of think, well, how? Depends if you have fat or don't have fat.

Dr. Jonathan Kanefsky (28:50)

So the process is, is really three steps. The first is we have to get the fat from somewhere. So harvesting the fat involves a process known as liposuction. So the areas are numb and we remove the fat with a combination of vibration and suction under low pressure, which minimizes the damage to the fat. Once the fat's collected, it's processed and treated and then it's re. Injected back into the body and sculpted.

Dr. Mark Hyman (29:12)

So you just add like a needle.

Dr. Jonathan Kanefsky (29:13)

Needle. Yeah. It's tiny. So everything's done through little keyhole entry points. So about two to three milliliter incisions. No big cuts. And the entry points are hidden throughout the body. So it's. It's really meant to be a.

Podcast Host / Announcer (29:24)

As.

Dr. Jonathan Kanefsky (29:24)

As aesthetically neutral. Yeah. So you don't. You're not seeing big scars anywhere. And I. I do all of the fat injection through one tiny entry point in the base of the breast. It's about the size of a tip of a pen, so.

Dr. Mark Hyman (29:35)

And it just kind of like, fills up like a balloon.

Dr. Jonathan Kanefsky (29:37)

It's. It's. I'm literally sculpting. I'm literally sculpting. So when the tools go inside, I'm. It's like I'm painting with a. A brush. Like 3D painting.

Dr. Mark Hyman (29:45)

Wow.

Dr. Jonathan Kanefsky (29:45)

And so it's about.

Dr. Mark Hyman (29:46)

Surgery is art.

Dr. Jonathan Kanefsky (29:47)

Surgery is art. Exactly. So I'm able. I'm able to. To sculpt the area to make sure that it. It's. It's not just like a 1 and 1 and done thing. Everybody's different. So certain parts of the breast need more fat here or there. And it's about sculpting and.

Dr. Mark Hyman (30:01)

And the results you get are just like an implant or better.

Dr. Jonathan Kanefsky (30:04)

So I would say, well, it depends what the aesthetic is you're going for. So I never try to push in a certain aesthetic on a patient. Most patients that come to see me want the more natural look. They don't want really large over, like, breast with that.

Dr. Mark Hyman (30:17)

Which.

Dr. Jonathan Kanefsky (30:17)

What is a giveaway that somebody usually has an implant is there's a lot of fullness in the upper pole. So the top part of the breast is really full. The natural breast doesn't have that shape. It's of a natural slope and then fullness on the bottom.

Dr. Mark Hyman (30:27)

Right.

Dr. Jonathan Kanefsky (30:27)

And that's what fat grafting can achieve. Sometimes it does take more than one round of fat grafting. The reason for that is because unlike an implant, you know, you can put almost any sized implant into. Into somebody. It's pretty traumatic. You're just shoving this large thing in there.

Dr. Mark Hyman (30:42)

Yeah.

Dr. Jonathan Kanefsky (30:42)

Whereas fat, you're limited. It's like a sponge. So if you imagine a sponge filling with water, it can only fill with so much water before it just flows out. And then the fat in the breast is the same way. You can only put so much fat in before the fat cells don't survive. So the first round of fat gr. You fill every. It's like A one to one ratio, you can double the volume of the breast. Not all of it will survive. Once that fat heals, the stem cells cause all these new blood vessels to grow in. And then with the second round, you can accommodate even more fat. And so you can get to the same size as an implant. But it may take more than one round of fat grafting, but the aesthetic will be different. It's going to look more like a natural shaped breast.

Dr. Mark Hyman (31:16)

Are there any complications or risks or challenges other than just normal surgery? Infection and bleeding, those are the main

Dr. Jonathan Kanefsky (31:22)

ones that we look out for. So infection, bleeding, it's still surgery. So just, just like any surgical procedure, those are, those are common things. The things that are more important to look at. With fat grafting, there's a risk of something called fat necrosis. So if the fat's not properly injected, they get these big globs, some of it will die. It can create an oil cyst and cause, cause problems. The thing that I see more commonly is the entry points can get, you can have a bit of scarring around them and that's hard to predict. Not everybody's scar is the same way, but usually the scars heal really well. And the question I get asked a lot, and it's super important, is fat grafting doesn't increase the baseline risk of breast cancer. So patients with fat grafting want to know, is this going to change my future risk of breast cancer? The answer is no. And the second thing is it doesn't obscure mammograms in the first six months. It can, which is important to be aware of if you have any family history of breast cancer. But onwards, most radiologists are well trained enough to know what calcifications from fat grafting can look like compared to breast cancer.

Dr. Mark Hyman (32:19)

And there's breast ultrasound and breast MRIs. So there's other technologies which help.

Dr. Jonathan Kanefsky (32:23)

So compared to breast implants, I think the risk profile is much lower, but it's still surgery, so gotta be careful.

Dr. Mark Hyman (32:28)

But, but it's not the all autoimmune issues and the breast implant illness and the cancer risk and all that stuff,

Dr. Jonathan Kanefsky (32:34)

it's your own tissue, so you're not dealing with any of these autoimmune issues. And it, it's gonna heal just fine.

Dr. Mark Hyman (32:38)

And so, so let's say ideally you'd want to be having a little extra body fat and you can use it and then you want to stay at the same weight. But what if you're like, like, you know, want an implant and then you're a little overweight and then you want to lose 20 pounds, what happens?

Dr. Jonathan Kanefsky (32:51)

So the fat that gets transferred is a great question. Fat that gets transferred is just like the fat anywhere else in your body. So if you lose weight, gain weight, it'll go in the same direction. The fat cells that survive will stay there. It's just their capacity to grow and shrink is what changes as the body weight changes. Usually I recommend patients, it's not around the time of surgery, is not the time to lose weight. So you want to achieve a weight that you're comfortable with within, like, like, let's say 5 to 10 pounds, then do the surgery, and then you want to just try and maintain your weight. If you lose a significant amount of weight afterwards, the breast size will decrease. And the same for the opposite, which is if you gain a lot of weight, the breast size will increase and patients will use that to their benefit all the time.

Dr. Mark Hyman (33:29)

Yeah, but if you're really overweight and you want to take OIC and you have a fat transfer.

Dr. Jonathan Kanefsky (33:35)

OIC and fat transfers do not go well together. So when I, if patients are on any kind of GLP1, I say we've got stop the GLP1 forever. Not, not forever. Just let, just reach, reach a plateau that you're comfortable being at. Stop the Ozempic or the other glp. You want your own for four weeks, let the fat fully heal and then you can restart. But the, the idea is about maintenance. It's not about going up or down significantly.

Dr. Mark Hyman (33:55)

And then there's new technologies. This is what's been around. This is what works. This is what you're doing right now. Yeah, but we were chatting a little earlier and you said there's some newer technologies that are available which are pretty interesting, which is using other people's f. Fat when there's an endless supply of that in America. Right. It's like you think people give. Give medical issues to make money by giving blood donations. It's wild. Or sperm donations. You do, like, only can do fat donations. Do you.

Dr. Jonathan Kanefsky (34:19)

Do you see? I mean, the OIC thing is really taking off. Apparently the Ozempic thing has taken off so much so that airlines are now saving money on fuel.

Dr. Mark Hyman (34:27)

Fuel, of course. Yeah.

Dr. Jonathan Kanefsky (34:28)

So we're. Maybe not for long.

Dr. Mark Hyman (34:30)

We will. Epic's good for climate change. Yeah, Wild. That's. Who knew the side effects. Everybody on epic. Oh, right now, no, save the planet. Take Ozempic in terms of, in terms of the, the way it's, it's. It's important, I think, for people to understand it's if this is fat tissue and it fluctuates.

Dr. Jonathan Kanefsky (34:48)

Yeah.

Dr. Mark Hyman (34:48)

But these new technologies sort of use an endless supply of fat from other donors.

Dr. Jonathan Kanefsky (34:54)

Yeah.

Dr. Mark Hyman (34:55)

So tell us about what that is, what it's called, how it works, what the risks are.

Dr. Jonathan Kanefsky (34:58)

So the big vision is that nobody puts an implant in ever again. I'm putting my stake in the ground maybe five to ten years from now, hopefully sooner, that we'll just say, you know what? Implant are really not it.

Dr. Mark Hyman (35:08)

You want the FDA to go, this is done. Yeah.

Dr. Jonathan Kanefsky (35:11)

And they've done it twice in the 80s. They said 80s or early 90s, there's a moratorium placed on breast implants because of these rheumatologists that were saying, I think implants are making people sick. We need to do more investigation. Bunch of research was done. Questionable about how the studies were funded and what the outcomes were, but they said, okay, they're safe, they can come back. And then again, the resurgence, I think in 2018, black box warning on implants. But they're still out there, there. And now there's these newer generation implants who are, you know, the whole like

Dr. Mark Hyman (35:38)

trans fats are now ruled they're not safe to eat by the fda, but they're still a cool whip in the grocery store.

Dr. Jonathan Kanefsky (35:43)

Exactly. Or it's like, hey, don't smoke the regular cigarettes, smoke the skinny ones. Which is exactly what's happening now with implants. The implants are getting smaller and there's a whole new design of an implant by certain Motiva is the latest one. And they've redesigned this implant for it to be more safe. But it literally, to me, I look at it as like, oh, it's a safer cigarette. I'm like, what are we doing? This is not.

Dr. Mark Hyman (36:00)

Why do they say it's safe and why do you think it's not safe?

Dr. Jonathan Kanefsky (36:02)

Like, I don't think it's safe because

Dr. Mark Hyman (36:03)

I heard, I've heard about this one.

Dr. Jonathan Kanefsky (36:05)

We have not changed the fundamental laws of biology. Biology, which is you put in a foreign object, it is going to have a reaction. If it's a less of a reaction, great. But there's still some percentage of of people that are going to have that reaction. They've done a lot of science. They changed the way that the rough surface of the implant is created. It's no longer abrasive chemicals. It's now a 3D printed surface. And it's done even more minimally invasively. But the root cause is still the root cause. People are still smoking.

Dr. Mark Hyman (36:28)

Silicone is.

Dr. Jonathan Kanefsky (36:28)

There's still silicone in the body. So. And now I, I saw some recently a surgeon's putting in 100cc implant that's a third of the size of this.

Dr. Mark Hyman (36:36)

That's small.

Dr. Jonathan Kanefsky (36:36)

It's not only is it small, you could easily do that with fat. So it just makes, it makes even less sense to me.

Dr. Mark Hyman (36:41)

Yeah, yeah, yeah.

Dr. Jonathan Kanefsky (36:41)

So to answer your question, I don't think so. Hopefully implants stop altogether, but that won't happen until there's better technologies out there that fully replace them. And the three technologies that I think are, have, are making waves and breakthroughs in the world of fat, fat transfer, fat grafting. The first is using your own fat but doing everything possible on the surgery side and recovery side to improve fat grafting retention.

Dr. Mark Hyman (37:03)

Yeah, I want to talk about surgery as a ceremony after what you do this because you're not just a regular surgeon. We're going to get into all that. So I'm going to save that. But, but there are ways to use various kinds of therapies and treatments to enhance healing. And I've recently, I had a bike accident and I smashed on my face and I recently had to use it and I was so amazed at how fast things heal.

Dr. Jonathan Kanefsky (37:23)

You look great, Mark.

Dr. Mark Hyman (37:24)

Thank you. So what's the name of this, this fat transfer that you get from other people? Like what is it called?

Dr. Jonathan Kanefsky (37:34)

Alay. Basically Alay is the name of the brand right now.

Dr. Mark Hyman (37:37)

But clay, like molding?

Dr. Jonathan Kanefsky (37:38)

Yeah, Aloe. Clay.

Dr. Mark Hyman (37:39)

It's aloe means foreign.

Dr. Jonathan Kanefsky (37:40)

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

Dr. Mark Hyman (38:14)

You want a dancer.

Dr. Jonathan Kanefsky (38:15)

It's. Yeah, it's a good, it's a good alternative which is you're not using an implant and you're using this other thing. It can be a little bit pricier

Dr. Mark Hyman (38:21)

at times and the immune reaction is.

Dr. Jonathan Kanefsky (38:23)

It's it's minimal. Yeah, some. Sometimes patients can have like there can. The body can react and have a bit of redness around it. But it's, it's rare now.

Dr. Mark Hyman (38:31)

And you. We also talked about a newer technology that is. It's kind of interesting to me that you say it's only a year or two off because it involves taking some of your own fat and then growing it in a lab. So can you talk about that?

Dr. Jonathan Kanefsky (38:42)

Sure.

Dr. Mark Hyman (38:42)

And what the promise of that is and the risk.

Dr. Jonathan Kanefsky (38:45)

So I think, I think this will be big in the future, which is you can. So it's really. I'll go over the four. This is the third one that we talked about. The third technology is banking your own, taking your own fat, getting the stem cells from there and growing ex vivo so outside the body, growing fat cells. And I think we'll see that in a few years as a safe alternative. So you could go to your doctor to get like a quick five minute procedure because you don't need a lot of fat for that. You just take a little bit of fat out, send it to a lab. The lab will grow that fat tissue outside of your body. And then whenever you're ready, you get a notification on your phone and come back into the office and you get the fat transfer.

Dr. Mark Hyman (39:18)

And how long does it take to

Dr. Jonathan Kanefsky (39:20)

grow, I mean fat like most. And this has been done. This isn't, you know, this is new. But it's been done many other examples. It's done been done for bone, it's been done for skin, it's been done for other tissues. Six to eight weeks.

Dr. Mark Hyman (39:33)

Basically you get a little fat sample taken out.

Dr. Jonathan Kanefsky (39:36)

Yeah.

Dr. Mark Hyman (39:37)

And it doesn't be a lot.

Dr. Jonathan Kanefsky (39:38)

Yeah.

Dr. Mark Hyman (39:38)

And then you can. You put in a lab and you cook it. Basically it goes in like a incubator and you grow your own fat cells. You can grow as much as you want.

Dr. Jonathan Kanefsky (39:46)

Yeah. It'll be, I would say right now it's probably cost prohibitive. It's more experimental. But like with any technology, as it becomes more abundant and scales, the, the cost goes down. What's available today and can be done today is you can bank your own own fat. So four technologies, four things we talked about for fat. The first is improving everything possible in the operating room with your own fat. The second is alo clay or using somebody else's fat. The third is banking or growing your own, growing your own fat cells outside your body. And the fourth one, which is available today is you take your own fat and save it and freeze it and process it. For later. And so if somebody's undergoing a procedure and wants to do fat grafting but doesn't want to have to have liposuction every time, they can store their own fat outside their body. And that's good for two things. It's good for. As a source of stem cells for any number of things in. And two as, as a volume filler.

Dr. Mark Hyman (40:32)

But ultimately you wouldn't even do the banking if you could just.

Dr. Jonathan Kanefsky (40:34)

Yeah, if you can just grow it, great. But right now that's not, it's not commercially available and it's, it would be extremely expensive. It's kind of like, you know, with impossible meat and all the lab grown meat, like lab grown meat's a thing today, but it's 800 burger. It's, it's. Or I don't know how much it

Dr. Mark Hyman (40:49)

costs now, but it's expensive.

Dr. Jonathan Kanefsky (40:50)

It's less.

Dr. Mark Hyman (40:51)

Not 800. Yeah. How far off is this growing your own fat technology for women?

Dr. Jonathan Kanefsky (40:55)

I don't want to put an exact number up. I'd say at least two to five years. It's, it's, it's, it's like not right around the corner.

Dr. Mark Hyman (41:00)

Five years in terms of the, the interesting, the volume. Because we're talking about, you know, fat transfer. If you're thin, it's hard, but if you have a lot of fat, would you be able to have bigger breasts?

Dr. Jonathan Kanefsky (41:08)

Yeah, and when I do fat transfers, I, I like to have at least 3 to 400 cc's of fat per side. And just for reference, this is a 250cc implement.

Dr. Mark Hyman (41:15)

So like double that almost.

Dr. Jonathan Kanefsky (41:16)

Yeah. And a can of soda is about 330cc's or something like that. So it's, it's a good amount knowing that not all of it's going to survive. And that's per side. So usually like in a, in the best case scenario you'd harvest about a literal of fat, which is, which is doable if you treat multiple areas in the body.

Dr. Mark Hyman (41:31)

As people are listening to this and wondering, you know, okay, this all sounds like promising. There's actually this aloe clay now which you can do, you can do if you're underweight, if you're, if you have plenty of body fat, you can use your own fat. How do you kind of coach women and explain to women when they're talking about their breast implants and worried about them and taking them out? Because that's a big deal. Like, I think it's, I just want to sort of spend a minute on the psychology of that. How you handle that. Because I deal with this and I feel uncomfortable, to be honest. Uncomfortable. Like, I'm like, God. You know, this is. This is a very personal thing. You know, I think as a doctor, this is affecting your health adversely. If you want to not have this autoimmune disease. You know, I have this woman who's got breast implants and her platelets are like 10, and I'm like, everything is just not moving the needle. And I'm just like, listen, this is the thing. I think it's causing it. But, you know, what's the threshold that you kind of say, okay, you've got to do do this.

Dr. Jonathan Kanefsky (42:22)

The first place is like, you're doing it comes from a place of compassion saying like, you know, this is a procedure that you have that may be impacting your health. And also medically, it is a diagnosis of exclusion. So let's check, let's do every other possible workup to make sure that it's not something like Lyme disease or your thyroid or this or that. It's like, once everything else is ruled out. Yeah, we've arrived at the final destination, which is. I think it's probably. It could be the implants. And it's important to do everything else medically.

Dr. Mark Hyman (42:47)

Well, that's what I do. I deep dive on every possible other cause from a functional medicine perspective of what could be causing it, and I get rid of that. And if they're still not better, and

Dr. Jonathan Kanefsky (42:55)

the latest research shows that it's actually more of a neuroimmunology, probably something closer to fibromyalgia, the way that it's approached and handled. And so, I mean, imagine all the patients that suffer from fibromyalgia. If you could say, I think it's this physical thing that's causing it. We've ruled out everything else. Let's remove it and see what happens. So the coaching or the counseling comes from first, compassion. The second. Where are you on the implant journey? Because if patient says, like, I heard about this yesterday and I think I breast implant list, I don't think it's a good time to have surgery with a week. It's. There's a lot of understanding that needs to happen and about the risks and benefits of explant, also the identity of who you're going to be on the other side because you've become this avatar of yourself over the past, however long the implants are there. And it's a lot to dramatically change your appearance if you're not fully sure that the symptoms are caused by the implant or where you're at psychologically to prepare for it. So that process takes time. Usually I recommend patients wait at least six months to a year. Many patients that come see me have been thinking about this for, for years. They've been on message boards, they've talked to other patients, they've, they've, they've really done a lot of their own research to understand what it's going to be like on the other side and they're ready for it. A big mistake is to do a surgery too soon just because a patient feels like they're, they're ready and then, then they're unhappy. And there have been situations where it's, it's rare, but once or twice patients, one patient stands out in mind. She had her explant, even though she, I felt like she was ready for it. She felt like she was ready for it. And then months, months or about eight months later, she's like, you know what? I feel better, but I can't handle the way that I, I look and I, I really want that look back. And that's, and that's part of the journey. So for me, it's more about doing everything I can from what I know and hearing what the patient's saying to say like, you're really ready for this journey. And it takes time. Also preparing before and after. There are protocols, things that help healing and you know, that's, that's everything from preparing psychologically for it to physically. The amount of modalities out there is amazing to, to detoxify afterwards.

Dr. Mark Hyman (44:56)

So how, how long after women get an explant surgery do they have to wait before they do some kind of other procedure like a fat transfer?

Dr. Jonathan Kanefsky (45:04)

I usually recommend waiting three months and it's, I always stage it. I don't do the explanation. And the fat crafting the same time, it's like demolishing and building a house at the same time just doesn't make sense. So let everything heal, adapt, get, get comfortable in your body and then we can talk about the next, the next step. And that can be done. That next surgery could be done either awake or asleep. And I think awake is important because less general anesthesia, less risk of all those heavy medications.

Dr. Mark Hyman (45:28)

I think for everybody listening, you know, I can say as a, as a practicing physician that this is a real phenomenon, the FDA thinks is a real phenomena, that, that it can cause a range of symptoms from sort of mild, you know, fatigue and cognitive dysfunction all the way to full blown autoimmune disease and cancer and it's not to be taken lightly. And it's a serious subject because a lot of women have this. About 5% of women in the country have breast implants, which is a big number. Many people are thinking of having implants. So I hope you get to listen to this and understand the risks and kind of wait a min. Pause and wait, maybe wait for these new technologies or use one of these other possible transfer, fat transfer techniques. You're also thinking about how to really take care of women in a way that's safe and effective, but your thinking goes far beyond that. And you're one of the few surgeons that I've ever met that's thinking holistically about surgery, its impact on. And I've had surgery many times and it's a very scary thing. There's not a lot of psychological support port and there's not a lot of ritual around it. There's not a lot of understanding of how it affects you. I mean, I had massive surgeries like about a year ago, and it was a, it was a lot. You know, I have a pretty good constitution and a pretty stable mind. So. But I remember, like, I mean, for mine it was, you know, it was, it was a very severe thing and I couldn't have died. And I remember going into the operating room and you know, just, you know, you're kind of in the hospital, you're in a sterile environment in, you're getting wheeled into the operating room, they kind of stick the needle in you. They go, okay, you're going to sleep out. And I remember this could be my last breath. This is my last moment of consciousness. And it was kind of scary. And you've been in the operating room for thousands of hours probably, and you understand what the normal approach is and you've created this whole other framework. You call it surgery as ceremony. And I love that. Um, so I, I'd love you to unpack that. What, what, what is that? And what do you do that's different? And why do you do it like that?

Dr. Jonathan Kanefsky (47:28)

So I know this might sound woo woo and a bit out there, but I believe that we've removed a lot of the ceremony from many parts of our lives. The intention behind why we do things, the protocol behind it, the process, the ritual. And I heard once this, it was, it was a US General was giving a talk. He said, what is a protocol but a process? A process but a ritual, and a ritual but a stage ceremony? And it, it stuck out to me as, how many things do we do regularly in our life that Are ceremonial nature. But we treat them as a protocol. Think about flying. You know, there's the FAA checklist.

Dr. Mark Hyman (48:00)

Yeah.

Dr. Jonathan Kanefsky (48:02)

Which turns into flight school. Which turns into the ritual of boarding an airplane. But the pro. I mean, the ceremony is like travel. Travel is an amazing experience.

Dr. Mark Hyman (48:10)

Yeah.

Dr. Jonathan Kanefsky (48:11)

But we've. We've removed a lot of that. And surgery is no different. We've taken what used to be, um. You know, it started. You were there in Egypt. We were in Egypt. And I was looking at these. The walls of. I think it was like. I can't remember.

Dr. Mark Hyman (48:24)

Ra or cob. Yeah. The gods. Yeah.

Dr. Jonathan Kanefsky (48:28)

But they had all these. They had. They had all these hieroglyphs of surgery and pharmacy and things like that. And I was like, wow. Even.

Dr. Mark Hyman (48:34)

And psychedelic mushrooms.

Dr. Jonathan Kanefsky (48:35)

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

Dr. Mark Hyman (48:58)

When I was in residency, one of the. One of the surgeons used to play the grateful dead in the operating room. So that was kind of like a ceremony. Music.

Dr. Jonathan Kanefsky (49:04)

Music. And I'll talk about this. Music is a huge part of it.

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Dr. Jonathan Kanefsky (51:07)

If you think about ceremony, what is a ceremony? Ceremony, it could be meditation, could be a week long retreat. It could be sometimes plant medicine experience. But you're, you're, you're, you have this desire to undergo a change. Whether it's psychological or physical, you're looking for an altered state. Again, it could be meditation, quieting the mind, could be. Some people do it with plant medicine. And then the third thing is you're, you have to go through the journey. You have a guide sometimes that brings you. And then if you look at surgery through that lens, well, you're wanting to undergo this major transformation whether it's elective or not. And you could have a broken knee or something. You, you want to be fixed. There is an altered state of consciousness, which is the medication that's using in surgery. It's without a doubt 100 million surgeries a year. People are having their consciousness altered for that time period. Your conscious is being unplugged. All these medications flood your system. And then you have to go through the journey, meet yourself on the other side. And very rarely is there psychological support after the surgery. To say even before to say like, oh, your, your body's changed, but your mind has to catch up with what's happened and the consensual part of surgery, which is, I know I'm going to receive this damage from my surgeon, which, you know, it's very carefully done, but it's still damaged damage. It's your. The cautery, things are being burned, things are being cut. You're asleep.

Dr. Mark Hyman (52:20)

The shaman once told me that, you know, your body can't different tell the difference between a samurai sword and a. And a surgeon's knife.

Dr. Jonathan Kanefsky (52:27)

Exactly. You. You are. It's exactly the.

Dr. Mark Hyman (52:31)

The.

Dr. Jonathan Kanefsky (52:31)

The thought that led. Led to this, which is surgery is a traumatic experience for the body and for unplugging consciousness just before it happens. Even though you knew what you went in for, when your body wakes up, it's still having to, you know, body keeps a score. It's trying to make sense of what's going on inside. So why not have a system that allows more support for the journey, for the experience of surgery? And that can happen before. That can happen during surgery and immediately after. So surgery ceremony is a protocol that has three parts. The first part is doing is having psychological support immediately. It's like. I call it like surgical psychology. So basically, in preparation for your procedure, you have. You meet with a therapist to go over the intentions, desire, fear, and anxiety that you might have around the surgery. The protocol that I use uses ketamine as part of the pro. The process. So it's ketamine assisted psychotherapy. Not a big. Not a big dose. It's a very light dose, but it helps kind of drop the ego defenses so you can get into the discussion with your therapist. The therapist then will elicit certain keywords, mantras, and, you know, Dr. Kat, we've, we've worked. She. She helped craft this protocol. Amazing therapist to work with will help basically pull out little key phrases, mantras, and things to understand that are unique to the. That patient that I can then use during surgery because patients are generally awake during their procedures to coach and talk them through it. So. And they're also listening to music during that first part. And this is where the Grateful Dead thing is actually pretty important. The music that sort of like neuroacoustic recall that you hear during this transformative experience where you're dropping into your why you're going to surgery. If that playlist starts playing again during surgery, it's like a warm hug. You're like, oh, I heard this before. I felt pretty good last time. Let me listen to that music again. And then I also have key phrases and words and intentions that I can say Back to the patient of why they're doing this. As a reminder, for example, one patient, her mantra was like, I want to come home to my body. And I could tell during the surgery as the medication was coming in. I also use ketamine as a anesthetic. During the surgery, I was able to. I said those phrases back to her. I said, you're coming home to your body, and you just smile. And then she's like, yeah, yeah, yeah, I'm ready. So the ceremony of the surgery itself is also very important. So you talked about having surgery. It's this clean, sterile environment. It's loud, it's noisy, it's weird. It's like, no, nobody wants to go to a party like that. You want the light to be good, you want the music to be good, you want the vibes to be good. Why can't an or be the same? So the energy of the staff that are in there, you know, they're here holding a patient's hand. Tactile sensation, the release, Release of oxytocin may be the best pain medication we know. So all those, all those things add up. Right music, right lighting, right vibe. Even the bed has to be warm. I use these vibrating pads to help distract patients from the experience, drop them more into a parasympathetic, sympathetic state. The ceremony of the surgeries has a lot of steps to it, but the most important thing is it's. It's about removing the things that are uncomfortable at the typical or environment. The last thing is actually afterwards. So it's body work. It's coming home to your body. I work with a great team of lymphat, lymphatic therapists that will help you land back in your body as you're integrating everything. And that's. That's just really important. So three parts before surgery was psychotherapy, the actual journey of the surgery itself, and then afterwards, with bodywork, and all of those things come together, together to. To. To be what I call surgery ceremony.

Dr. Mark Hyman (55:42)

Yeah, it's true. You know, I had. I had this massive surgery in my back and, you know, without the people I brought in to help me after, which was not recommended by the surgeon, I don't think I would be where I am. You know, I had lots of body work to get back in my body. I had, you know, dry needling, acupuncture. I had physical therapy. I had, you know, I had all these things that helped to move the energy and get my body back. And it's. It's amazing. I mean, my, My neurosurgeon and was like, what are you doing? Like you, we've never seen anybody recover like you, like you're an anomaly. And I'm like, well this isn't rocket science. It's just, you know, understanding how the body works. And surgeons are great at like cutting and leaving them. It's like boom, boom, you're done.

Dr. Jonathan Kanefsky (56:23)

Not anymore.

Dr. Mark Hyman (56:24)

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

Dr. Jonathan Kanefsky (56:49)

And so it's, it's things you can do to your body and things you shouldn't do. And the things you can do starts with foods that you eat, actual physical things that you can do to your body and, and some, some other parts of the protocol. So I generally recommend a whole food, mostly plant based diet, but having a lot of protein. Cuz after you have surgery it's like your body's running a marathon every day. You need a lot of supplementation.

Dr. Mark Hyman (57:09)

Yeah.

Dr. Jonathan Kanefsky (57:10)

The next thing is I'm a big believer in red light therapy. The specifically near infrared and infrared light, 650 nanometers is about the wavelength that really stimulates mitochondria and improves wound healing. Hyperbaric oxygen is amazing. I know you're big, big fan of that.

Dr. Mark Hyman (57:24)

Yeah.

Dr. Jonathan Kanefsky (57:24)

Acupuncture and lymphatic therapy is essential. I recommend it for all of my patients. It's, it's closing that loop between what's happening in my body and what's happening in my mind. So if, if you're anxious, you're gonna feel more pain and if you're feeling more pain, you're probably gonna feel more anxious. And it's just this loop. And those kinds of modalities like lymphatic massage, acupuncture, they, they cut the loop. You're addressing the mind. Relax, feel less pain. It also feels, it feels nice to be to held and touched. Yeah. There's other modalities that I think are great. Now more and more I'm recommending peptides to my patients. So TB500, BPC1 and Alpha. We Have a little peptide protocol that I think is, is, is more and more important.

Dr. Mark Hyman (58:02)

Up tissue repair, regeneration.

Dr. Jonathan Kanefsky (58:04)

Yeah. And touch on what you said is. I think the old paradigm of surgeons just cutting and leaving, I think it's done. I think that, I think the, the most cutting edge surgeon or the new, the, the new way is what do we do before and after surgery? How do we, how do we curate the whole experience for your wellness? Not just cut and done.

Dr. Mark Hyman (58:22)

Yeah.

Podcast Host / Announcer (58:22)

And I think, I think this kind

Dr. Mark Hyman (58:23)

of holistic view of surgery ceremony of preparing patients before, of how the environment is and how you do it and the post op care, which is quite different, is important. But I, I just want to touch on something I know you know about and I want to dive in because people don't think about this when it comes to surgery and it's going to sound very crass and you probably heard this in medical school, but you remember those patients you'd operate on and their tissues would just fall apart. Like you try to look so, and you're in the op, you're in the wound or in a surgical field like tissue paper, and it's like. Yeah, you can't grab onto it with a, with a needle and it'll rip. And, and we had a terrible saying for it. Do you remember what that is?

Dr. Jonathan Kanefsky (58:59)

Tell me.

Dr. Mark Hyman (59:00)

Piss poor protoplasm. Oh yeah. Do you remember that? Piss poor protoplasm. It's terrible. But it's kind of what doctors do to sort of deal with the gruesomeness of all the things they have to do is make jokes. But, but it, it's, it's a real thing. And, and I think it has to do with, with, with how your body heals and wounds and, and, and, and the, the cause of that, in my belief is that it's, it's people's overall health and diet and nutritional status. Because, you know, if your tissues are bad and you're malnourished and you're eating tons of sugar and you're inflamed and you have insulin resistance, which is to some degree over 90% of the population is on the spectrum, not of autism, but on the spectrum of, of insulin dysregulation and blood sugar issues, you know, you're not gonna heal as well. Like if your vitamin A is low or your zinc is low or your protein's low, as you said, or you have lower levels of omega 3s or

Dr. Jonathan Kanefsky (59:54)

copper, like all these, all these micronutrients are super important.

Dr. Mark Hyman (59:57)

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

Dr. Jonathan Kanefsky (60:25)

Yeah, I, I recommend them all the time.

Dr. Mark Hyman (60:26)

What, what, what should people do to prepare and what should people do people do after in terms of their diet and the right supplementation regimen to help them get through surgery?

Dr. Jonathan Kanefsky (60:35)

Great question. So before it's kind of like the do's and don'ts, there's things you should do, things you should definitely not do. So you want to avoid anything that might thin the blood. So avoiding omega 3s, ginkgo, ginseng, garlic, usually anything with a G kind of thins the blood. Not forever, just usually. Vitamin E. Vitamin E, yeah. So like omegas and that category, things that we know thin the blood. Avoid those for at least a week before surgery. Of course, consult your doctor to know for sure.

Dr. Mark Hyman (60:59)

Plus aspirin and Advil.

Dr. Jonathan Kanefsky (61:00)

Yeah. So anything that thins the blood. But, and, and it's interesting. Nsaids is less, less, less. So now the evidence for them that they, they.

Dr. Mark Hyman (61:07)

But is there really evidence about the omega 3s? Like is it just a, is it,

Dr. Jonathan Kanefsky (61:10)

we just know that it thins the blood. I, I'm, I'm a huge proponent of omega 3s, but we know like it's, it's the risk.

Dr. Mark Hyman (61:15)

We don't really have any good data that during surgery it's a problem.

Dr. Jonathan Kanefsky (61:17)

We just hypothesize that it, I recommend them afterwards all the time. I just said beforehand, just, just stop. Also with the surgeries I do, the risk of bleeding is so low because there's not really big incisions. So it's, it's less of a risk. But with other surgeries, yeah, for sure. But the things you should do is so I think protein intake is incred and more evidence that it's actually important in the wound healing. Zinc, copper, vitamin D. And so there are supplements out there that incorporate all those things and I, I, I share a few with my patients. I think they're, they're really helpful before and after surgery. I think the things that get slept on the most are arnica and bromelain. So arnica is a, a plant derived thing that helps with, with bruising. And bromelain is a, a compound from pineapple that helps with swelling before surgery. You would just want to make sure you're in the best shape possible to undergo the stress of surgery afterwards. You want to be doing things that are going to nourish the body.

Dr. Mark Hyman (62:05)

And the diet.

Dr. Jonathan Kanefsky (62:05)

Yeah, it's all. Oh, diet's. I mean, you know, this diet's the most. Diet. Diet's the most important part. Yeah. So having in general, I, I think a whole, whole food, mostly plant based but obviously with a good amount of protein can be animal. Animal base is good too.

Dr. Mark Hyman (62:18)

Yeah. We, we had, we were about to do a study to the, the, with the head of orthopedics at one of the key orthopedic surgeons at Cleveland Clinic, I think and he wanted to do a study of knee trans knee transplants, like knee replacements. And he was like, listen, a lot of our patients bounce back because, because they're meaning bounce back. They come back to the hospital with complications, infections, problems. And these patients who get knee surgery are usually overweight and that's why they have bad knees because you're putting massive forces of pressure of weight on your knees, which you're not supposed to. I forget the math on that, but it's like an exponential amount of force for every pound and they come back with complications. And so we were about to do a study where we put people on a 30 day program to reduce inflammation, to help them lose weight, to improve their metabolic health and nutritional health as a pre op strategy to reduce post op complications and then even post op the same thing. So I think that's really important. And I knew for my recovery I just loaded up on protein, anti inflammatory

Dr. Jonathan Kanefsky (63:14)

foods and you know, you want just the right amount of inflammation and all the nutritional support you can get. I do. I think in the future there will be diets that will be specific for certain surgeries. I mean it already sort of exists with, there's these things called early recovery after surgery protocols, eras protocols. A lot of hospitals have them. But I think with the more information we get about specific blood work and the type of surgery people are having and what's really good for them in their wound healing. Like if you're having bone surgery, it's probably better to be supplementing things that are going to support joints and collagen and things like that more push that kind of healing more. If you're having more skin surgery, things that are going to, you know, favor more skin healing brain. Like I do think there's, there is A world in which we have more organ specific or surgery specific diets afterwards that are tailored toward. Towards your recovery.

Dr. Mark Hyman (63:57)

Absolutely.

Dr. Jonathan Kanefsky (63:57)

Yeah.

Dr. Mark Hyman (63:58)

Yeah. I mean, it definitely wasn't the diet that I got served after my back surgery. So I think, you know, we don't really have this consciousness in medicine, but we will. And I think your work around understanding, you know, surgery ceremony around using all these nutritional and lifestyle modalities and psychological supports and post op healing technologies, whether it's peptides or red light or hyperbarics or lymphatic drainage, acupuncture, these are all things that should be used as part of standard of care. Hopefully they will be because they ultimately reduce costs because they, they reduce complications, they improve recovery, they basically save money. So, John, thanks for enlightening us about the dangers of breast implants, which I think most people need to know about. And also the hope of new technologies that are around because it's not just all bad news, there's good news because that was the problem before. I was like, okay, you need to take these out, but I'm sorry, there's nothing to do. And now there is, which is really refreshing. And, and where can people find out about your practice, learn more about you, understand what you're doing?

Dr. Jonathan Kanefsky (65:01)

Go see you best place is going to be online. My Instagram. It's rjohn K. So D R J O N K and I'm I, I answer most of the message I get and always happy to chat.

Dr. Mark Hyman (65:12)

And what's your website for?

Dr. Jonathan Kanefsky (65:13)

It's auraesthetica.com. so that's a U R Aura Aesthetica A E S T H I C A dot com.

Dr. Mark Hyman (65:21)

Okay, great. Aura Esthetica. We'll put a link in the show notes. I can't wait till your book comes out. I don't know when you're writing it, but you better write it.

Dr. Jonathan Kanefsky (65:27)

I'm gonna need. Give me some pointers.

Dr. Mark Hyman (65:31)

Definitely need to write a book on this.

Dr. Jonathan Kanefsky (65:33)

I'm thinking busted.

Dr. Mark Hyman (65:35)

Busted. Yeah, that's a good one.

Dr. Jonathan Kanefsky (65:36)

Yeah. Something about breast implants not being a thing anymore. Yeah. Anyway, we'll workshop the title.

Dr. Mark Hyman (65:41)

Okay. Okay. Thanks, John, for coming over and doing what you do and being a pioneer in all this and thinking about things differently. So glad to see how well you're doing with it all. Yeah.

Dr. Jonathan Kanefsky (65:51)

I appreciate you, your friendship, mentorship and always, always good vibes. All right, thanks.

Podcast Host / Announcer (65:56)

If you love this, do you have a question about my favorite books, supplements or recipes? Then sign up for my free Marks picks newsletter@doctor hyman.com marks picks where I'll share all of this information with you and so much more. You'll get emails from me every Friday with recommendations on things that have helped me on my health journey and I hope they can help you too. Thank you so much again for tuning in. We'll see you next week on the Dr. Hyman Show. This podcast. Please share it with someone else you think would also enjoy it. You can find me on all social media channels at rmark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review and subscribe to the Dr. Hyman show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness center, my work at Cleveland Clinic, and Function Health, where I am Chief Medical Officer. This podcast represents my opinions and my guidelines Guests opinions Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness center at Ultra Wellness center and request to become a patient. It's important to have someone in your corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public, so I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening.