Breast Implants Are Making Women Sick—Here's What's Happening with Dr. Jonathan Kanevsky - Transcript
Dr. Mark Hyman
Women are being gaslit by the medical profession about breast implants. The gaslighting is essentially saying to women, these symptoms are all in your head or take some Prozac, you'll be fine. I have seen many cases of women with severe illness correlated with their implants. What's even more impressive is when they take them out, they get better. Silicone comes from petroleum.
So this is a petrochemical industrial product.
Dr. Jonathan Kanevsky
We have not changed the fundamental laws of biology, is you put in a foreign object, it is going to have a reaction. Until I could predict who's going to have an adverse reaction to breast implants, it seemed completely unethical to be putting implants in for an elective procedure. The old paradigm of surgeons just cutting and leaving, I think it's done.
Dr. Mark Hyman
You call it surgery a ceremony. I'd love you to unpack that.
Dr. Jonathan Kanevsky
There is an altered state of consciousness, which is the medication that's used in surgery. You know, body keeps a score. It's trying to make sense of what's going on. For example, one patient, her mantra was like, I wanna come home to my body. I work with a great team of lymphatic therapists that will help you land back in your body as you're integrating everything.
Dr. Mark Hyman
Today on the podcast, I'm joined by doctor Jonathan Kanevsky. He is a board certified plastic surgeon in Los Angeles and a data scientist who advises Google and Neuralink. He is a leading voice in the treatment of breast implant illness, pioneering transformative framework he calls surgery as ceremony.
Dr. Jonathan Kanevsky
So the big vision is that nobody puts an implant in ever again. This is the only place an implant should be, which is outside the body.
Dr. Mark Hyman
John, welcome to podcast. Thank you. 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 forty years, and if you include medical school, it's I don't know what the math is, forty three years. I would say that 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. Mhmm. And there there's something in medicine called doctor 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 a pheochromocytoma in medical school, which is a rare adrenal tumor. I've never seen one in forty years.
I'm assuming you've never seen one.
Dr. Jonathan Kanevsky
It's always on the differential, but I've never seen one.
Dr. Mark Hyman
And it's basically like a rare tumor, so it means like you it doesn't happen around it. 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. We've 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 is definitely linked to adverse health outcomes. So you've spent your life, you know, training as a plastic surgeon. You're you went to McGill. You trained in California for your fellowship.
You've you really are an expert in 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 Kanevsky
So thank you first of for having me on so we can talk about this.
Dr. Mark Hyman
My pleasure.
Dr. Jonathan Kanevsky
Is an important topic, and and the way that you dive into it is gonna 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 '20 2010, so even more than ten years ago. He presented on something called BIAALCL, breast implant associated anaplastic large cell lymphoma. And I saw that for the first time in a conference in Vancouver.
Dr. Mark Hyman
And that's like basically an immune tumor
Dr. Jonathan Kanevsky
It's a cancer that's associated with the implant. And so this this very rare type of cancer associated with implants was the first thing that sparked my curiosity. 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. And fast forward a few more years, implants still are not banned or, you know, there's no major warnings about them as as this information's coming out.
Dr. Mark Hyman
Yeah. But the FDA still approves them.
Dr. Jonathan Kanevsky
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 finishing 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 implants are making me sick, and I just I just heard that over and over again. Yeah. And up until that point, the medical community, the plastic surgery community by and large was saying, you know, it's 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 Rashes.
Dr. Mark Hyman
Yeah. Even nervous system symptoms.
Dr. Jonathan Kanevsky
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 sure.
Dr. Mark Hyman
Called DII. Right? Correct. Implant illness. But there's so much more than that.
Dr. Jonathan Kanevsky
And it's even before that, it was ASIA. Was auto adjuvant silicone associated autoimmune problem. And then it's since been re categorized 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. Yeah. That have potentially up to a thirty percent chance of a complication.
Dr. Mark Hyman
Yeah. It's not like you're getting a heart transplant because you need for
Dr. Jonathan Kanevsky
Yeah. Your it's just like, this this is strange. Until I can predict who's who's gonna have these problems and why, I'm just gonna stop using breast implants and focus on a safer alternative. And that's that's that was the 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
So so there's more to talk about and unpack about this, but 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 and and and it's beyond just you know, I I kinda looked it up, and I was preparing for the podcast. But up to ten to twenty five percent of women have some type of complication. That's one in ten to one in four women have a complication, and it's everything from capsular contracture.
Right? And so and you can talk about that to to autoimmune and inflammatory issues you mentioned to this the ASIA that you talked about. It's autoimmune inflammatory thing, the breast implant illness. And the cancer risk you mentioned, this lymphoma. Even just local, you know, 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? Just kind of talk us through each one of those, because it's a lot
Dr. Jonathan Kanevsky
of stuff, and it's not just one thing that it causes. The complication rate is actually higher. If you look at all of the potential complications associated with implants, it's closer to thirty percent. So thirty percent 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, you know, less common complications about hematoma, like bleeding, infection, things like that.
But the three big ones that are known and make up most of that thirty percent is capsular contracture, BII, and the ALCL. Capsule contractor is essentially
Dr. Mark Hyman
That's the autoimmune, or that's the cancer? That's But what about the autoimmune? That's
Dr. Jonathan Kanevsky
the 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, they're very easily diagnosed. So capsular contractor is basically the capsule that forms around the implant. A foreign body, anytime Here go.
Dr. Mark Hyman
There's this little
Dr. Jonathan Kanevsky
Yeah. Here you go. You got the implant.
Dr. Mark Hyman
What tell us about here you go.
Dr. Jonathan Kanevsky
So this is a fourth or fifth generation
Dr. Mark Hyman
Oh, sorry. For those listening, we're showing a silicone breast implant, which you can't see if you're driving.
Dr. Jonathan Kanevsky
This is the only place 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 it's silicone shell with a silicone gel inside. It's a silicone gel polymer.
If I was to cut this open, it's kinda like a gut it would it wouldn't leak out like liquid as a gummy bear.
Dr. Mark Hyman
So Just just to be clear, silicone comes from petroleum.
Dr. Jonathan Kanevsky
Mhmm.
Dr. Mark Hyman
Right? So this is a petrochemical industrial product. Mhmm. 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. Mean, there's a range of effects of toxins. It's huge, and this is a you know, when you say polymer, doesn't sound like something should be in your body.
Dr. Jonathan Kanevsky
And silicone is one of hundreds of ingredients that are usually used in the process of making implants. I brought one that's smooth. The ones that are really causing the problem 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 contracture. So capsular contracture, this foreign body goes inside. The same exact thing happens if you gets if you accidentally get a piece of lead in your fingertip or, you know, thorn from a bush, the body encapsulates it.
It's gonna make that fiberglass covering around it. It's gonna 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 contracture 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 it'll contract on the implant, it'll get really hard, and that's what capsular contracts.
Dr. Mark Hyman
So they're like hard balls, like a baseball.
Dr. Jonathan Kanevsky
Yeah. 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 contracture. 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
Yeah, which is way more common than the
Dr. Jonathan Kanevsky
Way more common, harder to diagnose, it's the diagnosis of exclusion.
Dr. Mark Hyman
And there can be autoimmune illnesses like Sjogren's syndrome, rheumatoid arthritis, systemic sclerosis, mixed connective tissue disease, Hashimoto's. I mean, one in five women have hypothyroidism. That's twenty percent of women.
Dr. Jonathan Kanevsky
What's 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 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 Pretty good. And wired, something like that acts as an adjuvant, and it'll it'll upreg the community.
Dr. Mark Hyman
It's impressive that the FDA actually finally recognized this as a as a real thing. They acknowledged a breast implant illness in 2020 as a real condition, and it's not in women's heads. Mhmm. What's really interesting, maybe you can talk about this, is what happens and you've 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 do they get better?
Dr. Jonathan Kanevsky
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 that's a question you know, there's an incredibly large growing body of research in this field. And before I said, you know, the plastic surgery community was felt like it was kinda gaslighting women over the years. Yeah. 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 a capsule and the implant remain. So it's important to Why
Dr. Mark Hyman
would the capsule remain? Why don't you take the whole thing out? Because it's stuck?
Dr. Jonathan Kanevsky
It's a dangerous surgery. It's not easy. Because it's stuck in there? 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 are replaced between the pec muscle and the chest wall. So it's and and there's this you know, the technique that was that the surgeon was doing for us called unblock 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 technically challenging because you're operating in a small space Yeah. Trying get all the way around it.
Yeah. 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's stuck to the chest wall. You can get into a place that it shouldn't be like the lungs.
Yeah. Yeah. So it's a much more technically challenging surgery. 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 do no harm.
Dr. Mark Hyman
And you don't think with a capsule remaining still has silicone in it that's gonna cause issues?
Dr. Jonathan Kanevsky
It's still reactive inflammatory tissue, so anytime I can remove the capsule safely, I do. If I think it's gonna potentially put the patient at more risk, obviously, I wouldn't remove it. And it all has to do with I screen the patient to see what are the symptoms you're experiencing. You know, if the patient says, I don't have symptoms, I just want the implants out, we won't go there.
Dr. Mark Hyman
But what's interesting is the explant studies because it's one thing to say, well, can you prove by cause and effect? Because they're not going to do a randomized trial where they give a thousand women implants, and they give another thousand or 10,000 women, another 10,000 implants, and they follow them for twenty years since you get sick. You know?
Dr. Jonathan Kanevsky
That's
Dr. Mark Hyman
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 fifty to eighty percent of women see improvement.
Dr. Jonathan Kanevsky
I mean, you're removing this thing that's full of silicone that's causing this chronic inflammatory reaction. Yeah. 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 is what needs to be removed. The implant is prime time.
Dr. Mark Hyman
Yeah. Mean, that's sort of classic functional medicine. Someone's sick, you take out all the bad stuff Yeah. Until you see what happens. Because you don't know and 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 kinda your body can handle it to a certain 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. 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 in the silicone.
Dr. Jonathan Kanevsky
In in the things that are used to process the implants, they have all sorts of heavy metals. You know, the the dose or amount is probably what is the most important question, but they are they are present.
Dr. Mark Hyman
Yeah. It's small. But it's a cumulative effect of all this. And so I think that that, you know, we we're now in an era we're beginning to understand that, you know, toxins play a role in human health. And 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. You know, they just think you're fine. And so what 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 dark side of it is it's problematic, and it has created a whole string of issues that are concerning, and that have a lot of metabolic effects and cellular effects and cognitive effects. I mean, it's not just the autoimmunity.
You can get neuroinflammation and brain fog. You've said some of the, you know, neuropathies, headaches, POTS, things like that. So it's a concern. So I think that what I really 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 to this, I'm sure many women who are listening out 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, 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 know, you've got a wart. Take it off, and big deal. Know?
Because I'm dealing I deal with this regularly because I 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 silicone and other things. So, know, there are ways of 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 the silicone or your antibodies. There's two different kinds of of immune reactions. One is your white cells fight it, 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 going be hard to know.
And the question is, the women who were listening to this in in despair right now or husbands who are worried about their wives or partners, what actually is available now? Because you 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. So there's two ways that
Dr. Jonathan Kanevsky
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 I noticed 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 explants, 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 undergone a surgery to change a part of your image that might impact your identity to then probably anywhere from five, ten, fifteen years later, think about now removing 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 Yeah. Without implants, what does that look like? So Very. The second category is wanting to change a part of your body, wanting to, whether it's after cancer, breast reconstruction, or as a primary augmentation, to increase or change the shape and size of the breast, fat grafting is a safe option.
It may not achieve
Dr. Mark Hyman
So what is that?
Dr. Jonathan Kanevsky
Yeah. So fat crafting 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
All these women are saying, how do I get rid of my belly fat?
Dr. Jonathan Kanevsky
This is a is really a two for a two two for experience. So you can you can shape and sculpt one part of the body, and also use it as a medium. And I think it's the most natural way to do something, because the breast tissue itself is a combination of fat and gland, and so we're just putting fat where it's supposed to be. Fat grafting has there's a lot of myth around it over the past, it's been around for a long time, over a hundred years. Did it?
Yeah. Fat grafting's been around for a long time. Amazing. Initial What was
Dr. Mark Hyman
it used for?
Dr. Jonathan Kanevsky
The very first case was a case of liposuction that was done in like the eighteen hundreds. It did not go well. This was an experimental procedure at the time, but using transplanting a piece of fat actually for breast implant as a a breast Oh, really?
Dr. Mark Hyman
Wait. In the 1800s, they didn't have anesthesia.
Dr. Jonathan Kanevsky
This was this was like late 1800s. The story is it was it was a I believe it was a ballerina. 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. Uh-huh. Yeah.
So a ball of fat put somewhere else. Of course, didn't survive. We know a lot more about how tissue grows and regenerates now. You can't just take a blob of fat and put it somewhere else in the body and expect it survive. Oh, what do you do?
Well, the technology has gotten a lot better. The myth used to be, well, you transplant fat, it doesn't survive. That's kinda 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.
Yeah. You take these little adipose derived stem 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, 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 drops, little seeds in a garden versus just 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 damage the tissue, 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 soften the skin and also have the benefit of creating more of a contour. Ironically, fat grafting became popular because of breast cancer to the breast.
Dr. Mark Hyman
And that's what most breast cancer surgeons would do with then?
Dr. Jonathan Kanevsky
They'll do a combination of an implant because still 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 from one part of the body to sculpt and make the breast. But fat grafting is used throughout as a modality, and it's getting better and better.
Dr. Mark Hyman
So that's what you do. Mhmm. 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 are in terms of sizes and stuff. Because I think, you know, you kind of think, well, it depends if you have fat or don't have fat.
Dr. Jonathan Kanevsky
Right. 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 numbed, 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
So you just have, like, a needle and needle?
Dr. Jonathan Kanevsky
Yeah. It's tiny. So everything's done through little keyhole entry points, so about two to three millimeter incisions. No big cuts, and the entry points are hidden throughout the body, so it's it's really meant to be as 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.
Dr. Mark Hyman
And it just kinda like fills up like a balloon?
Dr. Jonathan Kanevsky
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 three d painting. Wow. And so it's about
Dr. Mark Hyman
Surgery is art.
Dr. Jonathan Kanevsky
Surgery is art. Exactly. So I'm able I'm able to to sculpt the area to make sure that it's it's not just like a one and one and done thing. Everybody's different. So certain parts of the breast need more fat here or there, and it's about sculpting.
And and
Dr. Mark Hyman
the results you get are just like an implant
Dr. Jonathan Kanevsky
or No. Better? 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 breasts with that 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 more of a natural slope and then fullness on the bottom. Right. 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. Lot in there.
Yeah. 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 grafting, 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 gonna look more like a natural shaped breast.
Dr. Mark Hyman
Are there any complications or risks or challenges other than just normal surgery, infection, and bleeding?
Dr. Jonathan Kanevsky
Those are the main ones that we look out for. So infection, bleeding, it's still surgery, so just like any surgical procedure, those are are common things. The things that are more important to look out 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 a bit you can have a bit of scarring around them, and that's hard to predict. Not everybody scars the same way, but usually the scars heal really well. And the question I get asked a lot, 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, it's just 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
Yeah, there's breast ultrasound and breast MRIs, so there's other technologies which help.
Dr. Jonathan Kanevsky
Compared to breast implants, I think the risk profile is much lower, but it's still surgery, so you gotta be careful.
Dr. Mark Hyman
But but it's not the autoimmune issues and the breast implant illness and the cancer risk and all that stuff.
Dr. Jonathan Kanevsky
It's your own tissue, so you're not dealing with any of these autoimmune issues, and it it it's gonna heal just
Dr. Mark Hyman
And and so so let's say, ideally, you'd wanna be having a little extra body fat, and you can use it, and then you wanna stay at the same weight. But what if you're like, you know, want an implant, and then you're a little overweight, and then you wanna lose 20 pounds? What happens?
Dr. Jonathan Kanevsky
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, recommend patients 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, let's say, five to 10 pounds, and 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
Yeah. But if you're really overweight and you want to take Ozempic and you have a fat
Dr. Jonathan Kanevsky
transfer Ozempic and fat transfers do not go well together. So when I if patients are on any kind of GLP one, I say, we gotta stop the GLP one Forever. Not not forever. Just let just reach reach a plateau that you're comfortable being Stop the Ozempic or the other GLP you want in your arm 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
And then there's new technologies. This is what's been around. This is what works. This is what you're doing right now.
Dr. Jonathan Kanevsky
Yeah.
Dr. Mark Hyman
But we were chatting a little earlier, you said there's some newer technologies that are available, which are pretty interesting, which is using other people's fat when there's an endless supply of that in America right now. It's like, you think people give give medical scissors to make money by giving blood donations? It's wild. Or sperm donations.
Dr. Jonathan Kanevsky
Yeah. Can
Dr. Mark Hyman
do it like, oh, you can do fat donations. Do you do you
Dr. Jonathan Kanevsky
see I mean, the Ozempic thing is really taking off. The why? The Ozempic thing is taking off so much so that airlines are now saving money on fuel.
Dr. Mark Hyman
Fuel. Of course.
Dr. Jonathan Kanevsky
Yeah. So we're present. Maybe for long, we
Dr. Mark Hyman
will Yeah. Ozempic's good for climate change. Yeah. That's wild. That's who knew?
Side effects. Yeah. Everybody on Ozempic, go right now. Save the planet. Take Ozempic.
Yes. In terms of in terms of the the way it's it's it's important, I think, for people to understand it's this is fat tissue and it fluctuates. Yeah. But these new technologies sort of use an endless supply of fat from other donors. Yeah.
So tell us about what that is, what it's called, how it works, what the risks are.
Dr. Jonathan Kanevsky
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? Implants are really not it.
Dr. Mark Hyman
You want the FDA to go, this is done?
Dr. Jonathan Kanevsky
Yeah. And they've they've done it twice. In the eighties, they said, eighties or early nineties, 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. A 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, resurgence, I think in 2018, black box warning on implants, but they're still out there.
Yeah. And now there's these newer generation implants who are, you know, the whole Like trans fats are
Dr. Mark Hyman
now ruled they're not safe to eat by the FDA, but they're still a cool whip in the grocery store.
Dr. Jonathan Kanevsky
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, there's a whole new design of an implant by a 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, it's like, oh, it's a safer cigarette.
I'm like, what are we doing? This is not Why do they say it's safe,
Dr. Mark Hyman
and why do you think it's not safe?
Dr. Jonathan Kanevsky
I don't
Dr. Mark Hyman
think it's safe because I've I've heard about this one.
Dr. Jonathan Kanevsky
We have not changed the fundamental laws of biology, which is you put in a foreign object, it is going to have a reaction. Mhmm. If it's a less of a reaction, great, but there's still some percentage of of people that are gonna 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 three d 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
Silicone. Silicone is
Dr. Jonathan Kanevsky
still There's still silicone in the body. So and now, I I saw some recently, surgeons putting in a hundred cc implant. That's a third of the size of this. That's small. It's not only is it small, you could easily do that with fat, so it just makes it makes even
Dr. Mark Hyman
Yeah. Less sense to Yeah. Yeah.
Dr. Jonathan Kanevsky
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 graft retention.
Dr. Mark Hyman
Yeah. I wanna talk about surgery as a ceremony after what you do this. Because you're not just a regular surgeon. We're gonna get into all that, so I'm gonna save that. But but there are ways to use various kinds of therapies and treatments to enhance healing.
And I've I've recently I had a bike accident, and I smashed it on my face, and I recently had to use it. And I was sort of amazed at how fast Yeah. Things heal.
Dr. Jonathan Kanevsky
You look great, Mark.
Dr. Mark Hyman
Thank you. Wow. So what's the name of this this fat transfer that you get from other people? Like, what is it called?
Dr. Jonathan Kanevsky
Aloe clay. Basically Aloe clay. Aloe clay is the name of the brand right now. Clay like molding. Yeah.
Aloe clay. It's And aloe means 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 it 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 you want.
Dr. Mark Hyman
A delayed answer.
Dr. Jonathan Kanevsky
It's yeah. It's 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 at times.
Dr. Mark Hyman
And the immune reaction is?
Dr. Jonathan Kanevsky
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.
Dr. Mark Hyman
Now, and you and we also talked about a newer technology that is it's kinda interesting to me that that you said 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? Sure. And what the promise of that is
Dr. Jonathan Kanevsky
and the risk? So I think this will be big in the future, which is you can so it's really I'll go over the 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
And how long does it take
Dr. Jonathan Kanevsky
to grow? I mean, fat like, most and this has been done. This isn't you know, this is new, but it's been done in many other examples. It's done been done for bone. It's been done for skin.
It's been done for for other tissues. Six to eight weeks.
Dr. Mark Hyman
Basically, basically, you get a little fat sample taken out
Dr. Jonathan Kanevsky
Yeah.
Dr. Mark Hyman
And it doesn't have to be a lot. Yeah. And then you can you put it in a lab, and you cook it. Basically, it goes in like an incubator. Yeah.
And you can grow your own fat cells. Yeah. And you can grow as much as you want?
Dr. Jonathan Kanevsky
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 fat.
So four technology four things we talked about for fat sharing. The first is improving everything possible in the operating room with your own fat. The second is aloe clay or using somebody else's fat.
Dr. Mark Hyman
Yeah.
Dr. Jonathan Kanevsky
The third is banking your or 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 wanna 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 the future, and two, as as a volume filler.
But ultimately, you
Dr. Mark Hyman
wouldn't even do the banking if you could Yeah.
Dr. Jonathan Kanevsky
If you can just grow it, great. But right now, that's not it's not commercially available, and it's it would 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 do you it's $800 burger. It's it's Or I don't know how much it costs now, but it's expensive.
Dr. Mark Hyman
It's less. It's not $800. Yeah. How far off is this growing your own fat technology for women?
Dr. Jonathan Kanevsky
I don't wanna put an exact number up, but 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
Eight to five years. In terms of the the interesting in 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 Mhmm. Would you be able to have bigger breasts?
Dr. Jonathan Kanevsky
Yeah. And when I do fat transfers, I I like to have at least three to 400 cc's of fat per side. And just for reference, this is a 250 cc implant.
Dr. Mark Hyman
So like double that almost.
Dr. Jonathan Kanevsky
Yeah. And a can of soda is about 330 cc's or something like that. So it's a it's a good amount knowing that not all of it's gonna survive. Yeah. And that's per side.
So usually, like in a in the best case scenario, harvest about a liter of fat, which is which is doable if you treat multiple areas in the body.
Dr. Mark Hyman
If 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 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 uncom 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 is causing it. But you know, what's the threshold that you kind of say, okay, you've got to do this?
Dr. Jonathan Kanevsky
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 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. So once everything else is ruled out Yeah. We've arrived at the final destination, which is I think it could be the implants.
And it's important to do everything else medically.
Dr. Mark Hyman
Well, that's what I do. I always 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
Dr. Jonathan Kanevsky
And 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, all the patients that suffer from fibromyalgia, 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 if a patient says, like, I heard about this yesterday, I think I have breast implant list, I don't think it's a good time to have surgery within a week.
There's a lot of understanding that needs to happen about the risks and benefits of explant, also the identity of who you're gonna 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 Yeah. To understand what it's gonna 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 I felt like she was ready for it, she felt like she was ready for it, and then months, about eight months later, she's like, you know what, I feel better, but I can't handle the way that I look, and I really want that look back, 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, 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 everything from preparing psychologically for it to physically.
The amount of modalities out there is amazing to detoxify afterwards.
Dr. Mark Hyman
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 Kanevsky
I usually recommend waiting three months. And it's I always stage it. I don't do the explant and the fat grafting at same time. It's like demolishing and building a house at the same time. It 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 risks of of of all those heavy medications.
Dr. Mark Hyman
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 this a real phenomenon 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 five percent 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 and kind of wait a minute and pause and and wait, maybe wait for these new technologies or use one of these other possible transfer fat transfer techniques.
You're also, you know, thinking about how to really take care of women in a way that's safe and effective. But your your thinking goes far beyond that. And and I I 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, and there's not a lot of ritual around it. There's not a lot of understanding of how it affects you.
I mean, had massive surgeries like about a year ago, and it was a it was a lot, you know. And I I have a pretty good constitution and a pretty stable mind, so but I remember like I mean, for mine, was, you know, it was it was a very severe thing, I could have died. And and and I remember going into the Operating Room, you know, it's just, you know, you're kind of in the hospital, you're in a sterile environment, 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, you know? And I remember this could be my last breath, this is my last moment of consciousness, you know? And was kind of scary.
And you you 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. We we you call it surgery as ceremony. And I love that. So 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 Kanevsky
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 that was giving a talk, he said, is a protocol but a process, a process but a ritual, and a ritual but a ceremony? Mhmm. And it it stuck out to me as how many things do we do regularly in our life that are ceremonial in nature, but we treat them as a protocol? Think about flying.
You know, there's the FAA checklist Yeah. Yeah. 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's an amazing experience.
Dr. Mark Hyman
Yeah.
Dr. Jonathan Kanevsky
But we've we've removed a lot of that, and surgery is no different. We've taken what used to be, 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, Ra or Cobb.
Dr. Mark Hyman
Yeah, one of the
Dr. Jonathan Kanevsky
gods. They had all these hieroglyphs of surgery, and pharmacy, and things like that, and I was like, wow,
Dr. Mark Hyman
even And psychedelic mushrooms.
Dr. Jonathan Kanevsky
Yeah, of course. Very strange. It's got a part of the experience. So five thousand 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 that. 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
When I was in residency, one of the one of the surgeries used play the Grateful Dead in the Operating Room. So that was kind of like a ceremony.
Dr. Jonathan Kanevsky
Music music, and I'll talk about this. Music is a huge part of it. If you think about a ceremony, what is a ceremony? A ceremony it could be meditation, it 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, it could be some people do it with plant medicine, and then the third thing is 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 wanna be fixed. There is an altered state of consciousness, which is the medication that's used in surgery. It's without a doubt, hundred million surgeries a year, people are having their consciousness altered for that time period.
Yeah. Your consciousness is being unplugged, all these medications flood your system. Yeah. And then you have to go through the journey and 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 body's changed, but your mind has to catch up with what's And the consensual part of surgery, 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.
It's your the cautery, things are being burned, things are being cut, you're asleep.
Dr. Mark Hyman
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 Kanevsky
Exactly. You you are it's exactly the the 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 immediate 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 process, so it's ketamine assisted psychotherapy. Not a big a big dose, it's a very light dose, but it helps kind of drop the ego defenses so you can get into this discussion with your therapist. Therapist then will elicit certain keywords, mantras, and you know Doctor.
Kat, we've worked out. She helped craft this protocol, amazing therapist to work with, will help basically pull out little key phrases, mantras, things to understand that are unique to that patient that I can then use during surgery, because patients are generally awake during their procedures, to coach and talk them through it. 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 neuro acoustic recall that you hear during this transformative experience where you're dropping into your while you're going to surgery, if that playlist starts playing again during surgery, it it it's it's like a it's like a warm hug.
Yeah. You're like, 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 wanna come home to my body. And I could tell during the surgery, as the medication was coming in, I also used ketamine as an anesthetic during the surgery, I was able to I said those phrases back to her. Said, you're coming home to your body, and you just smile, she's like, 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 always weird. It's like, 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?
Yeah. So the energy of the the staff that are in there, you know, they're here holding a patient's hand, tactile sensation, that release release of oxytocin may be the best pain medication we know. So 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 state. The ceremony of the surgery has a lot of steps to it, but the most important thing is 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 lymphatic therapists that will help you land back in your body as you're integrating everything.
And 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 to be what I call surgery ceremony.
Dr. Mark Hyman
Yeah. That's true. You know, I had I had this massive surgery on my back, and 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 bodywork 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 was like, what are you doing? Like, you we've never seen anybody recover like you.
Like, you're an anomaly. I'm like, well, this isn't rocket science. It's just, you know, understanding how the body works. And and surgeons are great at, like, cutting and leaving a patient. It's like, boom boom.
Dr. Jonathan Kanevsky
You're done. Not not anymore. You just And Yeah.
Dr. Mark Hyman
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 I don't lift heavy things or don't do that. It was like all the don'ts, not what the dos are. Not the dos, 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 Kanevsky
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 some some other parts of the protocol. So I generally recommend a whole food, mostly plant based diet, but having a lot of protein, because after you have surgery, it's like your body's running a marathon every day. You need a lot of supplementation. Yeah. 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 and improves wound healing. Hyperbaric oxygen is amazing. I know you're a big big fan of that. Yeah. 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, 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 TB five hundred, VPC one five seven, thymosin alpha.
We have a little peptide protocol that
Dr. Mark Hyman
I think is is more and more important. Tissue repair, regeneration, yeah.
Dr. Jonathan Kanevsky
And, Sachin, what you said is I think the old paradigm of surgeons just cutting and leaving, I think it's done. I think the 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
Yeah. And I think I think this kind 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 wanna touch on something I know you know about and I wanna dive in because people don't think about this when it comes to surgery. And it's gonna 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 sew them, and you're in the you're in the wound or in the surgical field.
Dr. Jonathan Kanevsky
Yeah. It's like tissue paper.
Dr. Mark Hyman
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? Tell me. Piss poor protoplasm. Oh, yeah.
Do you remember that? Piss poor protoplasm. It's terrible. It's kinda what doctors do to sort of deal with the gruesomeness of all the things they have to do is make jokes. But Yeah.
But it it's it's a real thing. And and I think it has to do with with with how your body heals in wounds. 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 ninety percent 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 three.
Dr. Jonathan Kanevsky
Using copper. Like, all these all these micronutrients are super important.
Dr. Mark Hyman
Yeah. And so so I'm curious. You know, what I really found interesting was as I began to do functional medicine, I started to, like, you know, use supplements and things thirty years ago. And the of the only other doctors and 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, there 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 Kanevsky
Yeah. I I recommend them all the time.
Dr. Mark Hyman
What what what should people do to prepare, and what should people do after in terms of their diet and and the right supplementation regimen to help them get through surgery?
Dr. Jonathan Kanevsky
Great question. So before it's kinda like the dos and don'ts. There's things you should do and things you should definitely not do. So you wanna avoid anything that might thin the blood, so avoiding omega threes, ginkgo, ginseng, garlic. Usually, anything with a g kinda thins the blood.
But that's not not forever. Just usually Vitamin e? Vitamin e. Yeah. So, like, in omegas and 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
Plus aspirin and Advil and
Dr. Jonathan Kanevsky
everything else. Yes. Anything that pins the blood. And and it's interesting. NSAIDs is less less less so now, the evidence for them that they they will But is
Dr. Mark Hyman
there really evidence about the omega threes? Like, is it just a is it
Dr. Jonathan Kanevsky
We just know that it pins the blood. I I'm I'm a huge proponent of omega threes, but we know, like, it's it's the risk of
Dr. Mark Hyman
bleeding We don't really have any good data that during surgery, it's a problem. We just hypothesize that it
Dr. Jonathan Kanevsky
I recommend them afterwards all the time. I just said beforehand just to 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 incredibly important, creatine more 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've shared a few with my patients.
I think 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 plant derived thing that helps with bruising, and bromelain is a compound from pineapple that helps with swelling. Before surgery, 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 gonna nurse the body for And the diet. Yeah.
Oh, diet's, I mean, know this, diet's the most important part. Yeah. So having in general, I think a whole food, mostly plant based, but obviously with a good amount of protein can be animal, and the base is good too.
Dr. Mark Hyman
Yeah. Were about to do a study 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 tran knee transplants, like knee replacements. And he was like, listen. A lot of our patients bounce back because they're I mean, bounce back.
They come back to the hospital with complications, infections, problems. And you know, these patients who get knee surgery are usually overweight, and they have that's why they have, you know, they get 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 it's like an exponential amount of force for every pound, and and and they come back with complications. And so we were about to do a study where we put people on a thirty 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, in my recovery, I just loaded up on protein and inflammatory foods.
Dr. Jonathan Kanevsky
And, you know, you want just the right amount 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, already sort of exists, but there's this thing 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 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 gonna 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 gonna, favor more skin healing, brain I do think there is a world in which we have more organ specific or surgery specific diets afterwards that
Dr. Mark Hyman
are tailored toward your recovery. Absolutely.
Dr. Jonathan Kanevsky
Yeah.
Dr. Mark Hyman
Yeah. I mean, it definitely wasn't the diet that I got served after my back surgery. So I think we don't really have this consciousness in medicine, but we will. And I think your work around understanding surgery ceremony, around using all these nutritional and lifestyle modalities and psychological supports and you know, and post op healing technologies, whether it's, you know, peptides or red light or hyperbarics, lymphatic drainage, acupuncture. These are all things that should be used as part of standard of care.
Hopefully, will be because they ultimately reduce costs because they reduce complications. They improve recovery. They they basically save money. So, John, thanks for enlighten 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, you know, okay. You need to these out, but, like, I'm sorry.
Like, there's nothing to do. You know? And and now there is, which is really refreshing. And where can people find out about your practice, learn more about you, understand what you're doing, go see you?
Dr. Jonathan Kanevsky
Best place is gonna be online. My Instagram, it's @doctorjohn.k, so d r j o n dot k. And I I answer most of the message I get and always happy to chat.
Dr. Mark Hyman
And what's your website for
Dr. Jonathan Kanevsky
It's auraaesthica.com. So that's a u r a, aura aesthica, a e s t h I c a dot com.
Dr. Mark Hyman
Okay. Great. Aura aesthica. We'll put a link in the show notes. I can't wait till your book comes out.
Don't know when you're writing it, but you better write it.
Dr. Jonathan Kanevsky
I'm gonna need your help. Give give give me some pointers.
Dr. Mark Hyman
I definitely need to write a book on this.
Dr. Jonathan Kanevsky
I'm thinking busted. Busted?
Dr. Mark Hyman
Yeah. That's a good one.
Dr. Jonathan Kanevsky
Yeah. Something about breast implants not Busted. Being a
Dr. Mark Hyman
thing anyway.
Dr. Jonathan Kanevsky
Yeah. Anyway, we'll workshop the title. Okay.
Dr. Mark Hyman
Okay. No. Thanks, John, for coming over and doing what you do and being a pioneer in all this and and thinking about things Yeah. So glad to
Dr. Jonathan Kanevsky
see Thank you.
Dr. Mark Hyman
How well you did with it all. Yeah.
Dr. Jonathan Kanevsky
I appreciate you, your friendship, mentorship, and always always good vibes. Alright. Thanks.
Dr. Mark Hyman
If you
Dr. Mark Hyman
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