Speaker 1 (00:07):
You are listening to The La Jolla Cosmetic Podcast.

Monique Ramsey (00:14):
Welcome everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. And today our episode is called the past, present, and future of breast implants. And my guest is our surgeon, Dr. John Smoot. Welcome Dr. Smoot.

Dr. Smoot (00:29):
Thank you. Glad to be here today.

Monique Ramsey (00:32):
So we're not gonna call you old cuz then we'd be calling me old too. But you started practice in 1990, which was really the same year that Connie Chung did, uh, this landmark broadcast on Face to Face, which warned about the dangers of all these old silicone breast implants. So you've seen a lot. And really today what we wanna do is sort of get your take on the things that you've seen over the three decades plus of breast surgery.

Dr. Smoot (00:59):
Well actually I started in 1988, spent two years in Houston doing my training. So I've got a few years under my belt. I did surgery with Dr. Cronin, the original, and uh, did implants with him and his and nephew who at the time were doing it. So I was learning from one of the very fierce pioneers in breast augmentation surgery.

Monique Ramsey (01:21):
So if we go back to like, let's go into the history, sort of the history books of, you know, some of the milestones in breast implants. So in the 1940s we read, we did a little digging. Japanese prostitutes would inject their breast with paraffin, sort of a non-medical grade silicone, believing that that would entice American servicemen. Have you heard that?

Dr. Smoot (01:44):
Oh, absolutely. Back in those early fifties, that was kind of the thing everyone was doing. And the injectable silicone came around and I, I saw quite a few patients who had that done. And at the time it thought like, well it's an inert substance, it's gonna do fine. It enhances their breasts and they do look good initially. But what we found out 20, 30 years later, that those things formed granulomas and they'd worked to the, out to the skin and become open wounds and became a huge problem with term determining, is it silicone or is it a tumor? And that quickly fell out of vogue in the sixties and seventies. And then we started putting in, I think it was in from exact date, late sixties I think when Dr. Cronin and Gerow put the first implant in and they were all silicone. But there were many different ways, silicone saline, paraffin, uh, there's been all sorts of different enumerations of, of implants through the years. But basically the one that won out was the silicone implant followed by the saline implant.

Monique Ramsey (02:46):
So that's, yeah, in our history, he invented that breast implant in 1961. And then in 1962 was that very first Houston lady named Timmy Jean Lindsey. She was the first woman to get those breast implants. So quite, quite a little pioneer for us. And so when you were training with him, was that the biggest part of his practice? Breasts?

Dr. Smoot (03:12):
Well, Dr. Cronin was a little bit older at that time. He was in his eighties. Oh oh. But he was still practicing but we still were doing implant surgery. The other associates of his were ones who taught me how to do this. But yes, I saw some of his early work and it came in and saw some of the problems associated with it. But mostly at that time we were using the Dow Corning Silastic-2 implants, Silastic-1, Silastic-2 implants. And that was such a remarkable thing because it was so soft and it felt so natural. But the problem we had is it had a rupture rate of about 90% after about 10 years.

Monique Ramsey (03:49):
Wow.

Dr. Smoot (03:49):
So they didn't last very long. And with the older silicone, that's the one that gave us all the problems cuz that silicone wasn't the one kind of silicone we used today. It was more of a liquid. It looked like molasses is really what it looked like. And that when it ruptured, it got into the tissues, it got into the muscle and became essentially just like you were injecting silicone into the, and became quite a problem to get it all out. And once it got into the tissues, it became quite problematic.

Monique Ramsey (04:18):
Oh, I bet. And now was it because the shell of the implant would break down so easily or?

Dr. Smoot (04:25):
Yes. The, the shells were, they weren't as strong like we do today. The shells that we have today are much better in terms of their strength and longevity. And we still see ruptures occasionally, but we don't nearly see the problems we had with those early, uh, Dow Corning implants. And hence, that's where all the trouble started.

Monique Ramsey (04:43):
When were those people coming in who had had those, maybe those Dow Corning implants that were starting to have problems?

Dr. Smoot (04:51):
Well that was about the late eighties we were seeing that. And that's why you say when that big hubbub with Connie Chung came up about what those implants are doing and they're breaking, rupturing, getting into the tissues, that's when the FDA stepped in, in 1992 banned them. And yeah, there were problems. There was no question about it but it, and the only implant we could use at that time then was the saline implant. It's the water filled implant. And you know, by being, doing my practice, that was a lot of my practice and it's just, it was kind of devastating to those of us who lived off that for a while. We didn't have much to do.

Monique Ramsey (05:26):
Where was the FDA and all this and did they review medical devices for safety? Do you know much about their involvement back then?

Dr. Smoot (05:36):
Oh yeah, David Kessler, he, he became quite notorious for what he did. They basically just had a knee jerk reaction with this. Yes they were problems, but they just basically banned them out completely saying all these problems. And we were causing these, these problems, autoimmune diseases and problems with them. And so when they shut it off then we still had to, and and rightly so, we as plastic surgeons did not have the research to back up what we thought. And so, alright, so we had to acquiesce to what the FDA had to say about it. Then after 1992 and it was what, 14 years later, after hundreds of tests and hundreds of researches research projects, it came up to show there really wasn't a correlation between silicone implants and autoimmune diseases. So that's why we got them reinstated in 2006 to be able to use again. But in that 14 year period all we could use was saline implants.

Monique Ramsey (06:32):
Right. If you take us back and paint a picture of, you know, what was it like when you were going through training? What were they teaching you about breast implants?

Dr. Smoot (06:41):
Well, it hasn't changed that much. I mean it was still do we put them above the muscle? Uh, we put them below the muscle. What type of things we do to help prevent capsule contracture? Cause that was a known complication even back then. And a lot of modalities were tried and things were tried to help reduce that, but it didn't really change things a lot. We did learn along the way that there are some things that positively do cause problems that's blood in in the pocket contaminants, you know, stuff on your gloves. So we have to have very clean sterile fields. Any type of contaminate can sometimes cause a capsule contraction. We don't know everything that caused them, but, and that was a known, known problem. But the problem was dealing with those ruptured silicone implants, that was, that was always a mess when you got into there. It was very hard to remove. I got on everything instruments, getting it outta the patient was difficult. So, you know, I wasn't sad to see those Dow Corning implants go away. <laugh>

Monique Ramsey (07:39):
And back. In terms of the women and and the popularity of breast implants, was it mainstream at that point?

Dr. Smoot (07:48):
Yes, there was quite a demand even back then. And when I first started my practice in 1988, in the first four years that was probably 50, 60% of my practice was doing implant surgery. And I was well trained. I did a lot of them. And so that was the bulk of my practice. The other things like facelifts and liposuction wasn't as big as a thing back then, but that was the bulk of what we did was a lot of breast surgery. And that just overnight in 1992 just went away, you know, and just, yeah, you know, half your income, half your practice just goes away immediately. That was for the guys that were well established, they were doing other procedures so it didn't affect them as much. But those of us that were just starting out, yeah that was a big whack to us all of a sudden.

Monique Ramsey (08:31):
Now did you have anybody in your immediate friends or family who got breast implants?

Dr. Smoot (08:37):
No, not that I knew personally or was related to me. No, we didn't, I didn't never have that opportunity to do that. But I remember thinking, when I first came into practice that, you know, putting implants in was such an easy thing. I remember my very first case, it didn't go well <laugh> and it humbled me very quickly. I said, you gotta really pay attention to what you're doing. And you know, even though I'd seen several hundred in my training and you came out and there's no mentor there with you anymore. It's all on you, it kind of had to wake up to pay attention to what I was doing. And I got good at it. I was, I did a lot of those surgeries and I think that, you know, the big problem was with the scare they gave women in 1992 just scared 'em to death.

(09:19)
And we had the same thing happen again here a few years ago with the A L C L and the textured implants. But it all kind of went away when we showed the science doesn't back up. But it, it scared a lot of women. It made a lot of problems. But I think because of it though, we made improvements to our techniques. We made improvements to the, the implants we put in nowadays. These new cohesive gel implants are what people call the gummy bear implants really have improved that. Yeah, they do fail occasionally we have to remove them, but taking them out is so much easier. They don't get into the tissues. It's just made life a whole lot easier for, for us and for the patient.

Monique Ramsey (09:56):
When this all started, were you practicing in Houston at that time?

Dr. Smoot (10:00):
No, I came right out here to San Diego directly out of my training and I joined my brother, Dr. Wendell Smoot and Dr. Alexander. And so we practiced together for about four years and then my brother and I left the practice and started our own practice. And we were together about 20 years until he retired. Then I left and came down and joined La Jolla Cosmetic Surgery and Practice.

Monique Ramsey (10:22):
Now in 1994, you mentioned there was like 20,000 lawsuits or more filed against Dow Corning and in 95 they just filed for bankruptcy <laugh>. So whatever happened, you know, inside plastic surgery practices between 1990 and 2006? Like did everybody switch to saline for pretty much every case other than the reconstruction?

Dr. Smoot (10:46):
Well, all the legitimate doctors, yeah, they did. We just switched to saline. Demand didn't go away. And again, we got really good at putting saline implants through small incisions. Still did the same things we did before in terms of where we placed them. Still did lifts and reductions and things like that. But it was just a, the implant didn't feel as good, was not as well as accepted. I mean it did, it gave them a nice look. But you know, saline implants just don't feel the same as silicone implants. And that's why 99% of what I put in now is silicone.

Monique Ramsey (11:18):
And so when that Mentor memory gel and Natrelle kind of came out in like around 2006, that new generation of silicone. So were you really on board with that?

Dr. Smoot (11:31):
Oh absolutely. There was several generations of it. But those cohesive gel implants really made a difference. Uh, the fact that, you know, when they break, it just stays together. Even today when you take them out, it just all comes out in one big piece. It doesn't come out like stringy molasses, which gets on everything. So, and replacing an implant is, is nowhere the problem it used to be. So younger surgeons that didn't deal with that have no idea how lucky they are.

Monique Ramsey (11:57):
I bet. Well, and I remember when those came out, you could poke a pin in them, make a hole and squeeze the implant and the little something would pop out and then you let go of that pressure and it would suck right back in. Like it wasn't gonna detach. I think that's what they were trying to say. It's not gonna break away.

Dr. Smoot (12:16):
Yeah. We take a knife and slice it open, squeeze it, and it bulges out and then it just comes right back together. It, it's cohesive, it stays together. It's sticky so it doesn't get out of the pocket. So we don't see the material getting out into the tissues. A lot of times on, uh, MRIs or mammograms they'll say inter capsular rupture of the implant. Well all that means that it's broken, but it's still contained within the scar tissue or the capsule.

Monique Ramsey (12:41):
Now you alluded to the A L C L. And so in 2017 this is kind of came into the, to the news, uh, where they discovered a link between textured implants and A L C L. And so the first question I guess is are textured implants still available?

Dr. Smoot (12:58):
Yes, there are doctors who still use it, but you said it in 2017, but we were onto this long before that came out. Oh, there was talk within the society that this was happening. There wasn't a lot of good data on it and then kind of when it broke, we kind of said, okay, now we gotta really pay attention to it. But it seemed to be related to textured implants. Allergan was the one who put most of them in, but it wasn't just Allergan implants, it was related to the textured silicone implants. Even if they had been textured implants have been removed years and had smooth it in, there still was a correlation to them developing it. Now you've gotta put it in perspective. There's not that many patients that developed this. I mean, of the millions and millions that have been put in, there's probably several hundred that developed this.

(13:41)
A L C L, I can't know the exact number, but it, it wasn't a, it wasn't millions people developed this, but it was enough that the alarms went off. Women got upset, felt we were deceiving them, we weren't telling the truth and we're saying far from it. But it wasn't something we could just do a quick test and say, yeah, you got it. You don't, you couldn't predict who was gonna do it. In my personal practice, I've seen one in the last 35 years that wasn't what I call an ALCL, we call it anaplastic large cell lymphoma. It's a type of cancer that related to the capsule and the texture. I've only seen one and my, my partners have seen one or two. So it's a pretty rare complication or of having implants. But you know, if you're a woman, you have implants. Yeah. That brings it to your forefront. You need to know about it.

Monique Ramsey (14:29):
Right. And what was the really the purpose of a textured implant versus a smooth?

Dr. Smoot (14:34):
Well the biggest problem we had in augmentation surgery was capsular contracture. In other words, the hardening of the breast, the hardening of the implant, which it felt the implant doesn't get hard, but the scar tissue around it forms an envelope and tightens and constricts it, making it feel firmer hard. And it was like, we know some things cause it, we couldn't always determine it. And if we could figure out ways to lessen that problem, then we'd have to deal with it less. Now, some of the earlier things were textured implants, some was the polyurethane coated implant. But that was pulled off the market because they had some supposedly cancer causing breakdown products. And we never found that it did that by the way. But that was the idea was to keep the breasts soft.

Monique Ramsey (15:18):
Jumping forward to the present. So now today there's so many choices and more coming all the time. And so if you could kind of walk us through what are the different variations of breast implants now and what do you tend to prefer and why?

Dr. Smoot (15:34):
Well, there's a lot out there, but the majority of them are silicone based. There's basically two companies, Allergan and Mentor, the big manufacturers, and then Sientra is another one. There's some other saving implant companies that are out there. I think there's some European brands that are not FDA approved here in this country. But those are the main companies. Now the saline implant is a saline implant. It's just water filled. The bag is the same with a silicone filled implant as a saline filled implant. The advantage of the saline implant is that it's, if it breaks, you know, immediately you can fix it. Disadvantage is, if you thin out, you can get rippling visibility and feels like a bag of water on their chest for the silicone implant. When you give 'em the two and they feel 'em, they almost always say, yeah, I want the silicone. It feels more natural. And there's different variabilities within the silicone in terms of the cohesiveness or the thickness of it. Cause some, you'd want to be very soft, malleable. Some you want a little more form, less distortion when they stand up or it's on end. And that for those, some of those patients that are very thin and you want to keep the implant shape, you want a little more cohesive implant where the, the thickness of the silicone is higher

Monique Ramsey (16:47):
And then you've got on top of that. Right. They get to think about profile, I guess, or you know, teardrop or round or

Dr. Smoot (16:56):
Yes, there are, they're, they're called anatomical teardrops that supposedly give a better slope. The upper pole, I don't know, the studies I've seen were they double blinded doctors and looked at 'em and said which one's round which one's teardrop? It was 50/50. So my, this is my personal belief on this is that it's not so much the shape that matters, it's the volume. Cuz if you don't get the volume right, they won't care about the shape. So I don't think the advantages of having a textured, uh, anatomic implant outweighs the, the problems you might see long term with A L C L. And that's the reason why I stopped using it. Albeit it's a far, it's a very small problem, but it's just not worth the hassle and worry of these patients knowing they have that implant.

Monique Ramsey (17:43):
Well, and I think, you know, if we get down to it, you know, breast implants are like the most studied, scrutinized medical device in the history of medical devices. You know, there have been so many studies. So when you step back and you look at the big picture, yeah there have been, just like with anything, there are some people who will have an, uh, an effect that isn't desirable or you know, have a complication from it or you know, but as I think what point you made earlier with millions and millions of patients, you know, the number of cases of some of these complications is very, very small. And that's kind of a good thing to keep in perspective.

Dr. Smoot (18:29):
That's right. They, they weren't many of these out there, but they're there. And rightly so. We need to be forward thinking and being advocates for the patients and saying, okay, we need to disclose all these things. These are potential problems,and have them well educated. So in all our consults we need to go, we do talk about these things about the potential problems and, and that's what we're going for with this.

Monique Ramsey (18:53):
Now, like everything, you know, breast implants or I should say breast sizes and shapes, there's trends over the years of larger, smaller, natural, very in your face <laugh>, think of the eighties, Pamela Anderson.

Dr. Smoot (19:09):
Well that's true.

Monique Ramsey (19:10):
Right? So can you kind of take us in your practice from that point of view, how has this style changed over time?

Dr. Smoot (19:17):
Well, additionally it was kind of just get something done to fix them, to have some type of fullness around us and then it kind of, you know, go bigger or go home. We got to that point, we're getting very large imprints. Was the, the trend then when all the problems started up, it started to trend away and then it came back. Now it's trending back to, to much smaller. I don't see a lot of women having a lot of big amps. Occasionally you see them wanting to have big fake breasts and that's okay if that's what they want. That's not what we advocate. And now that this stage in my practice, now I'm seeing all these ladies come back in their sixties and seventies saying, yeah, they're nice but I want 'em out now. I don't need 'em any longer. You know, they're not doing what I want 'em to do.

(20:03)
As I say, the fantasy's over and I just wanna feel better and get the weight off. And, and that's usually what I see, you know, we haven't mentioned it, but now we got the wrist implant associated illnesses problem that are showing up. Again, a very nebulous issue where women are saying their implants are causing their fatigue, their hair loss, their immune disorders, they're not doing well and this is the cause and there are guys out there that are spouting these theoretical causes, but there's no data on this to show this is what's causing it. So my partner does a lot of that, the explant registry, uh, where you're doing the block resections and, but the data doesn't show that that makes any more difference than just removing the implant. But because it's out there, and this is what these websites are talking about, it's saying you have to have these n block resections. And even that's a misnomer. That's not correct. En bloc means you're taking breast tissue with it. What we're talking about is en bloc, removing the capsule implant together.

Monique Ramsey (21:02):
I was talking about this with another surgeon who's now retired, Dr. Lori Saltz. And she said, you know, I, cuz she was really in the camp of, if we can't prove it's doing something harmful to you having another surgery, there's risks that go along with another surgery. And she said, but you know, I came to the realization, you know, you, there was no medical necessity to put them in other than you wanted them in. So I shouldn't worry. If you want them out, that's okay too. And so I thought that was really interesting because especially as scientists, you all wanna see the proof, right? <laugh>, why are we doing something

Dr. Smoot (21:39):
That's exactly right.

Monique Ramsey (21:40):
invasive if we don't know that it's gonna help.

Dr. Smoot (21:44):
That was right and that's what we thought. We, doing something just because the public thinks we should be doing something. Is it medically necessary? Have these, these women that have said all these problems, have they done an injustice on these women by scaring 'em to death and saying, I have to have my implants out instead of looking at the, the data. Now, I, most of the women that come in, they're knowledgeable of it, they know about it, but they're also pretty pragmatic about it too. And they understand what it is. And that is a risk. And we created a, you know, I know Dr. Saltz, I know her very well. She felt like we were just doing a surgery just to placate this, this scare. Not because it was based on good science.

Monique Ramsey (22:26):
So now some of the innovations as we go into the future, but I can think of like the Keller funnel and if you can talk about what that is and why that came into being.

Dr. Smoot (22:36):
Well let's go back a little bit here now. I talked on a previous podcast about the things we do to help take care of capsular contractures and to alleviate them and, and when they do occur. And I, because I, I'm a little older in my practice, I'm seeing women who've had implants for 20, 30 years and they've had multiple problems. How do you fix those problems? And I talked about graphs and the importance of putting grafts into keeping 'em soft and natural. Well one of the things that we wanted to do to help prevent those to begin with is how you put the implants in. So we've come up with our society, it's not me, but their society's come up with, we call it a 14 point program where how you have to prepare the pocket, how you touch the pocket. You don't touch the implant with your hands ever.

(23:21)
You're irrigated with antibiotics, you change your gloves and you put antibiotic in the pocket. All those things to decrease the potential contamination that may cause a capsular contracture. But even doing that, we still have about a 5% capsular contracture rate and everyone's a little different. But that's, but it does seem to help. Also the placement of decisions, uh, was very important. I used to do a lot of incisions around the nipple relapse and I had a lot of capsular contractors and when I changed it and went down underneath the breast, those capsular contractors really went down and I saw much fewer of those by doing, just changing those small techniques. So the Keller funnel was just meant to a way to insert the implant without ever having to touch the implant.

Monique Ramsey (24:06):
And is that something you use currently?

Dr. Smoot (24:09):
Like all the time.

Monique Ramsey (24:10):
All the time.

Dr. Smoot (24:11):
Oh yeah. I, I never touch the implant. Well, if I don't have to. I mean sometimes you have to, but if you try everything you can. And the funnel, it's just like a, a pastry funnel and it's the same principle. You apply pressure one in and it slides through a small opening and squeezes through the small hole and gets into the, the pocket without having to be touched. We used to have to use our fingers and stuff it in there.

Monique Ramsey (24:32):
<laugh>,

Dr. Smoot (24:32):
Which allowed for more contamination.

Monique Ramsey (24:34):
Right, right. And then you mentioned stratus and if, I think that's another innovation that we've seen and I know we did a whole podcast on secondary augmentation or, and so stratas is something we talked about in AlloDerm and how long have you been using those?

Dr. Smoot (24:52):
Yeah, those were called, well I've been, I, I started, that's probably one of the first ones, not the first one, but very early in the development of that we call ADMs, acellular dermal matrices. Basically it's collagenized tissue and we have human collagen tissue and porcine collagen tissue both work very well once the, the porcine type is much less expensive. The human is what we use in reconstructions cuz insurance will pay for it. But to use it in cosmetic surgery, which is cost prohibitive, but it works very well in terms of preventing that capsular contracture. And I had the fortunate situation where all my brother's patients who came in 20, 30 years later with all these problems and thinking they could never have nice looking breasts again and really making some marked improvements with them and improving their lives immensely. So yeah, I got a lot of experience with it.

Monique Ramsey (25:43):
And we're gonna send Gretchel, our wonderful videographer who's on vacation right now, but we're gonna send her into the OR with you on a couple of these cases so that we, you can really show and talk about what you're using and why and how it helps because uh, you're the master at that. And then, you know, something more common lately I guess is fat transfer to the breast.

Dr. Smoot (26:07):
Yeah, there's several variations of that. Mostly what we learned for fat grafting is from our reconstructive partners. Women have had mastectomies and breast tissues taken out and adding fat just created a better shape instead of a half dome look. And adding fat does a very good job of doing that, but using fat just for an augmentation doesn't work real well. You can get some improvements, but it's maybe a half a cup improvement. So rarely we just use fat for strictly augmentation purposes. But there's another thinking that you would do the, the composite breast where you put a, just say that woman needs a a 400 cc implant. Well what if we put a 200 cc implant and put 200 ccs of fat? So it's a cosmetic. Now this hasn't really caught on but that's, that's an idea. So if you think of a pyramid, you're pouring sand on a pyramid, that's kind of what you're doing. So the base rounds out nicely and you have a better shape. But again, it's, there's a cost factor in that having to harvest the fat, you have to have the fat to begin with. Mostly what I use fat for is for contouring deformities. You know, one's a little flatter, we need a little more volume here and just kind of more for camouflage. That works very well.

Monique Ramsey (27:26):
So kind of the icing on the cake <laugh>, I guess, you know, to make it pretty. Right. And when like a contour deformity, what would you mean?

Dr. Smoot (27:36):
Well, um, let's just say they have a dent somewhere on the upper breast or on the side of their breast or there's a scar that's pulling underneath a nipple. By releasing that, putting fat in there, you can sometimes correct some of those irregularities with fat. That's usually what I use it for.

Monique Ramsey (27:52):
Now I guess everybody who has a breast implant eventually will need to have it replaced. And so then that

Dr. Smoot (28:00):
No.

Monique Ramsey (28:00):
No. Oh really?

Dr. Smoot (28:01):
No, that's not correct.

Monique Ramsey (28:02):
That is, oh okay.

Dr. Smoot (28:03):
This is, this is the big, this is the big misnomer it comes out there is that it's, they think that for some reason years ago the implant company says you should have 'em replaced every 10 years. That's still out there. That is not true. If it ain't broke, don't fix it. <laugh>. And that's the montage here is that you do not wanna do something that you don't need to do. It's not like every so often you need to have 'em replaced. But the problem is, with these new implants, you can't tell when they need to be replaced. You can't look at 'em, you can't feel 'em. With some advanced tests, with some specialized ultrasounds or mri, you can detect a rupture and if they're broken, yeah that should be replaced. But you know, some of these implants will go 30, 40 years and do just fine. But that's the thing that, you know, you don't have to come in every 10 years and get warranty work. I still see that today.

Monique Ramsey (28:54):
So if you've had 'em for 25 or 30 years and you're not having issues, would you just say you're good?

Dr. Smoot (29:00):
Leave it alone.

Monique Ramsey (29:01):
Leave it alone.

Dr. Smoot (29:01):
Yeah, don't, don't mess with it. Or get, get an MRI and see if it's broken. Most of the time if they come in and I say, what do you think? I said, you look fine, don't mess with it. It's gonna be a, it's gonna be a very nice result because here's something that, it's hard to teach patients this: It's the adage, the enemy of good is better. When they want a little something done or a little improvement. Sometimes you get in there and you, things don't turn out like you want. You think, why did I ever touch this? So there's gotta be good reason to do something. Just to do something because you can do it, that is not good medicine, it's not, doesn't make good sense.

Monique Ramsey (29:39):
So looking into the future I found an article about tissue engineered 3D printed implants. Have you heard about these?

Dr. Smoot (29:47):
Yeah, but I don't know much about it.

Monique Ramsey (29:49):
Okay. <laugh>.

Dr. Smoot (29:49):
So I don't wanna comment on it.

Monique Ramsey (29:51):
I don't think anybody does yet cuz they're just starting to use them. Do you foresee any other advancements in breast augmentation coming soon?

Dr. Smoot (30:02):
Well there, I think there's some things that we're learning, some techniques that we're learning as I, I looked at what some of these other doctors are doing around the country. One of the, which is with the new techniques of instead of going strictly below the muscle or above the muscle, is going subfascial augmentation. It's a little trickier to do, but it can be done. And with using some of these techniques, it may work very well for reducing the capsular contracture rate and reducing the animation deformity when you go under the muscle. Cuz when you put on the muscle, when you flex it moves. I've seen some good work on that coming out. So we may be doing more and more of that as we go down the road. I think the implant craze is pretty much over, you still will do it, but not like it was in the early two thousands where people were just running in and just throwing their money down to have 'em put in.

Monique Ramsey (30:53):
<laugh>.

Dr. Smoot (30:55):
So there, there's some things on the future I think will show and it's just these techniques are getting better and better and, you know, trying to keep abreast of them, no pun intended, <laugh> to learn these things and these techniques is, is, you know, I do enjoy that cause I don't think I've got a corner on the market for that. And usually some will come up with a good idea. But the, the thing is, it's gotta be proven right. And I usually won't do something till it's been around for a few years and okay, okay, you did it, now does it work? Let's see what it looks like two, three years from now.

Monique Ramsey (31:27):
I think part of why I love working with you and with the, the surgeons at La Jolla Cosmetic is they don't jump onto every new trend. You know, you guys very carefully vet any new technology, you bring in any device, you know, it's all about, well is this really, is this the latest craze or is this something that's really gonna benefit the patient? And that kind of ethics is, is so important.

Dr. Smoot (31:56):
Yeah, if it's good today, it'll be good tomorrow. And if it's good tomorrow I'll use it. <laugh>

Monique Ramsey (32:01):
<laugh>

Dr. Smoot (32:02):
Proof's gotta be in the pudding and you know, a lot of techniques, a lot of these new devices are coming out. It's so wonderful. I said, well, let's see what it looks like two or three years and are they still talking about it? Then a lot of times there's a big flash in the pan and then, eh, it doesn't work. And we've all been down that road where we've got sold something to do something and, uh, that didn't work.

Monique Ramsey (32:23):
Well, thank you so much Dr. Smoot for joining us today and doing this sort of like little walk down memory lane of the breast implant, and where it's come and where it's going. If you were to sort of sum up what you think about breast implants now, you know, what, what would that be?

Dr. Smoot (32:41):
It would be simply that it's not going away. It will still be a demand for it. I think a lot of women define their femininity by their shape and how they look. And most women come in not because their boyfriend wants, husband wants it, they want it, they want to feel better, they wanna look better. So that's never gonna go away. But now it's, it's more in terms of just that and looking at the whole health of the person. And, and breasts are just one small portion. I mean, the big ticket item now and out there is mommy makeovers, you know, they're doing breasts, but you're doing tummies and backs and flanks and thighs and, and shaping completely. That's really the big one out there right now. But it's a lot of work and you've gotta be very careful who you do those on. So that's kind of where I see it going. It's, and I think as we refine our techniques, we'll still get better outcomes. I think that, you know, experience will always trump knowledge in the sense that someone who's been there and done that and done these things will always have a better handle on how to handle these problems.

Monique Ramsey (33:41):
Right, right. Well, and and hopefully in 20 years from now, surgeons won't be dealing with really complex hopefully because maybe these implants that we're currently putting in are so much better than the ones from 30, 40, 50 years ago.

Dr. Smoot (33:57):
I think you're right. We're gonna see fewer problems, but they're not gonna go away. Right. But it's still gonna be a better technique, a better approach. I'm, I'm really proud of our society for being proactive and trying to research these and learn and do things that will really enhance the beauty and, and overall well being of our patients

Monique Ramsey (34:15):
And that society. Which one are we talking about?

Dr. Smoot (34:18):
There's two societies. This American Society of Plastic Surgery and the Americans Aesthetic Society of Plastic Surgery. Both entities are, are focused on doing good work.

Monique Ramsey (34:27):
Well thanks again, and I appreciate you coming on.

Dr. Smoot (34:32):
Well, thank you Monique.

Monique Ramsey (34:33):
Thanks Dr. Smoot and everybody you can find in the show notes how to reach us and, and if you would like to talk to Dr. Smoot about either, uh, a first time brass augmentation or a revision, or a potential revision that you might not need, he'll let you know <laugh> so it'll be all in the show notes.

Speaker 1 (34:56):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I-5 San Diego Freeway in the XiMed Building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com or follow the team on Instagram @ljcsc. The La Jolla Cosmetic Podcast is a production of The Axis, the axis.io.