How Removing Your Breast Implants Affects Your Mental Health

Announcer (00:00):
You're listening to The La Jolla Cosmetic Podcast with Monique Ramsey.

Monique Ramsey (00:03):
What if the decision to remove your breast implants could transform more than just your body, but also your mind, your mood, and even your sleep? Today we have two very brilliant minds with us, our breast implant removal specialist, Dr. Luke Swistun and his wife, clinical psychologist and sleep specialist, Dr. Dominika Swistun. And they're here to tell us how breast implants can affect us psychologically from anxiety to quality of sleep. So welcome Dr. Swistun.

Dr. Luke Swistun (00:35):
Thank you for having us on.

Monique Ramsey (00:36):
Yeah, so thanks for coming because I think it's a really interesting intersection between what the two of you do every day. And did you ever expect that to happen?

Dr. Luke Swistun (00:48):
No. I mean, that was my opening thought on this is I'm really excited about this episode because it sort of culminates a lot of our training and I didn't even know it was going to come this way, but I've known Dominika since teenage years since high school, and this is before we had our training paths in our minds and things like that. And then I went on to do general surgery and plastic surgery and eventually aesthetic surgery, aesthetic plastics fellowship. Well, she went on her own path and finished undergrad and did a master's in clinical psychology, eventually a PhD in clinical psychology with also additional specialty training and sleep research and things like that. So we're sort of working on very different trajectories and doing our own thing. But then here we are, there's some patients that we share with. A lot of these themes sort of intersect, and the more she and I started talking about this and the results that we're seeing, the more we excited we got about this because honestly, I haven't seen this documented anywhere.

(01:44):
I've actually searched, but nobody correlates sleep to implant removal. Nobody correlates anxiety improvements with implants removal, but I'm seeing this all the time. This is one of the most consistent things that patients report on the other side of their implant removals. And maybe it's because I'm paying attention, but it's remarkably consistent. So in general, as you know, the vast majority of what I do is removing breast implants. And there's a thousand different reasons people want to do that and all of 'em are correct. And eventually everyone gets to that phase in my opinion, or the vast majority of patients get to that phase and a lot of them actually feel significantly better. And there are certain anatomic things that implants cause that are pretty much obvious. If you were to put a foreign object on your chest wall and carry it around for a decade or two, there are certain physiologic and anatomic consequences of that.

(02:37):
And that's what we're seeing in the longterm. And those are big reasons why patients explant. And usually they have to do with posture and pain because the implants under the muscle and things like that. There are also some systemic autoimmune inflammatory consequences of having a foreign object like made of silicone inside of your chest wall. And there are consequences of that. And all of those are patterns that I'm seeing. Interestingly enough, within that anatomic realm, there seems to be a common pattern of patients reporting improvement in three different things. Number one, anxiety. Patients just report, I feel less anxious. A lot of patients who had anxiety report later on, after we explant six months later that their anxiety gets significantly better. Sometimes they get off of their medications, sometimes they're just no longer using their rescue medication like Xanax for a panic attack just because they don't really get triggered anymore.

(03:29):
Sometimes they say that my breathing is better and that's why I feel like I can calm down a panic attack because I can just take a relax and breathe deeply, which is something I couldn't do with my implants in. So that's a common theme. Another big theme I've noticed is sleep patients basically report that their sleep improves, that they're just much more comfortable at night, and then they can get into deep sleep and then wake up a lot more rested and energetic and clear-minded and so on. And I'll let Dominika comment on that more a little bit later, but that's another remarkably consistent pattern. A third one is a lot more general, and I didn't really know how to even answer a lot of patients when they brought this up, but again, it seems to be very consistent. This is something that just, they bring up unprompted.

(04:19):
They basically say, I just feel better. I just feel happier. I just feel younger. I just feel like more at peace with myself. We did a post on Instagram about this, about things that patients said in different ways that all mean the same thing in my opinion, which is like my light is back on. I got myself back, I got my life back after we explanted. So there's something to it and I cannot put my finger on it. But the more we talked about it with Dominika, again, this was a part of our dissertation and there's a very, very plausible explanation for this as well. So with that, I would like to hand it over to Dominika Swistun, PhD, clinical psychologist and just introduce her formally on the screen and go from there.

Monique Ramsey (05:07):
So I want to welcome now Dr. Dominika Swistun, clinical psychologist, PhD, and she's an expert in sleep. And we have one other episode where we talked about sleep. It's fascinating. We'll put that link in the show notes. So welcome Dominika.

Dr. Dominika Swistun (05:22):
Thank you for having me.

Monique Ramsey (05:23):
Thanks for coming. So tell us a little bit about our topic today, and I think you wanted to talk a little bit about anxiety.

Dr. Dominika Swistun (05:32):
Yes, definitely when I was hearing Luke comment on experience with patients who were explanting or even before that who were coming to him with a host of various problems, challenges, difficulties in life, a lot of them sounded like psychological, behavioral, functional issues that I hear in my sessions. For example, in anxiety, when you think about anxiety and panic attacks, they're very much based in physiological response. Many things psychologically are we don't exist in vacuum or mental state and our physical, these things are intertwined, but anxieties is one of those that it's right there. And in the process of experiencing anxiety or panic attacks, what happens physiologically, your heart rate goes up and everybody can relate at some level, whether it was exams or things that scares us or big life events, but our heart rate goes up, our mind is racing, our thoughts are not clear.

(06:41):
We feel like we are having out-of-body experience, blood pressure goes up, our breathing is very shallow and fast. Our palms might be sweating. And overall we feel very panicky. Those are physiological that I explained. Of course, what'll go with it are thoughts. For some people they worry about that they will have a heart attack, that something bad will happen. Veterans often feel like their life is threatened. So depending on situation, there's a host set of thoughts that one is experiencing when physiologically you're already wind up that way. So when you think about implants, when you hear that it is a pressure, it is a tightness of chest, I can imagine how this would trigger thoughts of something's wrong. I can't breathe, what's happening to me. And it's very subtle and it's just like that tick in your head. And soon as you feel very tense, you feel very kind of panicky.

(07:48):
Your breath is changing. It's harder to take a deep breath. And your thoughts are starting to kind of surveil surroundings and feel like, oh, I must be nervous about what's coming. Maybe a meeting with the boss, maybe you worry about finances. And so quickly your thoughts are on the hunt for something negative, something that will explain that anxiety. So it may be started with a physiological trigger that you just couldn't breathe. Your heart rate was higher, your breathing was shallow, and you were in that uncomfortable tense state. And your thoughts follow with, well, let's see what's happening. Why would I feel that way? Does that make sense how

Monique Ramsey (08:28):
Yeah, it does.

Dr. Dominika Swistun (08:28):
That physiology and our mind starting to work together.

Monique Ramsey (08:33):
And I think everybody can, like you say, everybody can relate to some degree. And I think Dr. Swistun, Dr. , our other, Dr. Swistun and boy Swistun, we used to have Dr. Laurie, Saltz, girl Saltz and boy Saltz, Steve.

Dr. Dominika Swistun (08:48):
That's right.

Monique Ramsey (08:48):
Her husband, anesthesiologist. So in your case, so Dr. Swistun, I think he has a good example of a patient who had this anxiety. And so I want to pass the microphone over to him and have him take what you've been talking about, just the physical and mental things that go on when you start to have some panic attacks or anxiety and then transfer that over to a real life example. Okay. So Dr. Swistun, tell me about how you see from your patients and maybe a real life example of how that anxiety can manifest for patients who have breast implants.

Dr. Luke Swistun (09:33):
Well, the simplest example is a very extreme situation where a very young patient presented to my clinic to remove her implants, specifically because of anxiety. She basically developed intractable anxiety after her augmentation. Now this is sort of, in looking back, this is sort of the perfect storm patient, so to speak. She's young, she's very thin, she's very tall, and she wanted to go really big. So she went with 600 cc implants under the muscle, which are large implants under the muscle, which will feel very tight. And then because she was very thin, she was really feeling that pressure. And she actually already had, she said that she already had some preexisting generalized anxiety disorder, nothing very serious. There was talk of maybe treating her for it, but her psychologist or psychiatrist rather, at the time, never really recommended treatment yet. Hey, just watch it. Here's some rescue techniques.

(10:25):
When you start feeling panicky, take some deep breaths, calm down, and here's some Xanax for breakthrough panic attacks in case you need it. And after her augmentation, she said this basically just completely got out of control. She woke up after surgery in recovery and immediately had a panic attack. She was like, oh my God, this is so tight. I can't breathe. I can't breathe. The staff called the doctor over and the doctor examined her. Then it's like, you're fine, you're fine. These are just large implants. You're going to adjust to them, get used to them. And she literally told me she never did. That never really happened. They always felt tight, they always felt heavy. They always felt like she was closed in and claustrophobic and she couldn't breathe. And this affected her life very quickly, very significantly. She went from a normal functioning person to completely disabled in about six months. She saw two psychiatrists. She was maxed out on SSRIs with a short period of time. She had a lot of Xanax on hand, and she was using three to four pills every single day just to get through the day because of how many panic attacks were getting triggered in her life. And within six months, she was on full disability from work for intractable panic attacks. That was decided diagnosis. And she basically made the observations like, look, I can't live like this. I didn't have it this severe before I had an augmentation, and I love my implants, I love my result, but I cannot live like this. So she presented to our clinic nine months after her original augmentation. So she didn't even last a year with those implants and her symptoms got so severe. She basically said, can you just get them out?

(11:54):
So we went ahead and did that. The story makes, and by the way, no other symptoms, no chest, shoulder, back pain, nothing else, just anxiety. That was literally the only reason she wanted to remove them. And when we removed them, she woke up after surgery and in my recovery room and she was like, oh my God, back to normal. I can breathe again. I can feel like I can. I'm so much lighter and stuff like that. So there was an immediate improvement in her physiology or in how she felt. And then obviously we have a very strong follow-up with our patients. So I saw her two days after the surgery, a week after the surgery, three weeks after the surgery, three months, six months. And every single time at every single milestone, she was like, I'm back to normal. No panic attacks and things like that.

(12:36):
The biggest milestone was at the six month mark after we explanted where she basically comes back and says, well, I am down to one, my original psychologist, and he's actually weaning down my SSRI dose. I think we're going to get off of it next month, so I won't be on that medication anymore. I'm fine. Here's my full bottle of Xanax. I have not used any of these since we explanted. You can see the expiration or the refill date. I haven't refilled these. I was using three to four a day with my implants and I haven't used them since we explanted at all. And I'm basically back to normal. I'm back at work. I'm normally functional. So that is a very extreme example of a very common theme. Most patients that have some level of anxiety before we remove their implants reports to me long-term that their anxiety is much better if not completely cleared up. Well, the panic attacks are no longer an issue. They're not really happening anymore. I'm just not triggered as much. My kids spill milk on the floor before it used to just really trigger me. It would really annoy me. Right now it's like, okay, we'll just clean it up, no big deal. Very different sort of response to just things around you.

Monique Ramsey (13:40):
Yeah, kind of how you live your everyday life, because that really lends into your general just happiness in how you feel, how you treat others, how you perceive that they treat you and, wait until she hits menopause and then the spilled milk will be a whole nother whole nother topic. I digress.

Dr. Luke Swistun (14:02):
We're not there yet.

Monique Ramsey (14:03):
That's right. But no, really, I would think that if you have this patient, because it was extreme and that was the only thing that changed, put two and two together. I wonder. And in your experience for most patients, do they ever think that anxiety could be part of that that's connected?

Dr. Luke Swistun (14:28):
No, and that's the whole point is I don't think most people make that connection. And this is why I track these things. Every single patient that I see for implant removal, there's a whole box, whole role of check marks that I go over and I separate 'em to this is the anomic consequences of having implants, which postural changes and sleep and anxiety and things like that. And then there's these autoimmune symptoms, and I track these things and as far as I know, I'm the only one seeing these patterns because again, I've looked for literature that comments on this and I haven't found any. But the consistency of what I see long-term of these patterns cannot be a coincidence.

Monique Ramsey (15:06):
Right. Well, and if they come to you, maybe let's say because they're just over the implants or they have maybe other systemic symptoms, maybe IBS or I don't know different reasons, they might come to you not including anxiety, do they then comment later, I feel calmer?

Dr. Luke Swistun (15:27):
Yeah. Well, I mean what we do at the six month mark, which is kind of long enough time for them to heal and regain, go back to their life and original lifestyle and habits and things like that. I pull out that list again, the list we generated during our initial consult of all the complaints and things that I tease out of them with my questions. And then we go over check by check again. Is this still happening? Oh no, that's actually a lot better. Is this still happening? No, no, I haven't seen that. Is this still happening? Oh, it still is, but way better than it was before. So this is how I track these things kind of across the board.

Monique Ramsey (16:00):
So tell me what other maybe patterns you've noticed with patients, other things in their life that maybe bothered them before the explant and have resolved?

Dr. Luke Swistun (16:13):
Well, another pattern that I've noticed that patients that I stumbled upon really is sleep. And specifically the way this started is maybe three years ago now, patients started volunteering to me that they are dreaming a lot more after their explant. So basically we'll be sitting there at the six month visit, follow up visit after their explanation. And I'm like, okay, how was your result? How did the breasts feel? And how is everything healing and how are you feel? And she's like, yeah, this is good. I like the shape and size and stuff, but doc, I'm dreaming so much more. I fall asleep and I'm dreaming and I'm having all these vivid dreams. I haven't done that in 10 or 15 years, but I'm dreaming every night. And by the way, when I wake up, I feel more energetic and more motivated to do things. I started exercising again.

(16:57):
I haven't exercising like 10 years. I used to be a jogger. I haven't done that in a decade, but now I'm doing it again and it's so much more like me. And also I'm much more clearheaded. I'm not losing my words. I am not searching for words. One specific patient, this is the funniest specific example of it, is that she has three kids and basically they diagnosed her in her absent mindedness also almost as a deficient noun disease, DND. That's what the kids were telling me. Mom would come into the kitchen and look around, why did I come here? I have no idea. I forgot. And then the kids would look at her and make fun of her like, oh mom, his deficient noun disease again. And then the patient announced to me happily eight weeks after we explanted, he's like, you know what?

(17:41):
My kids literally told me last night, I no longer suffer from deficient noun disease, and by the way, I'm sleeping so much better. I'm more rested, I'm myself and all this stuff. So there is a huge pattern that I've noticed with people just dreaming more. And basically when this started, I told Dominika, this is just what they're volunteering. I just seeing a common pattern of patients just saying to me that they're dreaming more. And Dominika said, well, they're dreaming more. They're probably getting into REM sleep a lot more than they were before. So ask 'em more questions. Ask 'em about their sleep habits and stuff like that and see what they say. So I did, and a common theme that the patients would report back to me is like, well before I had my implants, I used to be a stomach sleeper, but after I had my implants, I can't do that.

(18:27):
They push on my chest, I get in the way. So I had to teach myself how to sleep differently. IE on my back or maybe on my side. But when I go on my back, then the implant's going to write up and push on my airway and I can't breathe. It's not comfortable. So I go on my side. But when I go on my side, then when the breast starts hurting because the implant's pulling, so I wake up and then I take a pillow and I put a pillow between my breasts and my arm, and then I fall asleep like that. But then 15 minutes later I wake up again because the other breast is pulling and hurting. So I take another pillow and I put it between my breasts and I fall asleep like that. But then a half an hour later, I wake up again because my arm went numb. So I go to the other side and I do the same thing. And then next thing you know, you're basically kind of tossing and turning all night and you seem to be interrupting your sleep and they never get a good night's sleep and this can perpetuate for months, years, or decades. And we've noticed just basically chronic sleep deprivation patterns in patients, which really correlate to her patient population of sleep apnea patients

Monique Ramsey (19:27):
Because almost like a sleep apnea in terms of the interruption, every few minutes you're awake again and not getting maybe that restful sleep you need. So that's really interesting. And I'm assuming just like the anxiety other than that one patient, I'm assuming sleep isn't maybe the driving force of why they come to you at the beginning.

Dr. Luke Swistun (19:48):
Absolutely not.

Monique Ramsey (19:49):
To do an explant. It's another one of these unintended benefits of

Dr. Luke Swistun (19:55):
Well, yeah, but then it is one of those things you don't really notice, but you see basically a lot of patients say, I didn't realize how much the implants were affecting me until I got them out. And this is an example of that. Just if you think about what we're messing with these implants in place, the core, core functions of life, sleep so important, breathing so important, and we're really restricting that to some extent for a decade or two or three. And that I think has profound consequences. I'll let Dominika comment a little bit more in depth about that.

Monique Ramsey (20:26):
Okay. Back with Dr. Swistun, Dominika Swistun. Let's talk about and explore just a little bit about sleep and the sleep cycles that your husband was talking about that he's noticing in his patients after they get their implants out.

Dr. Dominika Swistun (20:41):
Absolutely.

Monique Ramsey (20:42):
Tell us what's happening

Dr. Dominika Swistun (20:43):
And especially breathing component. Right? Breathing is so important during our sleep. Sleep apnea is a very serious condition that it's a breathing condition. It's not a sleep disorder. It's actually an interrupted breathing. So generally even in healthy population breathing during the sleep slows down, our heart rate slows down. There's a lot of physiological changes during the sleep. So any interruption with normal function will definitely impact how we sleep, how we go through sleep stages. And initially we fall asleep and we start with lighter, then deeper sleep, and then we go to third stage, very deep sleep. And typically at the end of that deep sleep comes REM. And REM is this very important stage where our bodies are paralyzed, we're not moving, but our mind is very active, our brain is firing. It's as active as if we are having conversation or going through daily events.

(21:45):
REM stage is very important for consolidating memories, emotions, making sense of our awake time, formulating the coping skills, dealing with stress. So REM is this fundamental component of frontal lobe functioning that everything that makes us human beings and experience things. When people have interruptions in sleep, they often don't get to REM stage or REM stage should get longer and longer as night progresses. So we go, we cycle through these stages, one two three, REM and again one two three, REM and REM becomes longer and longer as night goes on. If we wake up all the time, if we feel uncomfortable, obviously there are interruptions in these stages and they all play different role, but I can see how individuals who remove implants and are able to sleep longer, get into deep sleep and actually complete the full cycles set of four or five throughout the night, they're actually are dreaming.

(22:52):
They're actually sleeping more comfortably. They actually remember their dreams because things are happening more rhythmical, they're more in place at peace with their experience. And what we just heard, the experience in the day, it's just incredible because when we are sleep deprived, obviously things like fogginess, inability to focus, issues with memory, being impatient, our entire cognitive, emotional world is being compromised. For that very reason, sleep is the part where you were supposed to process that and put things into place. So it's not even that your brain didn't rest because it doesn't really rest during the sleep. It's just going through these filing and procedures that if that gets interrupted, we definitely will feel consequences of fatigue grogginess, but not being mentally quite there. And definitely emotional ones, right?

Monique Ramsey (23:49):
Because you're probably just a lot more short. Like your fuse is shorter, right? Because you tired and maybe your brain's not been doing what it's supposed to do. Your body's more tired, you just don't have the bandwidth to sort of

Dr. Dominika Swistun (24:03):
Exactly. Absolutely.

Monique Ramsey (24:03):
Give the grace to the people around you.

Dr. Dominika Swistun (24:07):
Exactly. And you only do the basic right. You try to get up, get yourself dressed, not fall on your face, go to work and complete the task. You don't have any more fuel for the fluff, for connection, for being brighter. I have perfect example of my patient who was treating sleep apnea again, breathing disorder that was interrupting her sleep. She was scheduling an appointment with someone and her daughter was standing on the side. And then after the appointment she said, mom, you were so rude to that person and this woman didn't even realize. What do you mean? I just tried to make sure that they get my day that we don't have a mess up. That's what it is. When you're running on low fumes, that's all you need to know. You need to make sure that they don't mess up. That appointment happened. So she was very short and not pleasant and she didn't even think that was rude.

(24:58):
And her daughter was just seeing that interaction and reflected back. And as she was sleeping better, she could see how she was just a different person. That brighter, like example of another person was, she's like my husband again, he always had odd sense of humor she would say, and it was irritating me. I was more upset. I rolled my eyes, I said, here you go again. His thing. But after sleeping better, she had kinder look at that like, oh, he's just that way. There was much more kindness in her for herself, for experiences, what a huge difference. You can see how that can lead to sense of guilt always being so grumpy, how that is this precursor for just depression because you always feel so off, you always feel so blah. And sometimes there's not an obvious reasons for that. And you're upset with your self. Why am I so angry all the time? Why am I so negative all the time? But that's why you're tanking up your guesting halfway and hoping you're going to run to New York and back. It's just not happening. It's going to be just the minimum.

Monique Ramsey (26:07):
Well, I wonder how many marriages would be saved if at the first time they go to counseling and everybody said, let's check for sleep apnea. Is everybody getting

Dr. Dominika Swistun (26:16):
Absolutely.

Monique Ramsey (26:17):
No. Really, because what you're describing, I think all of us have been there at one time and another with a partner or spouse where it's just like, oh my God, what is wrong with you? But if maybe you slept better, you would be like you say, more forgiving, give more leeway to what's going on around you and your workplace too. And so it's interesting that the implants, if they are disrupting sleep, that's going to really be a cascading that's going to cascade into their life in maybe ways that they had no idea.

Dr. Dominika Swistun (26:58):
Absolutely. When treating sleep disorders, we do mention mattress, right? How comfortable you're and the pillows, I mean, this is a certain weight on your chest. This is added hurdle throughout the night. So if you have to toss and turn, find the comfortable spot. If you're waking up multiple times, it's like sleeping on very uncomfortable mattress. That would definitely be linked to challenges with getting that recuperative sleep.

Monique Ramsey (27:24):
And I would assume if you wake up, let's say you go through the first couple stages, then you wake up, it's not like you go back into the slot to get to the next stage. You start at the beginning?

Dr. Dominika Swistun (27:34):
Yeah, you starting at the beginning. And the other challenges that you might not even be able to fall asleep right away because if you don't have these strategies right away, you will wake up and your brain will go, oh geez, again, I woke up. You look at the clock, you get up, you try really hard to fall asleep, and those are all the wrong things to do when you're trying to get to sleep. And that just perpetuates difficulties. And it even connect to the first segment of anxiety when we wake up. And if we feel that tension, we feel heaviness. And there is restlessness, obviously you will try to understand where's this feeling of kind of threat hypervigilance is coming from? And very quickly we all will find something. Well tomorrow or maybe I have a meeting, I have to make it to school for my child. Or you worry about someone, you worry about your sick parent. Right away your mind will find a reason to explain that anxiety, and you will start circling around that. You'll start worrying.

Monique Ramsey (28:33):
It's interesting that it could be just from something as simple as having breast implants. Nobody's going to make that connection, but certainly if you're not comfortable as you're trying to sleep, then of course one thing leads to another. Okay, so thank you for talking about how sleep ties in here, and we're going to go back to Dr. Swistun to talk about the next section of overall wellness and what he has seen in his practice.

Dr. Luke Swistun (29:06):
I'm pulling up a little, the Instagram post that we did the other day. So overall feeling of wellness is the other thing that I just noticed. Patients volunteer just willingly. I ask very open-ended questions at the six month mark when we first see them again after six months after the surgery. And basically the question is, was it worth it? Was it a good idea to go through the surgery of getting your implants out? And usually the immediate response is like, oh my God, best thing I've done for myself in my life. I'm like, okay, well elaborate. And then a lot of times it's like I didn't know how much they were affecting me until they were out. I did not realize how sick I was until I started feeling better. I sort of compiled these, this isn't all of 'em, but there's a post that we did on Instagram, that compiled

Monique Ramsey (29:58):
We'll link it,

Dr. Luke Swistun (30:00):
But it's basically a lot of patients saying the same thing in their own way, and it all links back to my life is better now. I feel happier. I feel more at ease. I feel just more like me. Okay. I did not realize how sick I was until I started feeling better, swipe. I feel I got my life back, I got my body back, I got me back. Where was I all this time? Where have I been? Literally, where was I all this time? Now that's me again. Everything is brighter and sharper. That was literally the comment. It's like my implants are out and I'm just like, everything's just brighter. Everything is sharper, everything is just happier. It's like my inner light was dimmed the whole time and now it's back on again. That's another one. And that was so profound.

(30:50):
Or another one is just I feel like I'm me. Bold, bold letters me. No regrets whatsoever. And then another one, I felt like I was a prisoner in my own body and now I feel liberated. I actually quoted this to a patient considering an explant yesterday, and she's like, exactly, exactly. I feel like a prisoner. I'm like imprisoned. I'm trapped in my own body. And so they all kind of hint at the same thing is that patients are just happier. And again, one of those very obscure, I can't put my finger on it type of comments, but nevertheless, a very consistent feeling, very consistent thing that they express. And interestingly enough, when I mentioned that Dominika has very good experience with that concept as well. So I'll let her take over.

Monique Ramsey (31:44):
This is so interesting to kind of, I'm sure none of these patients went in to surgery to get the implants thinking any of these things were going to be maybe a side effect for them. And obviously they're not a side effect for everybody. Some people do great with implants and they're fine and they don't have issues. But for the people who do have issues, I mean, do you think there's, what might be some of the reasons that they have this overall sense of just like the light is on? I mean, that's a really interesting statement to say I'm more like me.

Dr. Dominika Swistun (32:21):
That's very interesting concept, but makes total sense when you look at this connection and what Luke describes as just brighter, the light being myself, technical term is positive affect in psychology, just being feeling healthier psychologically, emotionally healthier. And there is a vast body of research connecting physical states, especially inflammation with depression. So we've heard a lot about inflammation in the context of having implants. Inflammation understood as your immune system respond to a pathogen. So when we're exposed to viruses, when we're exposed to bacteria, our body starting to mount a response to it to protect ourselves from the effect. We can also mount the same response, not necessarily to the pathogens in the absence of them, to things like stress, to things like lack of sleep. Also, overweight has been associated with this increased levels of inflammatory processes and the way we can measure it, we can take someone's blood sample and see that there's an increase of this immune cell, CRP or interleukins that indicates that we're maybe not having full-blown illness, infection, but that we have this pro-inflammatory state.

(33:53):
We're a little bit inflamed. And that has been linked to depression. That often triggers depression. It shows in this malaise, grogginess lack of motivation and often and also negative thinking and just poor life quality and generally feeling low and down. So now when you take these two things together, you can see how they merge if the implants are making individuals sick, causing that inflammatory response because this is your, it's recognized by your body as a pathogen, as something foreign. You have to fight it. If they're creating environment that it's like an autoimmune response, well that is tightly connected to how you feel emotionally. And very quickly you can develop this overall state of, combine it with the sleep issues, also, with anxiety, you develop this state of grogginess, dread, not feeling like yourself, and it just does not feel well. And you're trying to understand it, your mind trying to make sense of it and when you can, because it's like, well, why am I even feeling that nothing bad is happening?

(35:06):
And if it is, you quickly will find an explanation. But even if it isn't, you're like, I'm just wired that way. I'm just depressed for no reason. And then you start feeling bad even out of guilt. I've heard these explanations of people who are just saying, I don't know. I should be more grateful. I'm not connecting to myself, to my family, to my faith. I'm not the same person. And that in of itself is very depressing, knowing that living the life you have, you have no good reasons, but you're feeling crummy and you can't even explain why. These can be a profound thing. So if you can alleviate this physiological response, that's why the individuals are almost reacting with this kind of lift and oomph.

Monique Ramsey (35:59):
Well, and nobody's going to think that the implants are causing inflammation. The inflammation's cascading into all these other, it manifests in other ways. And now, I don't know if you know the answer to this question specifically, cuz I don't know if you're talking to patients in this way, but I wonder if would the patients who get their implants out and then they realize, I wonder if they have any sense of guilt, like, oh my God, I did this to myself. I would, I would be like, oh no, I'm the one who started this whole thing.

(36:38):
And how to forgive yourself to be like, okay, you didn't know that was going to happen. It doesn't happen to everybody. There's no way, it's not like you're reading a black box warning that you might have anxiety and you might have more inflammation. It's more like, okay, this happened and how to then give yourself a little bit of grace to say, okay, yeah, it was self-inflicted technically, but you didn't go into it thinking that was going to be what was going to happen.

Dr. Dominika Swistun (37:08):
Yeah, absolutely. That's a very good point. It's something that it's so individual for any given patient. I am sure there are some that will feel sense of guilt or regret or they will take maybe longer a little bit in the process of recovery, thinking that. But many things we do in life, we've done it to ourself, are self-inflicted that such is life. And you just have to move past that and be kind to yourself and just use it as a learning experience to know yourself to grow from that. And some people will just like, Hey, I'm glad I'm feeling that way. Who cares why? I'm just good and let's run with that. I think it just really depends on the person, but I would definitely be on the lookout for that because these individuals might take a little bit longer.

Monique Ramsey (37:57):
Mentioning freedom. Earlier we were talking because she, on the last time she was here on the podcast, she had long hair and now she has short hair. And so tell me a little bit about that.

Dr. Dominika Swistun (38:09):
Yeah, absolutely. Even the aspect of, we all do things right, we color our hair, we put our nails on, we put our lashes on, and at some point there is a certain satisfaction of getting rid of it. Maybe we'll go back to it, but for now, just not having the hassle, not feeling like there's always a plastic and acrylic or someone else's hair on you and things like that. I can imagine that getting rid of implants would have that liberating feeling too, that it's like, and there's always going to be Vogue too. And I feel like from at least, and maybe I'm skewed because I hear Luke's stories, but there is a certain shift towards embracing what you have, how you are, being more fit and athletic, being able to run and being more agile and not having the added weight. So there is a shift also in zeitgeist in what we consider to be sexy or feminine. And maybe that is also contributing, but definitely a certain lightness of being of I'm not committed to this, I'm not wedded to this. I'm not weighted down literally by it, and I'm just happy with the way my body looks. I definitely see a shift in a judgment about our beauty.

Monique Ramsey (39:29):
For sure. And I'm going on to my 34th anniversary in this industry, I guess you could call it this section of medicine, and there are different trends over time and the different shifts in how people view beauty and like you say, the Vogue of it all of maybe something that's more natural, that's more them using their own fat for augmentation, using their own tissue to give that fullness without having to have something foreign.

Dr. Dominika Swistun (40:06):
Oh, you almost like you pick your battles, right? Certain things are worth it, worth the hassle. They bring you enough of joy and there's not enough side effects. But I believe that for some individuals, the price is just too high. There's just too many impairments in general functioning, physical, psychological, cognitive, even, right? Being able to perform your job. That example that Luke gave of person who had to go on disability because she wasn't able to function. Those are extreme cases. Not always they happen, but they do at the different level. And I think it's for any given person to decide where you draw a line, how much you can put up with these things, and they're just bringing you enough joy that you'll carry on and how much you say it's just not worth for me. And it's always that individual decision. There's no right thing to say. What's pain in a struggle for one person might be, oh, well for another. And you really have to be just mindful of what your experience is and not to miss it just so your most optimal self healthiest you can be.

Monique Ramsey (41:09):
Are there any tools or therapies that you recommend to patients maybe after they have their explant that would support their mental wellness?

Dr. Dominika Swistun (41:19):
I think I would definitely focus on what the symptoms are after removal, like you've mentioned, someone might feel actually a sense of regret. Giving yourself time, understanding where this feeling is coming from, being kind to yourself. I mean, in more extreme cases I would say yes, seeking out maybe counseling for a couple of sessions to help you process that. If it's just the joy, because if many people are report just improvements, then that's great. I mean, it will dissipate with time, meaning that initially it feels like this great elation, right, a joy. But make sure that you remember, right, that you remember the lesson for future when you make choices because this is a learning experience of what brings you joy, what this experience was like.

Monique Ramsey (42:10):
Yeah. Well, and this is where I think journaling would come into play. So whether you journal the old fashioned way with a book and a pen, or there's different apps and I can't remember which app is on my phone and it'll pop up and it's like, do you want to reflect on you went to this place and this would be a good time to reflect on your day at this place or this memory? Because I think people forget. It's like, I had this, what are the 40 weeks or journal for when I was pregnant with my first child? And every day you're writing because you're all excited, but you forget. So you get further down or even after the fact and you look back and you go, oh yeah, I was feeling that way. So maybe for people to be sort of in that elation at the beginning and writing that down in some way so that later if you're kind of not feeling great, you could go back. Oh yeah, remind yourself what this experience did for you.

Dr. Dominika Swistun (43:08):
Absolutely. And there will be other experiences in life that will have the same mechanism. So you can see, I went through this and at the end I was okay, maybe beginning was difficult and adjustment, it's another thing. Even if it's for positive, it's a change. So you might have to adjust to clothes fitting differently. You might adjust to initially be patient with some discomfort and maybe pain after surgery or something. Again, being kind to yourself and patient and understanding that there's always a period of adjustment and it will look different for different people.

Monique Ramsey (43:44):
Right. Well, thank you so much for coming on again, and like I said, we'll put the link in the show notes for our sleep episode where we really take a deep dive into sleep and how that affects us in so many ways. And thank you for bringing your expertise here today.

Dr. Dominika Swistun (44:04):
Absolutely. My pleasure.

Monique Ramsey (44:04):
How it intersects with what your husband does every day and just getting your thoughts for everybody. I think it's been very valuable. So thank you.

Dr. Dominika Swistun (44:14):
My pleasure. Thank you so much, Monique.

Monique Ramsey (44:16):
Okay, for everybody who's listening, thanks again. If you're subscribing, put on your little notifications every Tuesday just about. We are going to send out an episode in every week, so sometimes we miss Tuesdays, but we'll put on your notifications and then you'll know when we have a new episode. And we thank you all for listening or watching today, and we'll see you on the next one. Bye.

Announcer (44:39):
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 for follow the team on Instagram @LJCSC. The La Jolla Cosmetic Podcast is a production of The Axis, theaxis.io.