Sarah Ashbaugh
Episode 19

Breast Implant Illness Is Real

Sarah Ashbaugh

This episode includes topics about

Joining Dr. Javad Sajan on the Plastic Surgeon Podcast this week is his patient, Sarah Ashbaugh. Sarah underwent en bloc breast implant removal after experiencing breast implant illness. Breast implant illness is a hotly contested topic within the plastic surgery community. In general, breast implant illness, or BII, refers to a collection of various symptoms that can occur months or even years after breast augmentation, as a reaction to breast implants.

Sarah first had a breast augmentation in Colorado in 2012. She had always had small breasts and knew that she wanted breast implants for many years. After a startlingly quick consultation where she didn’t try on implant sizers, she underwent the surgery.

Over the next seven years, Sarah began to experience various symptoms that she never had before. For example, she started having food allergies, headaches, recurrent sinus infections, and out-of-ordinary fatigue. Originally, Sarah was diagnosed with a systemic yeast infection. However, after getting a second opinion, her doctor recommended getting her breast implants out.

Eventually, Sarah scheduled a consultation with Dr. Sajan. Discussing her options, Sarah ended up undergoing an en bloc breast implant removal. Tune in to find out the results of Sarah’s surgery.

Subscribe to the Plastic Surgeon Podcast for more plastic surgery stories from real patients and providers. Follow Dr. Sajan and the Plastic Surgeon Podcast on social media @realdrseattle.

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Transcription pending. Check back soon!


Dr. Javad Sajan  0:00   

Ever wonder what motivates people to get plastic surgery? Did they regret it? What can we learn from the stories of plastic surgery patients? We're here to explore those questions and get some answers today with my guest, Sarah Ashbaugh on the plastic surgeon podcast.

Dr. Javad Sajan  0:32  

Hello, my friends welcome back. And thanks to our listeners for the amazing feedback. We have had so much fun so far and look forward to more of your insights and suggestions. Please rate and review us on Apple podcast to help us get you more great content. On the plastic surgeon podcast we listened to real plastic surgery stories of triumph and pain from real patients and providers to further understand their motivations or why they would risk their life under the knife. I'm Dr. Javan Sajan and Today my guest is the amazing, wonderful, fabulous Sara. Sara, we're here to talk to you about your journey, how we came to know each other and the procedure you underwent and how it affected you. So Sarah, you came to me with the history of having had breast implants and you felt the implants were making you not feel well and you feel you had breast implant illness. Is that correct?

Sarah Ashbaugh  1:21  

Yeah, I definitely felt that my breast implants were negatively affecting my health.

Dr. Javad Sajan  1:29  

How long ago? Did you have your breast implants placed?

Sarah Ashbaugh  1:33  

I got my breast implants in 2012, it was probably about 2013 that the symptoms started. At least being noticeable.

Dr. Javad Sajan  1:46  

Sure. What led you to get breast augmentation?

Sarah Ashbaugh  1:50  

I was always and secure as a really young I guess going through puberty. Girls around me for getting breast and I just never did and always wanted them. And in my early 20s I just decided that I was going to, I was getting married and I didn't want to be super flat chested on my wedding day. So I got a breast augmentation.

Dr. Javad Sajan  2:20  

Sure. How long did you think about it before getting it?

Sarah Ashbaugh  2:24  

Oh, years. I know I wanted them.

Dr. Javad Sajan  2:27  

Really? In the wedding is sounds like it was the trigger that there was the final thing that made you pull the trigger on the implants. Right?

Sarah Ashbaugh  2:34  


Dr. Javad Sajan  2:35  

And did you get saline or silicone? 

Sarah Ashbaugh  2:38  


Dr. Javad Sajan  2:39  

What part of the country were you in when you had the surgery done?

Sarah Ashbaugh  2:42  

I was living in Colorado.

Dr. Javad Sajan  2:44  

Okay, I wouldn't ask you the name of the doctor doesn't really, really matter. Did you do a lot of research and finding your provider.

Sarah Ashbaugh  2:50  

So I wish I had done more research. I knew that I wanted a very natural look, I was terrified of having a very fake aesthetic. And with that being said, I chose a doctor whose portfolio had very natural looking breast augmentations. And I went solely based off that I wish I had done a lot more research.

Dr. Javad Sajan  3:22  

Why do you say that?

Sarah Ashbaugh  3:23  

The time that she spent with me and our consultation was extremely brief. I kind of envisioned the consultation. I put a lot of trust in seeing her portfolio and her before and her after. And I kind of envisioned there being more time spent with the doctor and maybe like trying on or seen implants or her talking to me about the procedure more but there really wasn't. But I put a lot of trust in her.

Dr. Javad Sajan  4:00  

How did the consult go? 

Sarah Ashbaugh  4:02  

It was so quick. 

Dr. Javad Sajan  4:04  

Do you remember I know it was few years ago what happened were questions were asked ballpark or what you asked about?

Sarah Ashbaugh  4:12  

Yeah, I came in with a long list of questions. She answered everything really professionally. She had come recommended by several people. So I kind of had had my mind up before I went in that she is who I wanted to use. You know if I could do it over again I would have chosen differently.

Dr. Javad Sajan  4:34  

During your consultation, did you sounds like you didn't get to see the implants or tried them on? 

Sarah Ashbaugh  4:39  

I didn't.

Dr. Javad Sajan  4:39  

How was your size determine what kind you want?

Sarah Ashbaugh  4:42  

She just said she was going to choose something natural and I would be a fuller chested you know like a full see. And at that point I was a very flat A and that she would make sure I was proportion smell. And at that point, my breasts were two very different sizes. And she said that she couldn't promise my breasts would be identical. She could promise they wouldn't be identical. That she couldn't guarantee me that but that she would do her best. And she would make sure that I looked proportional. And I appreciated the transparency and the honesty in that. Yeah, there wasn't any try on. And I didn't know that was to be expected. I wish I had done more homework to be totally honest about it.

Dr. Javad Sajan  5:32  

Sure. What else would you wish you would have known going into the console? And I'm asking this because a lot of women sometimes feel that. So I guess what would you share with someone in hindsight about that kind of consultation.

Sarah Ashbaugh  5:48  

To definitely go to, you know, three different consoles. And just because you have a good feeling about one or two, to still do your due diligence and go, regardless of what your initial feeling is about somebody, or regardless of what recommendations you've gotten, or how great their portfolio looks. I don't know if you want to jump ahead this fast. But she also told me during my consult, you know, do not have children, three to five years post surgery, you really want to make sure your implants, your capsule settles, and your implants are set. And of course, at that point, you know, I wasn't even married yet. Kids weren't even on the agenda. This was in 2012. And she said definitely don't gain any weight. And of course, like that wasn't on my agenda, either. She was very, very straight forward. And I had read that her bedside manner wasn't particularly warm, but that she was spot on and knew her stuff. And that is what people had told me about her. And you know, I wasn't looking for a bedside manner. I was looking for somebody to do a stellar breast augmentation.

Dr. Javad Sajan  7:13  

Exactly. Did you online research or was it anybody that you knew?

Sarah Ashbaugh  7:17  

I did online research, and I had knew two people that had, had breast augmentations by her. Which were the type of breast augmentations I was looking for.

Dr. Javad Sajan  7:31  

Did your

Sarah Ashbaugh  7:31  

But they were older women. And I was really quite young, which I think made a big difference and how I was really comparing things. I don't know, I'm guessing. 

Dr. Javad Sajan  7:47  

Sure. You know, in some patients, if they're a woman, they prefer a woman doctor or some opposite, did that play a factor at all?

Sarah Ashbaugh  7:56  

You know, I've really done it, it didn't play a factor. But location played a big factor. And I was in North I was in northern Colorado and I was worried about so I did feel like my surgeons were limited as far as location wise. So I also felt I also chose her for those reasons. I didn't have like a ton of options now. It would have been no big deal to do it in Denver and then be in Fort Collins, it wouldn't have been a big deal. But at that time, it seemed like recovering and going back and forth to appointments. Yeah, there were several factors as to why and I ended up choosing her that just were a little more narrow which play into my age.

Dr. Javad Sajan  8:49  

And how did that surgery? 

Sarah Ashbaugh  8:50  

The surgery was fine. You know, the surgery really well, it was fine. It was a quick recovery. I recovered well, my scars were significant. I didn't my recovery overall as far as like me being able to get up, move around. Exercise soon after, and all of that was fine. My skin stretched you know, this is just the way it goes. It's not the surgeons issue. It's just the way I responded to the implants but my skin stretched pretty intensely so I had just huge stretch marks across.

Dr. Javad Sajan  9:36  

After surgery. Were you at your goal size that you were planning on being?

Sarah Ashbaugh  9:40  

I had actually wished that she had gone larger. And I wished that funny enough that they were this is kind of ironic, since the whole reason I chose her was for a more natural aesthetic, but I had wished that they were more I guess more pronounced I guess you could say, because they just weren't they almost looked saggy if I could. Yeah, they really did.

Dr. Javad Sajan  10:14  

When did you notice the sagginess?

Sarah Ashbaugh  10:16  

It was about six months after. So of course at first they were really, you know, swollen it takes quite a while for them to come down. And even then I had wished I was like, Oh, I hope they just stayed just like this, but I knew that they were going to come down. So I was nervous because I knew that they were gonna drop. And I was already not super pleased with them when they were supposed to be up in my face, you know? So.

Dr. Javad Sajan  10:53  

The profile you had was moderate plus, which is a flatter implant. I'm just curious, did that doctor talk to you about going higher profile? So you had more upper pole or that wasn't a point of discussion?

Sarah Ashbaugh  11:04  

No, not a point of discussion.

Dr. Javad Sajan  11:07  

How soon after was your wedding after your surgery?

Sarah Ashbaugh  11:11  

So I got my implants in April. My wedding was in August.

Dr. Javad Sajan  11:15  

Did you have the look you wanted for the wedding?

Sarah Ashbaugh  11:17  

Yeah, you know, I did.

Dr. Javad Sajan  11:19  

And when you felt there were a little bit saggy. Did you go back to your doctrines mentioned? "Hey, you know, I'm not in love with this. What can we do"?

Sarah Ashbaugh  11:27  

Yeah, um, I called. And I went in for kind of like we did the post, when they continue to check on things. And at that point, I had the really dark purple lines across me. And she was really dismissive. didn't have time to talk to me at all. It was a very quick appointment. She just said,

Dr. Javad Sajan  12:01  

How long it was?

Sarah Ashbaugh  12:02  

I don't think I spent more than, you know, 5 or 10 minutes with her. It was very quick.

Dr. Javad Sajan  12:07  

How long did you wait to get that appointment?

Sarah Ashbaugh  12:10  

I really don't remember. I didn't have much face time with her at all.

Dr. Javad Sajan  12:17  

And then so what did she tell you? Oh, it's fine everything? 

Sarah Ashbaugh  12:20  

Yeah. You know, yeah, it looks great. They look great. I mean, she kept reassuring me that everything looked great. You know, everything was. 

Dr. Javad Sajan  12:28  

She kept saying that multiple times, right?

Sarah Ashbaugh  12:30  

Yeah, like everything was part for the course. You know, and I, I mean, I had friends with breast implants, and mine did not look the same. However, I kept reminding myself, I went for a really natural look. So maybe that is why but I mean, mine just weren't placed the same.

Dr. Javad Sajan  12:53  

Exactly. And your friends who had it? Was it that you liked? Was it by her or someone else? 

Sarah Ashbaugh  12:58  

Somebody else.

Dr. Javad Sajan  13:00  

I see. So when you know, when we looked at your implants, and you had moderate plus, which gives a lot more bottom fullness and top. So that can give a saggy look. And one of the things that determines and someone who has an a cup, doesn't have much tissue. One of the things that determines how prominent their upper pole is, is where you put the implant. So if you put the implant too low, they get a lot of bottom fullness and or top foremost, and you look empty. If you put the implant typically where I do it, where I center the implant behind the nipple, placing it in that plane typically gives the best results because what happens as you balance 50% upper pole, 50% lower pole. But what some people do, and I don't like this look as far as for my patients, they'll put a don't do a 2/3 1/3 while only 1/3 is above the nipple and 2/3 is below the nipple. And I think that gives a very saggy look long term, but he gets the patient happy in the interim. But my patients I tell them look, it's gonna look good. Might usually not pick the profile you want we talked about all of it usually go high profile arounds. And we're gonna wait six to nine months for them to settle. Because if they look perfect at three months, what that tells me is in the year two years, you're going to be way too saggy, and I'll be totally bottoming out. So that's, you know, I think it's doctor preference but I think you have to think for your patients long term, not in the intermediate term.

Sarah Ashbaugh  14:24  

100%, 100% and I knew that when she kept saying that the swelling you know, everything will you know, settle down it will the swelling will die down. I'm like oh no, I want them to stay just like they are right now.

Dr. Javad Sajan  14:39  

Did you ask her if she could do a touch, change or revision or anything like that or you didn't get there during your 5 minute appointment?

Sarah Ashbaugh  14:47  

I asked what could be done? And she said there was nothing that could be done like it is what it is.

Dr. Javad Sajan  14:53  

Not even changing the implants. Did you ask about that? Or she didn't give you that option.

Sarah Ashbaugh  15:00  

I don't, I wanted to know, like what my options were. And she didn't. I didn't know what my options were like, what even could be done with my situation. And she didn't give me any options. So I didn't even know if that was on the table. I didn't know what was on the table, I just knew that I wanted them a lot more perky than they were.

Dr. Javad Sajan  15:22  

And for the stretch marks, did she recommend anything? 

Sarah Ashbaugh  15:25  

Nothing. And I was incredibly insecure about the stretch marks, those were really intense. And I knew that, that wasn't her fault. It wasn't like I was blaming anybody, I was just simply really insecure about it. So I was using a lot of like scar stuff and anything I could.

Dr. Javad Sajan  15:49  

So stretch Marks can happen after breast augmentation, it's not common, but it does happen in women who have less skin are going bigger. So when I look at all the data, the one thing that can help is using usually, it's a generic medication called tretinoin. So if you start using tretinoin early when you're getting stretch marks, what I've seen in my patients is you can usually reverse the course on the stretch marks. So typically what we'll do is if someone's getting stretch marks with implants, which is very rare, but it does happen absolutely happens. Especially the A cup going bigger, is we'll use a special cream called Tretinoin, which is prescription and then we'll laser it off every three to four weeks. And by doing that, typically you can pause and reverse the course but it's a tough one to treat. So how was life then after implants? You got married.

Sarah Ashbaugh  16:39  

I got married. I was considerably larger. I mean, I've been I mean, I didn't actually tell anybody about my fiance at the time about my implants. 

Dr. Javad Sajan  16:58  

He didn't know or?

Sarah Ashbaugh  16:58  

No, of course, he knew like my girlfriend knew. But I hadn't actually told my like my father and I went to visit him and the second I walked in the door, my step mom opened the door and she's like, come into the bathroom. And she goes, you got your boobs done. I mean, I was considerably larger and it changed my whole frame. I mean, I was big in the fact that wasn't big in like perkiness, I was big in like my whole, how do I describe it? It was just saggy. Like, it wasn't a.

Sarah Ashbaugh  16:59  

You weren't proud of it? 

Sarah Ashbaugh  16:59  

No. Yeah, it wasn't a like perky. Just my boobs were bigger. It was kind of like my whole trunk seemed to just kind of be bigger. So it wasn't really the aesthetic. But anyway, so got my boobs. And 2014 I found out that I was unexpectedly pregnant in the middle of grad school. 

Dr. Javad Sajan  18:12  

What were you in grad school for? 

Sarah Ashbaugh  18:14  

I was in grad school for education. I got my master's in education. So I got pregnant, and we had our son in 2014. So then that was a pregnancy and my boobs got giant enormous. So then I breastfed, um, and then right after, and then in 2016 I had my daughter breastfed her too. So at the end of that my breasts were just worn out 

Dr. Javad Sajan  19:02  

You felt that were deflated.

Sarah Ashbaugh  19:04  

Yeah, I mean, they were totally deflated, but they were worn out to say the least. Mama was tired.

Dr. Javad Sajan  19:15  

Yes, yes. Yes, pregnancies take such a toll and such a journey. When did you notice your implants were making you feel sick?

Sarah Ashbaugh  19:24  

I believe I got my surgery in 2019

Dr. Javad Sajan  19:30  

With me yes

Sarah Ashbaugh  19:31  

With you. So it was 2018 I think that I started to make the correlation.

Dr. Javad Sajan  19:40  

What symptoms were you having in the intern?

Sarah Ashbaugh  19:43  

So it took me a while before I really exit out. I kind of went down the list and took out everything that I could before. When I say took out everything I couldn't. I mean I really tried to eliminate all possible things before I thought it could be my implants. So the symptoms I had, I had chronic sinusitis. I mean, I had one sinus infection after another sinus infection, which seems crazy. 

Dr. Javad Sajan  20:17  

When did that start after the implant?

Sarah Ashbaugh  20:19  

Quite a few years later. So my inflammation and my body, I think, was a very gradual thing. I think it was a very slow thing that builded that built over time, excuse me. I don't think it happened right away. It started really slowly. Like early on with my implants. I started getting a lot of headaches, migraines started for me and I had never had migraines previously. But I didn't attribute those to my breast implants. I never, in my wildest dreams thought my implants could have anything to do with any symptoms that I had. I was extremely fatigued all the time. I had a lot of brain fog, I put on about 20 pounds that I really could not get off. We'll leave out there. I guess the inflammation overall was just compounding. And towards the end, I started to develop a lot of really interesting food intolerances, which I have never been sensitive for. had any problems with foods before.

Dr. Javad Sajan  21:40  

Like what?

Sarah Ashbaugh  21:42  

Night shades, almonds, beef.

Dr. Javad Sajan  21:52  

And what would happen when you eat these foods? 

Sarah Ashbaugh  21:54  

my asthma would act up, hives, are starting to get a skin rash. My I developed psoriasis are eczema, rather eczema, I was having a bunch of random elements

Dr. Javad Sajan  22:13  

In the sinus stuff. What about talking about that again.

Sarah Ashbaugh  22:17  

So the sinuses were really starting to interfere in my life. Really severely to the point where I was sick constantly, I couldn't take care of my children. Nothing I was doing was helping and I had removed all sorts of foods out of my diet, dairy was a massive trigger for me. And I went and saw a doctor and they told me that I had a systemic yeast infection in my body, which was I found to be like, rather a little bit cuckoo. 

Dr. Javad Sajan  23:00  

Was this an MD or DO or natural path?

Sarah Ashbaugh  23:03  

Yeah, it's an MD.

Dr. Javad Sajan  23:05  

So how do they determine that just clinical, they do a test run? 

Sarah Ashbaugh  23:09  

Yeah, they, you know, run some tests on you. And, you know, you walk out with like a huge, whopping bill and you know, $1,000 in supplements later and you're like, "Hmm I don't know if this is true, or you know what kind of data"? 

Dr. Javad Sajan  23:26  


Sarah Ashbaugh  23:27  

You kind of wondering, right kind of shaking your head. So they tell me that I have this yeast thing. So I'm like, Okay, I'm gonna think about this. So anyways, I was really grabbing for straws to try to figure out what was going on with me. But I had so I took some crazy antibiotic, it was like xifaxan or something, which is supposively get rid of this systemic yeast thing I had going on and that didn't get rid of any my symptoms.

Dr. Javad Sajan  24:04  

So you were born to all these doctors getting all these tests, spending all these money, nobody has an answer.

Sarah Ashbaugh  24:10  

Nobody has any answer. I even went to this like crazy other like, Doctor, right? Shouldn't of course she couldn't fix me. So then I was seeing my ear, nose and throat doctor. And she's the one who I had, had two sinus surgeries with her. And she's the one who brought up my breast implants.

Dr. Javad Sajan  24:36  


Sarah Ashbaugh  24:37  

And she is the one who talked to me about the overall inflammation in my body and said that I should really consider having the amount within the next 12 months. And this is the first that I had heard about my breast implants being of concern As far as being related to everything that's going on, mind you, I've already been down a whole rabbit hole with this crazy cuckoo stuff.

Dr. Javad Sajan  25:11  

It's not crazy. They're real symptoms.

Sarah Ashbaugh  25:13  

Well, no, my symptoms are totally real. But I had done on, you know, trying to figure out what this yeast thing or whatever.

Dr. Javad Sajan  25:21  

So do this, your ENT doctor, did she have other patients who had these symptoms? or how did she arrive at this.

Sarah Ashbaugh  25:28  

So she is very up on research. She had been studying breast implants and links with overall inflammation. And I had given her like all of my history, I've told her everything I was doing. And she's the one who ultimately recommended that I consider within the next 12 months getting them out. I really trusted her. Because she had been through a lot of my sinus stuff with me. But it was the first day I'd heard of it. And it was the first I had, even yeah, it was just the first time I had considered my implants being of any issue with me personally. And she explained that it's just my body overall is clearly in a sense of are in a state of inflamed state, and I need to just dial down the overall inflammation. And implants are a foreign body. And it's worth taking them out and seeing what will help because at this point, I've tried lots of different avenues. I'm on a very restrictive diet, I had taken all sorts of things out of my routine, and I was on all sorts of medications, I had been on strenuous antibiotics, nothing was getting me better. And it was really affecting my quality of life. So that's when I started researching surgeons. And that's when I got to you.

Dr. Javad Sajan  27:20  

And what information did you find about breast implant illness after your talk with her.

Sarah Ashbaugh  27:25  

That was a whole new world. I think it's become a lot bigger now. And unfortunately, you know, you can kind of attribute all sorts of things to breast implant illness, you know, they're like, "Oh, you have hair loss, like you could have breast implant illness, or, oh, you know, you've got headaches or you have GI issues". But I think really, what it will down to is, I think a small percentage of women can, or people in general can have, you know, sensitivities to foreign things in their bodies, and sometimes your body will remain in an inflamed state. And I don't think it happens very often. But I do think for me, it helped dial down the overall inflammation considerably. I think it's been a really life changing thing for me to get them out. And I didn't take the decision lightly.

Dr. Javad Sajan  28:25  

Of course. So going back to your journey here about this, you do some research, you see these nonspecific symptoms, and my personal opinion is I think breast implant illness is real. I think it's very rare. Now in this part of the country, I probably in my state, I probably put in more implants and probably anybody else. And but I also believe that there's a very small percentage of women that don't respond well. And you have to treat them. Right? So I think you fall into this category, and you started doing research. And did you meet with doctors or what was your first step?

Sarah Ashbaugh  29:02  

So I did an online consultation with someone North who own she used to do breast implants. And then she only did she moved to only doing X plants, but 

Dr. Javad Sajan  29:17  

She's in Washington state or somewhere else?

Sarah Ashbaugh  29:19  

She's in Washington State. 

Dr. Javad Sajan  29:20  


Sarah Ashbaugh  29:20  

Yeah. So I had a consultation with her, but initially, I started looking into it and there's like, you know, a handful of originally when I first started looking into it, there's a handful of doctors that will do this, like very specific type of procedure and the way I wanted them removed and so then I found this other lady who was up north and I did an online like a virtual consultation with her and she's really difficult to get to location wise again, as we're talking about earlier, and I wasn't sure at that point, I forget exactly. But I knew at that point that I was not just going to have one consultation, yes, I learned that the first time that I wasn't just gonna go with one person. How was that consult? It was good. She was very straightforward, didn't have a ton of time. I'm seeing some parallels. She's done. She had done a lot of X plants. And she was really much more interested and doing work on patients who had had a verified, who had had an MRI and had shown a leaked implant rather than somebody who just preferred to have them out. I mean, she would she would have, she would have done it. But I think she was she was more interested in also like the reconstructive side of it as well. And I was really not sure at that point, what my future was going to look like, on that road. I wasn't ready to make any decisions about that. I just wanted to get them removed.

Dr. Javad Sajan  31:29  

Then, did you have was mine the next consult? Or did you have others?

Sarah Ashbaugh  31:33  

Yours was the next, I was so excited about yours.

Dr. Javad Sajan  31:38  

Why is that?

Sarah Ashbaugh  31:39  

My sister in law gave me a list of names of surgeons who would likely be able to perform my procedure. And she actually recommended you for the work that you've done in the Seattle community, specifically with transgender people. And she just said that you are an incredible surgeon, and that I would probably really, really jive with you. And I hadn't considered bedside manner up until now. But I actually got on your web page and started checking it out. And you had talked in depth about the imblock removal, which was what I was looking for. So I thought, "Hey, I'll schedule a consult". So then I did. And when we met, you answered all of my questions extremely thoroughly, you heard all of my concerns, you did not think I was crazy, which I really valued. Because up until this point, that hadn't been my experience, I had even my father has a good friend who is a plastic surgeon and put in an awful lot of breast implants. And I had talked to him when I was considering getting my breast implants out. He was like your breast implants are not the problem. Do not get your breast implants out. Bla bla bla bla bla. So just for you to be open to it was really incredible. So we had a great console, and you were really thorough with how you would remove them up, which was really important to me.

Dr. Javad Sajan  33:37  

Then the consult went well. And then we took during the concert, we talked about removing the implant with the entire show. And I shared with you that some women can feel it's not very nice looking after surgery. How did that feel? When I told that to you? I said you could feel this figured,

Sarah Ashbaugh  33:57  

Yeah, um, maybe just figured isn't the right word. But I felt like they my breasts are ready didn't look good. And maybe not just didn't look good. Like they didn't look right. They were bottomed out. And they had looked that way before kids, they never looked right to begin with. So I regretted ever having my initial breast implants. So to me, I didn't have much to lose with my health because I was really miserable. And I didn't have anything to lose with the implants because they needed to come out anyways.

Dr. Javad Sajan  34:33  

I agree. And there's options. Some women do want to do their inblock some women will say let's do a lift at the same time. Some people say let's do fat transfer at the same time. And when we chatted about this, my recommendation was let's get you let's get the implants are what the show. See how you do. If you feel better and you're healed, then we might be done. And you might not want more because your skin will have some contraction. Now one of the things that I do When I removed the implants, they do something called internal colorization. So that's a procedure that I have come up with, that I've developed where we after the implants removed, we heat up and cauterize the entire inside shell, whatever is left of the tissue of the muscle and all that. And that gives skin contraction and shrinking. So that sometimes can help avoid doing a lift, which would have put an anchor incision on your chest or around the area or down on the sides. We talked about all these things. 

Dr. Javad Sajan  35:27  

And sometimes when I do this console, Sarah, I use a few strong words, because the last thing I want is for somebody to have the surgery and feel very dis feel a lot of dysphoria with their chest swell. Although I know it's usually not the case, I'll use strong words to say how it's going to turn out to make sure people are really committed to to this operation and understanding where it goes. My reason for oftentimes, although I will do it, sometimes not doing a lift or fat transfer, which I will do sometimes at the same time as this surgery is because when you do it together, there's a higher risk of complications. If you do a thorough and block and inblock means take off the implant with the entire capsule that can take two to four hours. And then when you add full body lipo and fat transfer or lift, it becomes a very long operation for an outpatient setting. And it's hard to predict where things are going to move after you take out the implant with the show. So usually I'll do the enbloc with internal colorization let you heal, and then we decide if more is needed. So the surgery day came, how were you feeling up to that day?

Sarah Ashbaugh  36:39  

So I felt great about everything. I was really nervous. I didn't, I felt like I was almost like I could just leave my implants. And I had only had him in for seven years. Like this is kind of another elective thing. I already feel like crap. I'm rocking the boat again. You know, part of me was thinking that and the other part of me was like, I have nothing to lose, this could change my life. What happens if I feel miraculously better? Just go for it, Sarah. And then I got really worried right before my surgery that what happens if I do come out just looking even more botched than before. And so I called your office, pretty much panic attack. And I'm like, I think I need to get a lift. Like during this. Like, I can't just like come out looking like this. What happens if I just look ridiculous. And you actually talk to me, I didn't have to talk to anybody you called me. And you said you explained it all over to me. Like we need to see how your breasts heal? How the skin retracts? And then we can make a better, you know, I need to see how your health is. And you were so good with me. And I felt reassured we went into surgery. And I knew I was in good hands. I knew I was.

Dr. Javad Sajan  38:07  

What am I rules is whenever that happens, you know, obviously the front people answered the call. And then we always schedule a call up and at the end of usually that day to go over it. But the surgery is a big deal. When you do what I do when I can I do 10 to 15 operations a week, it can become very routine for the provider like me. But for me, I always remind myself that everybody who I have the privilege of operating on is the first time usually in their life, they're going through this because my family's had surgery. So I feel it, you know. And I try to tell myself, every conversation, every interaction, this is a huge deal for somebody that waited months, if not years for this. And I have to make sure I treat them that way and give them that experience. And I think it's when you lose track of that is sometimes when the bedside manner goes down. And for me the bedside manner is not just indicative, in my opinion, of how nice the person is, but how well they'll do the operation. Somebody who has crappy bedside manner in my opinion, they're not the person who's going to pay attention to every detail on the surgery. They'll be like, "Oh, it's going to be fine. It's going to be fine. I hate when people say that providers say that". It's only going to be fine, because I'm gonna make it fine, right? There's not going to be some mysterious magic that's going to happen. That's gonna make anything fine. So we had the surgery done. Was it painful compared to the actual implants?

Sarah Ashbaugh  39:30  

You know, to be really honest, I didn't remember the exact pain. I remember it being a little more painful in my opinion.

Dr. Javad Sajan  39:39  

I've heard that inblock is cambia.

Sarah Ashbaugh  39:42  

I felt like it was more painful, but I didn't. I couldn't compare them side by side. Right? It was seven years difference. So in my opinion, I felt it was more painful than my breast implants.

Dr. Javad Sajan  39:54  

Would you say it's more painful than labor.

Sarah Ashbaugh  39:56  

Um, you know,

Dr. Javad Sajan  39:58  

The first time that's the secondly.

Sarah Ashbaugh  40:02  

No. Getting my poor Hot Pocket stretched like that is definitely the worst.

Dr. Javad Sajan  40:15  

How are you feeling the night of surgery if you remember?

Sarah Ashbaugh  40:18  

After the surgery? I was in a special kind of triangle pillow. So I was propped up. And I remember feeling really like the ultimate detox for me. Because once I had decided that I wanted them out, I really wanted them out. I they had to go. So getting them out was just a really cleansing thing. I just needed them out. I didn't, it didn't matter anymore. I just wanted them out. So even though I felt like I was on painkillers, so it was fine. But I was propped up. And I remember I was kept really comfortable. So I was bandaged I didn't have drains,

Dr. Javad Sajan  41:10  

No drains. Yeah. I think I'm the only person who does it without drains that I know of in the country. And then you started. You had your postop week when we took off the binder and you saw your breasts in the mirror. How was that first time?

Sarah Ashbaugh  41:26  

I think it was emotional for me. It was emotional for me for sure. I haven't a big sense of regret just ever messing with my breast to begin with in my early earlier 20s. I was happy. I was very happy that, that they were out and I had at least begun the process of you know the worst was over. 

Dr. Javad Sajan  41:49  

The symptoms that you were having with the GI the sinus, the migraines, the fatigue, did you notice a change in that?

Sarah Ashbaugh  41:56  

So craziest thing ever. I thought worst case, you know, say nothing gets better. Fine. Like I have this crazy. You know, my doctor told me to get them out. I have had one sinus infections since I got my breast implants removed. And that was during a cold. And I had sinus infections back to back to back to back to back when they were in, and I have had just one. 

Dr. Javad Sajan  42:32  

And about almost a year and a half two years.

Sarah Ashbaugh  42:35  

I mean, it has been night and day for me. My energy level is up. I've lost all my weight. I'm down to my wedding weight.

Dr. Javad Sajan  42:47  

Are you trying to lose weight? Or did it happen by itself?

Sarah Ashbaugh  42:50  

It's come off. It's come off. I'm not doing anything. I wouldn't say like drastically differently. I have more energy. So I'm able to exercise more regularly. But I'm still not. I mean, I've only worked out once this week. So say I'm breaking any records.

Dr. Javad Sajan  43:07  

What about the migraines?

Sarah Ashbaugh  3:09  

Um, yeah, my migraines are considerably better. The fatigue is better. The I think what it boils down to is the inflammation overall, as dialed down. My food intolerances are gone completely, completely. I don't get hives, I can consume all the foods that I wasn't able to consume. Towards the end when I had made the decision to get my breast implants out. For me, it's made a night and day difference. An incredible difference for me.

Dr. Javad Sajan  43:49  

Sounds like you're happy you went through the decision. 

Sarah Ashbaugh  43:52  

A 100%. 

Dr. Javad Sajan  43:53  

Would you do it again?

Sarah Ashbaugh  43:54  

Yes. I would do it again, in a heartbeat.

Dr. Javad Sajan  44:00  

Thank you so much for being my guest today, Sarah.

Sarah Ashbaugh  44:03  

Thank you for having me.

Dr. Javad Sajan  44:04  

Your journey has been amazing. The insight that you have is going to help so many other women learn more about themselves. I have learned a lot from you. And I know your ordeal will help many of our listeners as they go through their own journeys. I appreciate your time, sir. And I'm happy to have you as my patient and I would say also friend. 

Sarah Ashbaugh  44:24  

Oh, thank you. 

Dr. Javad Sajan  44:25  

When you look back at your journey, or while you've been through with the implants and then block if there was one thing you could share with other women going through this or thinking they may have breast implant illness. What would you tell them?

Sarah Ashbaugh  44:39  

I would tell them to follow their gut and if they feel that this could be them to definitely try to eliminate other anything else that it could be before they just jumped to surgery. See what else it could possibly be? And, and then look at this as an option, because it is a small percentage of people, but to definitely listen to your body.

Dr. Javad Sajan  45:09  

You're so right. And one thing people will often wonder is, is there a test for this? How do I know if I have it? So as you know, exactly, this is a breast implant illness, there's something called a diagnosis of exclusion. So what that means is, it's a diagnosis you reach to when everything else is negative, we're in when every other test is negative. And it's important to go through their journey ruling things out. Because for example, there's so many other things I could call something like your symptoms, lupus, rheumatoid arthritis or name a few. A little bowel syndrome, Crohn's disease, I could name 100 diseases that have tests that you can diagnose. So it's important to make sure there's nothing going on that's readily treatable before you go through a surgery. In a call, it becomes a diagnosis of exclusion when nothing else is positive, and you have the implants and you have the symptoms and then you make a decision do I want to try or risk undergoing an electro operation to make this better? 

Dr. Javad Sajan  46:10  

Thanks for listening to the plastic surgeon podcast. Please rate and review us on Apple podcast to hear more great content. From my live surgeries on Snapchat and my adventures throughout the week catch us on all social media @realdoctorSeattle. See you next time. Bam what.

Episode 18

Episode 20