KIRSTY Seward was fit, she was healthy and she was 25.
She ate well, she trained hard, and like most people, she wanted to look good and feel good too.
Dr Seward had chosen to get breast implants.
"At the time it just felt like such a normal thing to do, it was so accepted," she said.
But, now 30, the Newcastle woman is one of a growing number of people undergoing "explant" surgery after suffering a range of symptoms they believe to be caused by their body's reaction to the implants.
"Looking back now, looking at my photos I think, 'What was I thinking?' I didn't need to change anything," she said.
"It's just such a vulnerable age. When I was 25, I was a different person. I feel like I was yet to learn who I really was."
At first Dr Seward, an accredited practicing dietitian and university lecturer with a doctorate in behavioural science, loved her new breasts.
She had the procedure with a plastic surgeon in Bondi who had the credentials, experience and reputation to do a good job.
"They looked amazing," she said. "I didn't want them to look too fake, I just wanted them to look in proportion to my body. And they were nice. I liked them."
When her hair started to become so thin it was "snapping off", Dr Seward initially put it down to stress.
"I was doing my PhD, working full time and running a business, and I thought I was just stressed out and run down," she said.
"Then in the past 12 months I started to realise something just wasn't quite right. I felt tired all the time.
"I've always been fit - I used to train most days, sometimes twice a day, and I got to the point where I couldn't even train three days a week, and when I did, I had muscle fatigue and muscle weakness.
"I was going to sleep and my joints were aching. Even if I had 10 hours sleep, I wouldn't wake up feeling refreshed. I was napping whenever I could."
A friend who had recently had her breast implants removed raised the idea that Dr Seward's symptoms could be the result of breast implant illness (BII) - a term that some women and doctors use to refer to a wide range of symptoms they say can develop after a reconstruction or cosmetic augmentation.
To date, research has found little evidence of a connection between the range of symptoms and breast implants, and some studies in the US have suggested the link is "improbable". But online - and particularly on social media - a growing number of women are sharing their symptoms and experiences.
There are more than 130,000 people in one private BII group on Facebook, with members citing chronic fatigue, hair loss, digestive issues, anxiety, headaches and concentration problems.
"I kind of shrugged it off at first," Dr Seward said.
"But I just knew something wasn't right.
"I knew that level of fatigue, and what I was feeling, wasn't normal."
She went to her GP to look into what could be causing her debilitating fatigue, muscle weakness, joint pain and brain fog.
"I've got endometriosis and we were questioning polycystic ovary syndrome as well," she said.
"We looked into low iron, thyroid markers, anaemia. My B12 was fine. It just didn't make sense.
"I had brain fog. I went from writing a 70,000 word thesis to being unable to write a paragraph some days. I couldn't understand it. I had all these ideas in my head and I couldn't get the words on the paper. I started to struggle a lot."
Dr Seward went through the symptoms listed by thousands of women in a Facebook group.
"I was going through the lists and going, 'Yes. Yes. Yes. Oh I've also had that'.
"I've always been healthy and active and I eat well. It was refreshing to be in a community talking to women who got it. Because you feel crazy sometimes. You're feeling awful, but the blood tests are coming back normal and fine."
She raised the idea of BII with her GP.
"My doctor was quite supportive. They all tend to say the same thing - that there isn't much evidence, that they can't say it's a 'thing' and they won't diagnose it, but he was supportive," she said.
Earlier this month, Dr Seward had her implants removed.
"Being 30, and single, and taking away something that society sees as 'sexy'... I'd be lying if I said concerns about body image didn't come up," she said.
"But putting my health ahead of that was a priority. The explant itself is a little more risky, because they have to remove the tissue capsule around the implant too. So, it was scary.
"But I followed my intuition. I just felt that something wasn't right with them, and I trusted my body.
"I am already feeling so much better for it."
Professor Anand Deva has begun trying to find answers for the women suffering with symptoms they associate with BII.
"Rule number one as a doctor, listen to your patients. I don't think anyone can dismiss anything until we have hard data behind it," he said. "We have to approach everything in the best interest of the patient."
The plastic surgeon and director of Cosmetic and Plastic Surgery at Macquarie University's Faculty of Medicine and Health Sciences said the idea of BII was not new.
"It has always been this controversial thing bubbling away," he said.
"And when you have a group of women with a collection of symptoms that are fed a lot of information and scientific reports - of varying credibility - through social media, this thing gathers momentum.
"My role in all of this is not to continue to fan the flames, but to tease out whether there is a biological basis to what people describe as breast implant illness."
Around 20,000 women have implants each year in Australia - 75 per cent cosmetic and 25 per cent reconstruction. Around 10 per cent of women will need a revision at the five-year mark, mostly due to 'capsular contracture' - when the scar tissue or capsule that normally forms around the implant hardens and squeezes the implant.
Professor Deva said he had spent 20 years researching implant-related complications, including breast implant-associated anaplastic large cell lymphoma (ALCL) and capsular contracture, which had helped change world-wide practice.
"But my focus going forward is to tease out some of the variables that might predispose women to having a variety of symptoms. It's not going to be easy, because we are not dealing with something that is black and white," he said.
"With capsular contracture, you either have it or you don't. It's not grey. Same with lymphoma. With BII, every body system has been reported by women as being affected by breast implants. And so, when you have symptoms of fatigue, hair loss, loss of libido, metallic taste in your mouth, joint pains, weight gain, and weight loss, where do you start?"
Professor Deva, who is currently recruiting for a study on BII, believes he may find some answers relating to the body's immune system response.
"It kind of makes sense in the broader picture," he said.
"If your immune system is there to protect you against foreign invaders, it can be potentially there to protect you against foreign objects as well. A cycle of inflammation set up by our immune system attacking components of the implant, or something living on it, might be enough to drive the immune system crazy and ultimately drive a lot of these systemic symptoms."
Professor Deva said inflammation was the driver of breast implant-associated lymphoma.
"So the question I have now, as a scientist, is whether inflammation triggers this sort of systemic illness because of autoimmune or immune type activation," he said.
Professor Deva said any women in Australia undergoing an explant procedure could register for the study via an online portal at saferbreastimplants.org/breast-implant-removal.
Tissue samples and cultures would be collected and analysed for the study, with symptoms and the systems they affect tracked for 18 months post-surgery.
"There is a whole layer of psychology on this that needs to be considered as well... The variables are many-fold," he said.
But Professer Deva said there was certainly "biological plausibility" for BII.
"I wouldn't be wasting my time and energy on doing the study otherwise," he said. "But it is complex. It's kind of an upside down study where we are not quite sure what causes it, but if we can track the symptoms and look at the women who do well - maybe, just maybe - there will be some patterns that pop up that might help us start to be able to answer these questions.
"It may yield nothing, but we have got to try.
"Looking at the preliminary data, my sense is that about a third of women will benefit and have good sustained reduction of their symptoms - the challenge is to work out why. And those numbers may change as we gather more data."
Professor Deva warned that explant surgeries had become a "very commercial space" - and that the explant surgery itself came with "significant risk".
He urged people to be wary of any surgeons making any guarantees about outcomes after explants.
Dr Seward agreed. She said she was quoted prices between $12,000 and $17,000 for the explant procedure.
"I wish I could hug 25-year-old me and tell her she was so much more than enough, she always was enough just exactly the way she is," she said.
"This is a whole new journey of self love."
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