Study Uncovers Link Between Plastic Surgery and Mental Illness

A recently published study in the Annals of Plastic Surgery reports that women who undergo cosmetic breast augmentation are three times as likely (compared to the same age women who did not choose this procedure) to either commit suicide or suffer death related to alcohol or substance abuse. The suicides begin to show up ten years post-implant.  Considering that abuse of alcohol and substances to self-medicate is higher for those with mental illness, these statistics are revealing.

It is not the surgery itself that causes a higher death rate; rather, the study accounts for the higher death rate due to perceived underlying mental health conditions that may have brought the client to the plastic surgeon in the first place. This study will hopefully focus greater attention and screening for why the client walks in the door.

"An unknown percentage of women undergoing cosmetic breast augmentation have pre-existing psychiatric problems," said Dr. Joseph K. McLaughlin, a professor of medicine at Vanderbilt University School of Medicine and an author of the study. "We have to figure out whom these people are and if there is a common denominator."

Many plastic surgeons do mental health screening and others refer their patients out to psychotherapists (how thorough these evaluations are is an unknown at this point). More than 300,000 American women choose breast augmentation surgery each year. This study may encourage better choices to address and monitor both pre- and post-implant mental health screening.

Psychologists like David B Sarwer, an associate professor of psychology in psychiatry at the University of Pittsburg, agree that the study poses questions about whether patients need mental health screening. Dr. Sarwer, who wrote a commentary accompanying the study, parses out two words-evaluation vs. history-in regard to such screening: "It would not be warranted to have every plastic surgery patient undergo psychiatric evaluation...But it does suggest that plastic surgeons need to get a thorough psychiatric history of their patients."  It is unfortunate that Dr. Sarwer does not specify the difference between evaluation and history, nor elect to offer any type of useful criteria to follow. Interestingly, other plastic surgeons have shared that many of their patients take mood-elevating medications like Prozac. Does this send up a red flag for the surgeon?

Practicing plastic surgeon Dr. Nahai reports that doctors in his position routinely ask clients about their psychiatric history, acknowledging that "...[We] may be dealing with a high-risk group...It is our responsibility to ascertain that a patient is a stable person with realistic expectations who wants breast augmentation for the right reasons."

What exactly is the "right" reason for breast augmentation?

There is great pressure generated by the media (in all forms) about perceived notions of female beauty, including breast size. Easier access to this type of procedure raises the numbers too, although the price can still be steep. But let's not kid ourselves. We know the difference between societal pressures and what is best for ourselves... don't we? How does one decide to take action for elective surgery to correct what is perceived as a flaw? When does one cross that line between preference and unhealthy obsession?