Study Uncovers Link Between Plastic Surgery and Mental Illness

Patient Expert

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?

To address this question, I am drawn to the psychological condition of Body Dysmorphic Disorder (BDD). BDD "is characterized by an excessive preoccupation with a real or imagined defect in your physical appearance.

People with Body Dysmorphic Disorder have a distorted or exaggerated view of how they look and are obsessed with actual physical characteristics or perceived flaws...They often think of themselves as ugly or disfigured. People with body dysmorphic disorder often have problems controlling negative thoughts about their appearance..."   Certain physical obsessions in a person with BDD include breast size. Severe BDD can lead to suicide ideation or suicide.

The underlying cause of BDD is still unclear, however, the following issues may either lead to, or co-occur, with BDD: chemical imbalances in the brain (low serotonin), obsessive-compulsive disorder, eating disorders, generalized anxiety disorder and other psychological, behavioral or cultural factors where someone feels that she must live up to unobtainable or unrealistically high standards of personal appearance or success.

I do believe an article on BDD could easily have been inserted next to this study in the journal to highlight direction for answers. There are tests for BDD that plastic surgeons could use: there is a questionnaire, the BDDQ, and an examination, the BDDE, both of which focus on concerns about physical appearance to evaluate the key tendencies of the disorder.   Could this be a beginning step to discover the "common denominator"?

Undergoing breast augmentation could also be linked to a type of co-dependency for those with BDD: once I can be a certain size, I will feel better and be happy. Once the moment comes, and the new breasts are in place, other issues will surface because the underlying emotional issues were never addressed. It is a chase for happiness that eludes. Once you make it to the destination you think will make you happy, another shows up down the road. And the chase begins again. The abuse of alcohol and other substances as well as suicide ideation and action do not go away.

Then again, are we the public placing our expectations too high on the plastic surgeons? This is an elective surgery. So who is accountable? Are the plastic surgeons practicing the oath "First do no harm...?" Is the work they do only putting off the inevitable? Within the mental health community, should we be taking charge of this concern and making it known that corrective surgery does not automatically remove the emotional impetus to undergo the cosmetic procedure?

In the end, perhaps a better system of checks and balances between the client, their general practitioner (or therapist) and the plastic surgeon may create yet another stopgap to uncover emotional concerns as yet undetected and save lives rather than altering bodies.


  • Press Release August 15, 2007. Study Suggests That A Need For Physical Perfection May Reveal Emotional Flaws by Natasha Singer