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THE PSYCHOLOGICAL EFFECTS OF AUGMENTATION MAMMOPLASTY IN MIDDLE-AGED WOMEN Rebecca L. Kennedy Psychology 191 Professor Moser March 6, 2008 Abstract Studies are being conducted on whether or not women experience negative psychological effects after undergoing augmentation mammoplasty. Results from studies and research cited within the paper suggest that the effects of augmentation mammoplasty are not always beneficial to the patient.

Further research is needed to establish the extent of negative psychological effects of augmentation mammoplasty so that patients can have detailed information to educate themselves with while they make the decision whether or not to undergo augmentation mammoplasty. The Psychological Effects of Augmentation Mammoplasty in Middle-Aged Women Women rarely refer to the curves and natural imperfections of the female form as a work of art. “The female form is a combination of multiple attributes which cause many conflicting descriptions when taken as a whole” (“Female Body”, Wikipedia).

Past research has demonstrated that women have had issues with their appearances since the late 1800’s. These issues affect women on a daily basis, physically and mentally. In a 1997 U. S. survey, 56 percent of women have some type of problem with their overall appearance (Castle, Honigman & Phillips, 2002). Many women believe that undergoing cosmetic procedures will help them with, or even solve the issues they have with their appearance. Although there are several cosmetic procedures available today, augmentation mammoplasty, commonly referred to as breast augmentation, is one option for women.

According to the American Society of Plastic Surgery (“ASPS”) there were more than 329,000 augmentation mammoplasties performed in 2006 (“ASPS Studies”, 2008). Augmentation mammoplasty is the third most popular procedure in the United States for American Women today (R4MD, 2006). This procedure consists of inserting an implant under the breast or under the chest muscle, to allow the implant to expand and give the breast better contour and more cleavage.

The first silicone implant was developed in 1961 by Houston, Texas plastic surgeons, Thomas Cronin and Frank Gerow, and in 1962, Timmie Jean Lindsey, a 36-year-old mother of six, was the first woman to be implanted with silicone implants (“Breast Implants”, 2005-2006). There are many steps involved in the augmentation mammoplasty procedure. One of the more important steps will include choosing the right surgeon. The surgeon will need to be someone a woman feels comfortable talking to about her complaints, worries and expectations.

The surgeon needs to be a member of the ASPS, which will ensure that he has trained for at least five years with two years in plastic surgery, experienced with many different procedures and adheres to a strict code of ethics. Being a member of the ASPS also ensures the surgeon is board certified by the American Board of Plastic Surgery (“ASPS/ASAPS”, 2008). Although choosing the correct physician to perform the procedure is important to obtaining the desired result, the psychology behind choosing to undergo the procedure is the primary concern a surgical candidate must address.

Augmentation mammoplasty and psychology may appear to be unrelated; they are in fact interconnected in many ways. From the reasons behind wanting breast implants, to going through with the procedure, as well as the after effects of the procedure and how a woman handles it, psychology is a part of the whole process. There are many motivating psycho-emotional factors to explain why women get breast implants, some of which lead to positive psychological effects. Psychological motivators characterize these factors.

Internal motivators like insecurity, poor body image and needing attention and external motivators like a flaw or abnormal condition (“Breast Implants”, 2007). It is extremely important for a surgical candidate to consider the effect the procedure will have on her in the long run, both physically and psychologically. A candidate’s significant other may not respond to her change in appearance the way she expected. The women the candidate works with may make work life unpleasant to the point that she no longer enjoys her job.

These may seem like small speed bumps compared to the bigger issues a candidate may face when considering this procedure, but speed bumps that are not considered can stack up to form a wall. Recent studies show that “people report increased satisfaction with the body part they had surgery on, but results are mixed on whether plastic surgery boosts self-esteem, quality of life, self-confidence and interpersonal relations in the long term” (Dittmann, 2005).

Based on the FDA’s analysis of research done by Inamed, a manufacturer of one of the two breast implants approved by the FDA, women experienced a decrease in overall mental and physical health after having augmentation mammoplasty than before. “Almost every measure of emotional and physical health, including social relationships and self-esteem, declined after getting breast implants. The only improvements were in self-reported sexual attractiveness. ” Patients also reported that they were more satisfied with their implants directly after the procedure than they were two years later (Zuckerman, Sanoro & Hudak, 2003).

Augmentation mammoplasty is not appropriate for everyone, regardless of a woman’s defects or flaws. Women who are healthy, have realistic expectations, and are emotionally stable, but are unhappy with the shape and/or size of their breasts, are appropriate candidates to undergo the procedure. On the other hand, inappropriate candidates include those who are going through a stressful period, like divorce, and someone who was in an accident who wants to be restored to the way they looked before (“ASPS/ASAPS”, 2008). Individuals who suffer from Body Dysmorphic Disorder (“BDD”) are also inappropriate candidates.

BDD is defined as having a preoccupation with a certain body part to the point that the part of the body is repeatedly changed or examined to the point it affects other parts of that person’s life (Dittmann, 2005). People with BDD who proceed with cosmetic surgery experience no improvement with their BDD symptoms. A study was conducted to evaluate the effect of cosmetic surgery and the stability of 30 patients with a minor flaw in appearance, 12 with BDD and 18 without BDD, five years after their request for cosmetic surgery. 4 of the 30 patients were re-evaluated by telephone interviews, 10 with BDD and 14 without BDD, regarding their interventions, their satisfaction with the intervention, BDD diagnosis, handicap, and psychiatric comorbidity. 7 patients with BDD and 8 patients without BDD had cosmetic surgery. Overall, satisfaction rates were high in both groups. Despite this high rate, 6 of the 7 patients with BDD still had a BDD diagnosis and exhibited higher levels of handicap and psychiatric comorbidity compared to those without BDD.

Moreover, at the time of the telephone evaluation 3 patients who did not have a BDD diagnosis before the operation had developed such a diagnosis. This study shows that cosmetic surgery is not effective on BDD diagnosis, handicap or psychiatric comorbidity. In fact, it shows that cosmetic surgery can increase the symptoms of BDD in patients who did not show symptoms of the disorder before undergoing cosmetic surgery (Tignol, Biraben-Gotzamanis, Martin-Guehl, Grabot & Aouizerate, 2007).

There have been arguments offered as to whether or not potential plastic surgery patients should receive psychiatric evaluation before being considered an appropriate candidate for a procedure. The evaluation might help in some cases, but in the long run and in most cases if a woman wants the procedure bad enough she will find someone to perform it. In addition to the concern about the evaluation of psychological problems in potential patients, it is equally important to manage psychological complications after surgery.

Surgery is a “high-stakes stressor. ” The most important complications to patients are psychological rather than physical. Simply ignoring psychological complications of surgery can lead to delayed recovery periods, dissatisfaction with the results of the procedure, hostility toward the surgeon, and anxiety. A study was done in a large group of plastic surgeons to investigate the amount of negative psychological outcomes compared to amounts of adverse physical outcomes to gain insight on the seriousness of each type of preoperative complication. The study design was a descriptive, correlational survey that assessed psychological complications reported by plastic surgeons. ” The questionnaire was sent to 702 randomly selected board-certified plastic surgeons.

Results showed that psychological complications were much more common than physical problems. Surgeons encountered 95. 4 percent of their patients experienced anxiety reactions; 96. 8 percent of surgeons patients were disappointed, depression was experienced by 95. 0 percent, 92. percent of surgeons were encountered by patients with nonspecific physical complaints, and 88. 5 percent with sleep disorders. “75. 8 percent of surgeons reported that screening for depression was important, but only 18. 8 percent identified screening for post-traumatic stress disorder as important, even though 86 percent had diagnosed post-traumatic stress disorder in their postoperative patients. ” Patients who experience physical complications are more inclined to experience psychological complications.

Patients have an increased risk of experiencing postoperative psychological complications if there were underlying psychological conditions present before the operation. Disappointment, anxiety, and depression were the most frequently seen psychological complications (Borah, Rankin & Wey, 1999). Although the FDA approved breast implants in 2006 of two manufacturers, Inamed and Mentor, there is still research to demonstrate there are various problems associated with these two manufacturers’ products.

The FDA found that augmentation mammoplasty patients have at least one serious complication in the first 3 years after having the procedure. Many patients will need additional surgery within 5 years of the procedure (“Breastimplant. org”). Complications of augmentation mammoplasty include capsular contracture, which is the hardening of scar tissue around the implant and one of the most common complications associated with the augmentation mammoplasty. There are four grades of capsular contracture – Baker Grades I-IV. Grades I and II typically require no treatment.

Reopening the incision and releasing the capsule treats grade III. Grade IV requires repositioning of the implant or even implant removal. Consequently, capsular contracture may reoccur after additional surgery. Another complication is that breast implants may affect a mammogram reading, referred to as mammography, which can result in a higher risk of undetected breast cancer. Further, if the surgeon injures the nipple nerves, there may be temporary numbness. There is a 15 percent risk of the numbness being permanent. Another complication of augmentation mammoplasty is the rupture or deflation of breast implants.

Some causes for rupture/deflation of implants include, but are not limited to surgical error, damage by surgical instrument, capsular contracture, trauma or injury, and normal aging of the implant (“Smart Breasts”, 2002). These complications are by no means exhaustive of the potential problems a patient may encounter, but they may all lead to negative psychological effects on the patient. Issues between the relationship of complications and patient satisfaction were studied in Hetter’s questionnaire on 165 augmentation mammoplasty patients 22 and one half months after their procedure. 6 percent developed capsular contracture; 41 percent developed alterations in nipple sensation; 10 percent were not satisfied with scarring; 91 percent felt better about themselves; 47 percent experienced an increase in outgoing personality; 53 percent had improvements in sex life; 96 percent felt the operation met their expectations; 88 percent were satisfied with results and 96 percent, which includes some who were not completely satisfied, said they would have the procedure again (Goin & Goin, 1981).

After a surgical recovery period of 24 to 48 hours, and a few days of reduced physical activity, there will be a few weeks of soreness and swelling. In most cases, a mild case of unhappiness, often referred to as “the Third-Day Blues”, is common and results when a patient gets back her energy but her appearance has not started to improve. It may take awhile to emotionally recover and adjust to the change to your body. In some cases, post-operative depression occurs.

Patients who are vulnerable to post-operative depression are normally those who had dealt with depression before the procedure (“ASPS/ASAPS”, 2008). A study was performed to measure the presence of negative bodily experience and depression in patients requesting augmentation mammoplasty. The study consisted of 30 patients, average age of 30. 4 years old, who were compared with a hospital controlled group, with an average age of 30. 8 years old, who had never requested augmentation mammoplasty and had been admitted for minor surgery. The typical patient was a relatively well-educated, white housewife. Each patient underwent individual psychological assessment, which included a semi-structured interview, mental status examination and administration of the Beck Depression Inventory. ” Results indicated that significant amounts of depression were observed as well as several psychological problems related to a negative bodily experience. The study shows that careful pre-operative psychological assessment and treatment it is crucial (Schlebusch, 1989). A variety of poor psychological outcomes have been associated with augmentation mammoplasty along with depression and BDD including disappointment, anxiety and suicide.

There were four epidemiologic studies done to determine the suicide rates among women with cosmetic breast implants, compared with expected general population suicide rates in four different countries: The United States, Sweden, Finland and Denmark. It was found that women who undergo augmentation mammoplasty have a higher rate of death by suicide than those who had not undergone augmentation mammoplasty. “Overall, a total of 58 deaths from suicide were observed in the four studies, compared with the expected number of 25. death in the general population, yielding a significantly elevated relative risk of suicide in post-operative augmentation mammoplasty patients. ” The results indicate a need for increased attention to potential psychiatric risks before and after augmentation mammoplasty (McLaughlin, Wise & Lipworth, 2004). One theory is that patients who died from suicide may have attributed their psychological problems to their breast size. When they underwent augmentation mammoplasty to resolve this problem, the problem persisted.

From another point of view “a person who is so obsessed with their breast size as to have surgery to increase it may be fairly fragile psychologically and more prone to suicide independent of whether they underwent surgery or not” (Anonymous). It is well known that women want to improve the way they look. As long as the desires to undergo cosmetic surgery are for the right reasons, the patient is psychologically stable, has no history of depression or psychological disorders, and has weighed the benefits and consequences involved in cosmetic surgery, it is ultimately her decision.

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