Plastic Surgery No Substitute for Mental Health Treatment continued...
"The flip side of this is a number of studies that show improvement in self-esteem and self-worth following breast augmentation. It has that effect, but it is not a substitute for mental health care," Nahai tells WebMD.
"For the great majority of women, there seem to be psychological benefits associated with cosmetic surgery," clinical psychologist David B. Sarwer, PhD, tells WebMD.
Sarwer, associate professor of psychology at the University of Pennsylvania's Center for Human Appearance, says any rise in self-esteem after breast augmentation cannot permanently offset underlying suicidal tendencies.
"I would not want to say breast implants fix this underlying predisposition to suicide," Sarwer says. "We do not say plastic surgery is a treatment for any kind of illness."
Psychological Screening for Women Seeking Breast Implants?
Sarwer has analyzed the research linking breast implants to suicide. He notes that the data come from silicone breast-implant safety studies. At the time researchers designed the studies, they were mainly looking for evidence of cancer and immune dysfunction.
The studies were reassuring about those worries. But when evidence of a suicide link emerged, it left researchers with very little information on the women's mental state and psychiatric history of psychiatric treatment.
What little evidence there is suggests that prior psychiatric hospitalization -- a major risk factor for suicide -- is disproportionately common among women who get cosmetic breast implants.
"Plastic surgeons need to do a better job of screening patients for psychological illnesses," Sarwer says. "My colleagues at the University of Pennsylvania and I have recently reviewed these findings, and we argue that plastic surgeons should evaluate the psychological status of all patients. If they encounter a patient in psychiatric treatment or with a history of psychiatric hospitalization, they should insist that those patients get a mental health consultation prior to surgery."
Nevertheless, Sarwer admits that there's too little evidence right now to develop specific screening guidelines. Lipworth agrees.
"I really don't know what screening would look like," she says. "We really need to describe these underlying disorders to know what to look for. So there is more work to be done before making recommendations."
Nahai, a leading plastic surgeon, says that plastic surgeons evaluate patients based on two major factors. The first is motivation for having the procedure.
"If a woman is getting breast implants to save a marriage, or they want to attract more men when they go into a singles bar, this isn't going to work," he says. "But if a woman is doing it for herself, for her self-esteem, and wants to look better in her clothes, we are seeing someone who is doing it for the right reasons."
The second factor is a woman's expectation.
"The key things are whether the patient has realistic expectations about the implants," Nahai says. "Does this patient understand that having her breasts enlarged is not going to change her life? Because it is only what she does with the change in appearance that can change her life."