Psychological Screening for Women Seeking Breast Implants? continued...
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."
Nahai also says it is the responsibility of the plastic surgeon to assess every patient.
"Frankly, most of the women who come in to see us for breast implants are on some sort of mood-elevating drug, and it becomes a little difficult to sort them out," he says. "Sometimes I ask them, 'Have you discussed this with your psychiatrist?' If I have a high level of suspicion that you may have a psychological problem, I will also ask the patient for permission to discuss this with your therapist and ask whether this is the right thing for you at this time of your life."
Lipworth, however, does not think that all plastic surgeons maintain Nahai's high standards.
"With over 300,000 women getting implants in the U.S. last year, I am not sure how much screening is going on," she says.