Deciding About Breast Implants: An Emotional Journey
Most women who get breast implants are realistic about the surgery, says David K. Wellisch, PhD, professor of psychiatry at the David Geffen School of Medicine at UCLA. He has authored a textbook chapter on the subject.
For them, it's a body image issue, he says. "They simply are not happy with their bodies and wish to improve them. They have realistic expectations that if this is done, they will look more satisfying to their own eye and to others. But their self-esteem does not depend on it."
However, the journey to the operating table can be emotionally painful for some. One study showed that in the year before their breast implant surgery, women reported greater distress about their appearance and more teasing about it. They also spent more time in a psychiatrist's office than women who didn't get the surgery.
Over the years, Rod J. Rohrich, MD, chairman of plastic surgery at the University of Texas Southwestern Medical Center in Dallas, has come to recognize the patient with unrealistic expectations. "I want to do it if the patient is doing it for themselves -- not for their new boyfriend, or to save their marriage."
He won't treat patients who are going through major life changes -- divorce, death in the family, he tells WebMD. "I tell them up front it won't change your life, won't get you a new job, won't get you more dates. But it can make you feel better about who you are."
When Breast Implants Mask a Bigger Problem
When self-esteem and sense of self are more fragile, that's when people tend to have unrealistic expectations of breast implant surgery, explains Wellisch. "They are seeking transformation of sense of self. The gap between their ideal self and real self -- or the way they see themselves -- is greater than for the other group."
For these women, breast implant surgery is a band-aid approach to a bigger problem, he says. "They do feel better after this kind of surgery. I've seen it in my practice. But the surgery cannot transform a fragile or extremely vulnerable sense of self."
It's no surprise to Wellisch that studies show an increased risk of suicide among some women with implants, often 20 years later. Some women may hope that breast implants are a quick fix for mental health problems.
"It could be that the women have a psychiatric illness, then they feel better after the implants," says Loren Lipworth, ScD, an assistant professor of preventive medicine at Vanderbilt University, Nashville, Tenn., who worked on some of the studies. "Studies have certainly shown high levels of satisfaction and improved quality of life after this surgery."
But a decade later, the satisfaction fades for some reason, Lipworth says. "It may be that the psychiatric illness gets worse later on, or that it may develop later on. We don't know for sure."