Those are the findings of two separate studies presented at the American Society of Plastic Surgeons Plastic Surgery 2006 conference in San Francisco.
In the other study, women who had surgery to correct asymmetrical breasts reported a better quality of life and higher self-esteem six months after the surgery, says Elvio Bueno Garci'a, MD, PhD, a professor at the Federal University of Sao Paulo, Brazil, who led the study.
Cosmetic Surgery and Antidepressants
Freedman and his colleagues evaluated 362 men and women, most of them middle-aged women, who had undergone cosmetic surgeries such as facelifts, breast augmentation, breast reduction, and tummy tucks. Before their surgeries, 301 patients (83%) were not taking antidepressants; the other 61 patients (17%) were taking the medications.
Why did he do the study? "A lot of people are concerned about adverse effects from antidepressants," Freedman tells WebMD. "We were looking to see if cosmetic surgery alone would impact people's decisions [to stay on or quit the medications]."
The two groups, he says, were similar in age, sex, and types of surgery performed. Six months after the surgery, 19 of the 61 patients on antidepressants had stopped the medication, a decrease of 31%.
Fifteen (5%) of the 301 patients that weren't taking antidepressants before the surgery began to take them within six months after they had surgery; Freedman says that figure is consistent with what would be expected in the general population.
"You could theoretically claim they stopped and started [antidepressants] due to other stressors," Freedman says. For instance, a patient may have been on antidepressants before surgery to ease his feelings of grief, which then subsided enough to stop the medication.
But Freedman says he ruled out this possibility by questioning all patients before and after the surgery about major life stressors such as divorce and death in the family. No major life changes were identified that may have played a role in the patients' decisions about antidepressants, he says.
Self-esteem was boosted all around, he found; 99% of those not taking antidepressants before surgery and 98% of those who did take antidepressants before surgery cited better self-esteem.
Evaluating Quality of Life
Garci'a's study included 35 women who had asymmetrical breasts and underwent surgery to create balance. While some asymmetry in breast size is common, in some women the breasts may differ by a cup size or more.
"The breast asymmetry often appears during the breast development in teenage years," says Garci'a; this is often the time when teenage girls begin comparing themselves to other women, especially in "body-exhibition situations" such as going to the beach or swimming pool, or in department store dressing rooms. The feelings of being different, he says, can interfere with social activities.
To correct the condition, surgeons use breast augmentation, reduction, a lift, or a combination of techniques to create balance.
When Garci'a quizzed the patients before surgery and then three and six months later, asking about their health-related quality of life and self-esteem, he found the treatments provided improvement that increased with time. The quality-of-life evaluation included eight dimensions, such as physical and social functioning, degree of pain, and general health status. He found improvement in all eight areas, although the improvement was only significant in four.
Beauty Based on Symmetry
Other surgeons say the findings of the two studies make sense. Richard W. Fleming, MD, a plastic surgeon in Beverly Hills, Calif., operated on a 55-year-old woman who was on antidepressants. About four months after the woman had a facelift, brow lift, and eyelid lift, Fleming got an unexpected telephone call.
"I got a call from her psychiatrist, who told me the surgery did more for her than 10 years of psychotherapy. She had self-esteem issues."
Correcting imbalanced breasts can make life easier for young women with a lot of asymmetry, says Walter Erhardt, MD, a plastic surgeon in Albany, Ga., and chairman of the American Society of Plastic Surgeons public education committee. "These young ladies, as they are developing, are reluctant to talk about it or mention it and think there is something wrong with them. It becomes a really emotional issue for them."
One of his recent patients had practically no breast development on one side and was a D cup on the opposite breast, he says.
"The whole basis of beauty is symmetry," says Richard Ellenbogen, a cosmetic plastic surgeon in West Hollywood, Calif., who has a recurring role on the television show Dr. 90210. Symmetry is valued, he says, in facial and other body features, so making a patients' body parts more symmetrical is bound to please them.
Patients who go into cosmetic procedures with realistic expectations fare better, says Fleming. Consumers should expect their doctor to ask them as many questions as they ask the doctor about cosmetic procedures.
"We are very careful evaluating the person," Fleming tells WebMD. "We have a four-page questionnaire the patient fills out before the doctor sees them. A good cosmetic surgeon will determine a patient's motivation and expectation." And will decline to do the procedure, he says, if either is unrealistic.