Psychosocial Factors Within the

Realm of Aesthetic Plastic Surgery

Hilary McCord, PA-S

hilarymccord@uky.edu
Advisor: Professor Powdrill
Spring 2008

My Audience
Plastic Surgery
Psychiatry
Dermatology
Primary Care

Growth of the Industry

American Society of Plastic Surgeons reports
~ 11 million aesthetic procedures were performed
in 2006.

NONSURGICAL
Botox
Restylane
Microdermabrasion

SURGICAL
Breast Augmentation #1
Rhinoplasty
Liposuction

Breast Augmentation #1
330,000 in 2006
55% increase since 2000
Expected to increase in the future due to
the FDA reapproval of silicone implants
Invention of the Gummy Bear implant

Growth of the industry: Why?

Sociocultural theories emphasize the

interaction of the mass media and cultural
ideas of beauty with notions of Self-Ideal
Discrepancy and Social Comparison
Theory.

Growth of the Industry: Why?

The most recent example of mass media influence
is the explosion of aesthetic surgery Reality T.V.

Extreme Makeover
(ABC)
The Swan (FOX)
I Want a Famous
Face (MTV)

Plastic Surgery:
Before and After
(TLC)
Miami Slice (Bravo)
Dr. 90210 (E!)

Influence of Reality T.V.

Crockett (2007)
concludes 4 out of 5
patients reported
plastic surgery Reality
T.V. directly
influenced them to
pursue an elective
cosmetic procedure.

Didie (2003) reports

70% of cosmetic
breast augmentation
patients studied,
endorsed T.V. as a
significant source of
knowledge for the
procedure.

Influence of Reality T.V.

In 2005, the American Medical Association issued an
amendment to its constitution and bylaws addressing
concerns arising from reality television programs
influence on patient expectations regarding medical
care and standards to guide physicians participation
in such programs

Breast Augmentation
Psychiatric Disorders: yet, another
prevalent factor:
Sarwer (2003) reports 40% of women
seeking breast augmentation were under
the care of a mental health provider.
Meningaud (2001) similar results

Assessment of the Breast

Augmentation Candidate:
the PAs Role
Identify the motivating factors for the
intervention and expectations of the
surgical outcome
Recognize Body Dysmorphic Disorder and
consult with Mental Health Services
Elicit a psychiatric history to determine risk
for post-operative suicide

Identify Motivating Factors to have

Breast Augmentation
Body

Image
Dissatisfaction
may be the
primary
motivational
factor (Cash
1996)

Identify Motivating Factors to have

Breast Augmentation
Valence is the measure of the importance
of body image to a persons self-esteem.
Value is the degree of dissatisfaction with
ones appearance.
Breast augmentation patients have high
valence and high value. (Sarwer, 1998b)

Body Dysmorphic Disorder

DSM-IV (ICD-10:F45.2)
Extreme body image dissatisfaction
A psychiatric illness of perceived ugliness
Absolute contraindication for breast
augmentation or any cosmetic surgery
Avoid litigation

Body Dysmorphic Disorder:

Recognize It and
Consult Mental Health
Frequent mirror gazing
Perform repetitive time consuming
behaviors regarding the imagined defect
Doll-like appearance
Extreme rituals of camouflage
Surgery Junky

Body Dysmorphic Disorder:

Recognize It and
Consult Mental Health
15% of cosmetic surgery patients
2% general population
57% of BDD patients attempt suicide
Patients treatment of choice: mo surgery
Psychiatrists treatment of choice: SSRIs
and Cognitive Behavioral Therapy

Post-operative Suicide: the

importance of a psychiatric history

Six international epidemiological studies

have found an unexpected relationship
between cosmetic breast augmentation
and suicide

(Brinton, 2001) (Koot, 2003) (Pukkala, 2003) (Jacobson, 2004)

(Brinton, 2006) (Villeneuve, 2006).

Designed to investigate overall mortality in

women who underwent breast
augmentation.

Death by suicide associated with:

Breast augmentation vs. other forms of cosmetic

surgery
Older age at implantation >40 years old
Women who had their implants for longer
periods of time
History of psychiatric hospitalization with breast
augmentation vs. other forms of plastic surgery
Suicide rate approximately twice that expected
from estimates of the general population.

Conclusion
The aesthetic plastic surgery PA:
must be aware of the influence television
and western culture has on a patients
desire to invasively alter their appearance
has the duty to ameliorate the patients
body dissatisfaction with surgical
intervention while providing info on
benefits and risks of the procedure.

Conclusion
The aesthetic plastic surgery PA:
should decide the appropriateness for
surgery on a case-by-case basis and
include collaboration with Mental Health
should consider results of existing studies
on suicides link to breast augmentation.

Conclusion
The plastic surgery physician assistant
has the right to refuse a surgical
intervention if it is perceived as causing
future harm to the patient
PRIMUM NON NOCERE

For Fun
Association of Plastic Surgery Physician
Assistants www.apspa.net
BDD VIDEO
http://www.youtube.com/watch?v=Kfcohe
wREYc
Reality TV and Cosmetic Surgery VIDEO
http://www.msnbc.msn.com/id/20068105/

References

American Medical Association, Council on Ethical and Judicial Affairs, Ethics of physician
participation in reality television for entertainment (Resolution 607, I-04). Nov 23, 2005,
http://www.ama-assn.org, accessed on 3/1/2008.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders
fourth edition. 2000.
American Society of Plastic Surgeons, National plastic surgery procedural statistics for
2006 (Press Release). March 23, 2007, http:// www.plasticsurgery.org, accessed on 3/1/2008.
American Society of Plastic Surgeons, New reality television programs create unhealthy,
unrealistic expectations of plastic surgery (Press Release). March 30, 2004,
http:// www.plasticsurgery.org, accessed on 3/1/2008.
Brinton, L., et.al. Mortality among augmentation mammoplasty patients. 2001; Epidemiology 12:
321-326.
Brinton, L., et.al. Mortality among augmentation mammoplasty patients: an update. 2006;
Epidemiology 17: 162-169.
Cash, T., et.al. Development of the Appearance Schemas Inventory: a new cognitive body-image
assessment. 1996; Cognitive Therapy and Research 20: 37-50.
Castle, D., et.al. The outcome of cosmetic surgery in psychosocial terms. 2002; MJA 176: 601-604.

References

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References

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Koot, V., et.al. Total and cause specific mortality among Swedish women with cosmetic breast
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Pukkala, E., et.al. Causes of death among Finnish women with cosmetic breast implants. 2003; Ann Plastic
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