Plastic surgeons are aware, he added, that some potential plastic surgery patients may not be appropriate candidates. "Our members screen for psychological problems as well as medical," he said. If there are any "flags," he added, the plastic surgeon would refer the potential patient to help. That is routine practice among plastic surgeons, D'Amico said.
Another expert, David B. Sarwer, associate professor of psychology at the Center for Human Appearance, University of Pennsylvania School of Medicine, Philadelphia, wrote the "invited discussion" that accompanied the study.
In it, he urged physicians to heed the study results and to assess patients before they undergo cosmetic breast implants and other procedures, in particular looking for psychiatric problems. If a woman is under psychiatric treatment, Sarwer also urged the plastic surgeon to contact her mental health professional to assess whether she is stable enough for the surgery.
In an interview, Sarwer said "women thinking about breast implants or any form of cosmetic surgery should ask themselves three basic questions," including, What is the nature of my concern? Are the areas I want to improve modest defects that others don't even see when they are mentioned?
The woman should also ask if her motivation is internal or external. For example, if she is getting a breast augmentation to gain a promotion or save a marriage, that's not a good sign, he said. However, if she believes the breast change will improve her appearance in a reasonable way, that's a better sign.
Women should also be asked if they have realistic post-op expectations. Those who agree with statements such as "People will find me much more attractive" or "I'll have more friends" may be in for difficulties later, Sarwer said.
The news isn't all bad, he added. "Clearly, there are psychological benefits associated with cosmetic surgery and breast implants," he said. "But, a small minority of patients have these very unfortunate outcomes."
To learn more about breast augmentation, visit the American Society of Plastic Surgeons.
SOURCES: Loren Lipworth, Sc.D., senior epidemiologist, International Epidemiology Institute, Rockville, Md., and Vanderbilt University Medical Center, Nashville, Tenn.; Richard A. D'Amico, M.D,, president-elect, American Society of Plastic Surgeons, and plastic surgeon, Englewood, N.J.; David B. Sarwer, Ph.D., associate professor, psychology, Center for Human Appearance, University of Pennsylvania School of Medicine, Philadelphia; August 2007, Annals of Plastic Surgery