Heidi Montag: A Case of 'Plastic Surgery Addiction'?

May 8, 2010— -- Heidi Montag wants more plastic surgery?

A third breast augmentation may be in the cards for the reality TV star and aspiring singer, according to her husband, Spencer Pratt.

Montag wants to increase the size of her breast implants from 700 cc's to 800 cc's within the next two months, Pratt told Life & Style Magazine.

Pratt says Montag's decision followed an offhand comment by Ryan Seacrest, in which he said that Montag's breasts "didn't look that big." She came home in shock, he told Life & Style, adding that he has tried to keep her away from the plastic surgeon -- with little success.

Pratt's interview comes on the heels of Montag's January confession to a whopping ten cosmetic procedures during one visit to the operating room in November 2010. She had a chin reduction, fat injections in cheeks and lips, breast and buttocks augmentation, and liposuction, among other enhancements.

This built off her 2007 breast augmentation and rhinoplasty.

"I think that it sounds crazier than it looks," Montag told ABC News' Nightline in a January interview, "I think I just look like a different, improved version of myself."

Montag admitted to being "obsessed" before the surgery, spending hours looking through Playboy trying to decide what breast size she wanted, but she denied accusations of being "addicted" to plastic surgery.

"None of those people [that say that] know me at all," Montag told "Good Morning America." "And that's just a judgment. I'm not addicted."

Montag said her enhancements are necessary to help her to succeed in her television and music career. She said she needs sex appeal to make it in this "very cutthroat industry."

Dr. Frank Ryan, Montag's plastic surgeon, defends his patient's choice to purse her various enhancements, saying it's not uncommon in Hollywood.

But when does the desire to surgically perfect oneself go too far? ABCNews.com asked psychologists and plastic surgeons to weigh in on this issue.

Nip, Tuck, Squared

"There's a pressure that one feels in show business that you're going to have a better chance at success if you enhance your looks," says Dr. Malcolm Roth, director of plastic surgery at Maimonides Hospital and president of the New York State Society of Plastic Surgeons. "And sometimes that may be appropriate," he adds, if the patient has realistic expectations and a healthy attitude about the changes.

But "there's no question that some people develop an addiction to plastic surgery," he says. "There is a rush after jumping through that firey hoop: they're happy about the way they look and for some people that rush makes them want to do more and more."

"When self esteem isn't where it needs to be, people try to tweak themselves to feel better about themselves, but when it comes to doing that with plastic surgery, it's a very slippery slope," says Jody Schwartz, a psychologist in Los Angeles.

"Sometimes it becomes a little addictive and the person is never pleased -- it's never enough," she says. "This is when it becomes something that a plastic surgeon should not try to help."

Sometimes these patients have what is known as body dysmorphic disorder, a mental illness in which someone becomes obsessed with a perceived flaw in one's appearance, often seeking repeated surgical means to "fix" the issue.

Schwartz, who treats plastic surgery patients with body dysmorphic disorder, says that to put it simply, "BDD is not being able to see how you look in reality."

Anorexia and bulimia are the most well-known incarnations of this type of skewed body image, but an "addiction" to perfecting the body through cosmetic surgery can be another way of playing out the same body-image issues.

"It starts as an insecurity, but then [some part of them] thinks that fixing the things on the outside will fix problems inside," Schwartz says.

When to Raise the Red Flag

It's rare that someone will actually become "addicted" to plastic surgery, says Dr. Julius Few, a Chicago-based plastic surgeon, but for in some cases, that "really good feeling" gained post-op becomes a substitute for other things that are missing in the patient's life.

And when patients use the physical changes of cosmetic surgery to fulfill psychological needs, it raises a red flag for plastic surgeons, Few says. "Plastic surgery should not be used to offset something totally unrelated that is going bad in their life."

Dr. Henry Kawamoto, a clinical professor of plastic surgery at the University of California, Los Angeles, says he's had patients with body dysmorphic disorder and says that you get a feel for what the red flags are when a patient comes in.

If they have a long history of multiple procedures, that's a clue, he says. Or if they "talk about flaws that we can't see or that can't be improved with an operation, that's another flag."

Few and Roth say that all board-certified plastic surgeons are trained to gauge when it will be psychologically, as well as physically, healthy for a patient to undergo a procedure, but when in doubt, they refer their patients to counseling.

"Many times there are patients who are already a 10," Roth says, and it seems like they may be having psychological issues that make them think they need to change. In this case, "serious consideration should be given to psychiatric counseling prior to a trip to the operating room," he says, "and I often will suggest that."

Kawamoto says that he will tell them, "'You've maxed out; I can't improve on what you already have.' But unfortunately, they will always find somebody to do it for them."

Schwartz says our society is in part to blame because "in our world of beautiful people, people want to look like those beautiful people they see, to look like a model, and people have gotten carried away."