Psychological benefits of cosmetic surgery breast augmentation

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Acknowledgments
I would like to express my special appreciation and thanks to my Family, for the sacrifices they made in order for me to achieve and to strive towards my goal. My appreciation also goes to my dissertation supervisor_______________ I am extremely grateful for your invaluable source of guidance. Above all my sincere gratitude goes to Almighty God, the source of my strength and wisdom especially when the “going got tough”. Finally I would like to dedicate my project to my Family for their never ending support.

Abstract
Learning objectives: To have a clear understanding of the psychological issues that propagates or contributes to the growing tendency of women going out for breast augmentation and other cosmetic surgical procedures. The study should further look into the psychological benefits enjoyed by the patient undergoing through the cosmetic surgery process.
Background: Breast augmentation and other cosmetic surgical processes started in 1960 and have continued to grow in demand over the past years. Such move is a sign of increased number of people have low body image and self esteem.
Methods:
Result:
Conclusion:
Chapter 1
Introduction
According to (Magee and Crerand, 2013) increasing number of people are becoming dissatisfied with their physical appearance in the world. A good percentage of people have the problem with their physical appearance something studies suggest may be related to psychological issues. Cosmetic surgery provides an opportunity for women to improve their breast appearance. Studies show that that the people involved in carrying out cosmetic surgery are on the rise. In certain age bracket, the physical look can affect one’s self-esteem and affect their ability to perform. Magee and Crerand (2013) confirm that physical appearance is one of the largest if not the largest contributor to self-esteem and self–concept amongst children and adolescents. Globally, the urge to change body image has been found to induce self-improvement behaviours such as exercising, dieting and carry out plastic surgery.
Swami et al., (2009) define cosmetic surgery as a process aimed at enhancement, maintenance and restoration of the person involved physical appearance through either medical or surgical procedure. The concept of improving general appearance is common in the western world with the United States recording as high as 11.7 million cosmetic surgeries in 2007 alone according to according to report released by America Society for Aesthetic Plastic surgery in 2008. Various policies allow cosmetic surgery such as FDA policy that allows medical products to be used as long as they are considered safe and effective. Even many teenagers have undergone through the processes with silicone gel breast allowed for women above 22 and saline breast implant allowed for women above 18 years. However, there is a loophole in the system and teenagers aged much younger can undergo breast augmentation as long as their parents give consent.
Objective
General Objective
• To understand the psychological benefit of cosmetic surgery breast augmentation
Specific objective
• To understand why people have cosmetic surgery (breast augmentation).
• To understand the relation of psychology and cosmetic surgery (breast augmentation).
• To understand the factors that stimulates the increase in number of people carrying out cosmetic surgery (breast augmentation).
• To understand if there are negative psychological effect of cosmetic surgery (breast augmentation).
• To understand the social factors that motivates a person to have cosmetic surgery (breast augmentation)?
Research Questions
• Is their psychological benefit of cosmetic surgery breast augmentation? (MAIN)
• Why do people have cosmetic surgery (breast augmentation)?
• What is the relation of psychology and cosmetic surgery (breast augmentation)?
• What factors stimulates the increase in the number of people carrying out cosmetic surgery (breast augmentation)?
• Is their negative psychological effect of cosmetic surgery (breast augmentation)?
• Are their social factors that motivate a person to undergo cosmetic surgery (breast augmentation)?
Problem Statement
The rapid rise in the number of people doing surgery is on the increase especially in the western world. Unfortunately the increase is a result of psychological relationship where the person involved has low self-esteem and resolve to cosmetic surgery to improve their physical attributes. The research paper, therefore, should point out why increasing number of people in the modern society resolve to cosmetic surgery.
Research risks
Various risks are possible in research and the examples of such research risk are:
1) Physical threat or abuse especially during data collection
2) Risk of emotional breakdown due to complexity of research.
3) Social relationship breakdown
4) Legal risk of violation of various rights
Chapter 2
Literature Review
Introduction
Breast Augmentation, commonly called ‘boob job’ and is a breast enlargement procedure. According to (Plasticsurgery.org, 2015) breast augmentation is also called augmentation mammaplasty, and the process involves adjusting fullness and at the same time improve the symmetry or shape of the breast to replace the initial weight lost during pregnancy or weight reduction. Practically three types of breast augmentation procedures exist namely: saline solution, silicone gel and composite filler. However it reasonable to note that composite fillers are never manufactured anymore, and the breast, in this case, can be filled with soy oil and other material to improve benefit (Basile and Basile, 2015). While saline breast implant is sterile salt water filled and silicone implant is silicone gel filled, it is good to note that most patients go for saline implants due to shorter and smaller scar at the incision point. The saline implant also produces a better overall result due to realistic textures and size improvement. Unfortunately, the possibility of cosmetic problems is much higher in silicone gel than saline implants.
Before carrying out breast augmentation, a patient needs to carry out self-evaluation to determine if the process is necessary (Roberts et al., 2015). Therefore, the patient needs to ask themselves questions like: is carrying out breast augmentation is the best available option? What are the possible complications of carrying out breast augmentation? Will the implants require future replacement or not? And finally, what are the chances of the risk of the surgical process such haemorrhage, scarring and infections.
Reason for Breast Augmentation
Though most of the women do not go for breast implant due to the medical background, a little percentage of women has a medical reason for carrying out breasts augmentation. Therefore, Breast Augmentation is commonly carried for reasons such as: To replace and improve partially or fully damaged breast tissues due to trauma or diseases like breast cancer, to augment or improve the breast size, form and feel and to correct and fix damages or imperfections of a previous breast implant carried out on the same patient (Sarwer, 2007). However, doctors challenge patients to request for breast augmentation for sensible reasons, and that are normally expected to be personal rather than to impress a third party. At the same time, the patients may be taken through a psychometric test to determine the mental status and ability to take such decision for themselves without the influence of any disorder. Though confirmed by past studies, women normally feel much improved after the operation regarding better social life, improved self-esteem, improved physical appearance and improved health condition in cases where the patient had a medical basis for carrying out breast implant.
Psychological effect of breast Augmentation
Breast Augmentation is a process that is common in the western countries with increasing number of people having problems with their physical appearance. The process is if not well handled can lead to psychological issues and possibly result to patients getting depression. According to (WebMD, 2015) breast augmentation is common with people who are unhappy with their physical body and have a realistic expectation to improve their physical beauty in the persons own eye or the eye of the people around. However, according to David Wellisch who is a psychiatrist professor at David Geffen School of Medicine believe the performance women who have gone through surgery are more susceptible to implant surgery.
Medical experts like Rod J.Rohrich who is the managing director at University of Texas South-western Medical Center in Dallas believe some patients have an unrealistic expectation and prefer doing surgery to patients who want to do it for their personal gain. This is because some patients may be exposed to psychological stress or emotional meltdown since they do breast augmentation for flimsy reasons like saving the marriage or to please their partners (WebMD, 2015; Shiffman and Mirrafati, 2001).An expert such as Wellisch such analogies by occurrences such as increased risk of such patients committing suicide years later and wrong conclusion by most of the patient that the procedure can help improve mental health problems.
Interestingly experts like Loren Lipworth, an assistant professor of preventive medicine at Vanderbilt University in Nashville is worried that women might be having a psychiatric illness because studies on the patients that have gone through breast augmentation record increased satisfaction and subsequent improvement in the quality of life (WebMD, 2015). Lipworth, however, is surprised the satisfaction fades with time for a reason still not well researched. However it is never a surprise that breast augmentation is associated with depression and patient with a history of depression are warned to stay away from the process. Rohrich refuses to attend to patients with unrealistic requests believing such patients are susceptible to emotional or psychological problems. Before the breast augmentation process, patients need to be tested for self-esteem and body image to detect any sign of body dysmorphic disorder which is a mental problem that require psychiatric evaluation and psychiatric support (Shiffman et al., 2011).
A good percentage of women carrying out breast augmentation normally suffer from psychological distress as a result of their physical appearance of their body and driven by third party criticism about their physical attributes. According to study done by (Crerand, Franklin and Sarwer, 2014; Sarwer et al., 2011) shows that a good percentage of women seeking for Breast Augmentation health care are in one way or the other linked to past psychotherapy sessions, had at one time suffered low self-esteem, has experienced psychological depression before, possible attempted suicide before or possibly suffer from mental illness referred to as body dysmorphia. The same analogy shows that women breast augmentations are positively important in influencing mental health and improve quality through improving physical health, physical appearance, social life, self-confidence, improved self-esteem and improved sexual functioning. In Denmark, the percentage of the patient requiring breast Augmentation that have a history of psychiatric hospitalization stand at 8 percent (Solvi et al., 2010).
Body Dysmorphic disorder that is the main psychological has two different causes as explained by two theories that are psychologically motivated. Body Dysmorphic disorder can either be caused by unconditional displacement of sexual or emotional conflict in a person due to a condition where a person suffers from inferiority complex, emotional guilt and problem with the personal image. Unfortunately, the first theory does not have empirical evidence to back it. However, studying breast augmentation from the cognitive –behavioural perspective shows that Body Dysmorphic disorder can be caused due to the interaction of key factors such as behavioural, emotional and cognitive factors.
Body Dysmorphic disorder normally exhibit the high relation to cognitive factors especially in the development and maintenance of the disorder. That is due to the patient unrealistic attitude where an individual is focused on achieving perfection in body symmetry. In that case, such patient is involved in selective attention especially on an area they feel have a defect and such personal monitoring to detect flaws may result to misinterpretation. Unfortunately, people suffering from body dysmorphic disorder tend to misjudge their physical appearance and see themselves worse of more than they are (Yordanov, 2014). Behavioural perspective relates body dysmorphic disorder with the situation where people learn more about appearance from the media or peers and bringing the urge to reflect that on themselves. Such negative though about a person only create anxiety and negative emotion leading to such reckless and poor decisions. In some cases, the patient develops maladaptive behaviours like frequent mirror checking to help cut down the emotional distress they might be suffering from (Sarwer and Infield, 2012).
Body Dysmorphic disorder is also caused by socio-cultural relations such as the history of the patient such as a situation where a patient is raised in a family involved in poor upbringing that involve neglecting or neglecting the patient physical appearance. In such cases, the person involved may develop Body Dysmorphic Disorder and such development is common during the period of the adolescent. The physical and psychological changes that occur at the adolescent stage combined with the social-cultural changes result to body dysmorphic disorder (Sarwer and Infield, 2012). Bad practises such as teasing result to an individual questioning their physical appearance normality and that may happen even if there is no body flaw present. In other cases, a person may develop self-dissatisfaction with the body appearance as a result of developing body dysmorphic disorder from watching issues related to physical imperfection in the media.
According to (Crerand, Magee and Sarwer, 2010) the dissatisfaction with the physical body appearance can also be linked to eating disorder such as anorexia and bulimia nervosa that both contribute to body image dissatisfaction. It is noted that individuals suffering from eating disorder have increased emphasis or focus on their physical appearance, and that might lead to increased frequency of need for cosmetic surgery such as breast augmentation. Unfortunately, a person with an eating disorder will ignorantly believe cosmetic surgery such as breast augmentation will improve their extreme dissatisfaction with their physical appearance. Though no conclusive research has been done to link eating disorder to breast augmentation and other cosmetic surgery, some studies have shown an improvement in the eating disorder symptoms after the patients underwent through procedures that improved self-esteem like liposuction, breast augmentation, chin augmentation and rhinoplasty (Young, Nemecek and Nemecek, 1994). The improvement in the eating disorder and subsequent reduction in emotional distress occur for about ten years after the operation procedure. However, a clear and conclusive research is needed to find out how frequent is eating disorder prevalent in cosmetic surgery patients undergoing procedures like liposuction, breast augmentation, and chin augmentation and rhinoplasty (Sarwer et al., 2011).
Body dysmorphic disorder that is a major reason for women undergoing through breast augmentation can be treated using non-psychiatric treatment methods. According to (Crerand, Magee and Sarwer, 2010) three-quarters of the patient suffering from Body dysmorphic disorder will seek for cosmetic surgery while 64% of the of the patients who consulted for the cosmetic surgery option underwent the process. The commonly requested procedure by people suffering from body image desertification is cosmetic surgical processes and dermatological procedure. An example of Non-Psychiatric treatment processes is Acne agents, rhinoplasty, collagen injections, electrolysis and tooth whitening.
Crerand, Magee and Sarwer (2010) Links breast augmentation to suicide and the study indicate that patient who has undergone through the breast implant have two to three times greater risk of being involved in suicidal practises as indicated by epidemiological studies. However, the epidemiological research indicates that women who undergo through the process at old age around 40 years or more and have had the implant for more years are more susceptible to committing suicide. However a clear relationship of breast augmentation and suicide is still unclear and it is possible that some women seeking breast augmentation might have been exposed to personality issues like substance abuse and divorce threats that may influence the patients to consider suicide. According to ( Sarwer et al., 2011) indicate an increased chances of women who have undergone through breast implant seeking outpatient psychotherapy treatment and that is a possible indication of psychological distress which increases the chances of such patient committing suicide.
Motivation for Breast Augmentation
The decision to carry out breast augmentation is a challenging one to take especially if the reason for undergoing the cosmetic procedure is not medicinal. The motivational factors to undertake cosmetic surgery can either be internal or external. Internal factors are factors such as to improve the self-esteem of the patient while external involve secondary gain such as pleasing a boyfriend. In a clinical setup, it is very difficult to assess if a patient is internally or externally motivated to undergo the cosmetic surgery process. However, experience shows that patients that have internal factors as their motivation perform better in their medication process.
Women can also be motivated by the need to reshape their psychological status and improvement in other social relationships. This is in line with the report that most improve the quality of life, body image, improved self-esteem, increase marital happiness as well as improved sexual satisfaction. The decision to undergo through the cosmetic surgery process is enhanced by the awareness (information) and medical reasons. Many women going through breast augmentation and other cosmetic surgery report having information on the benefits and risk mostly from the mass media. Candidates suffering from body image dissatisfaction are prone to breast augmentation and other cosmetic surgery procedures, and this is common with big breast women compared to women having small boobs.
Cost of Breast Augmentation
Cosmetic surgery is a relatively expensive process. According to research done by America society of plastic surgeons, the breast augmentation process cost averagely $3,708 as represented by America cost of breast augmentation surgery. The cost normally includes the cost for anaesthesia, fee for the surgical facility, medical test fee, post-surgery insurance garments, medical prescription and surgeon fee (Plasticsurgery.org, 2015). Normally health insurance plan doesn’t account for any medical bill paid for the cosmetic surgery.
WebMD (2015) approximate that the cost of surgery ranges from $5,000 to $10,000 and the variation depend on the place where the surgery took place, the doctor carrying out the surgery and the implant type. Breast implants are categorised into two namely saline and silicone. Most breast augmentation candidates prefer silicone due to more real look, but it is riskier especially if it leak. The difference is that saline implants are silicone shell filled sterile salt water while silicone implants are filled with plastic gel.
Fig 1: Breast Augmentation before and after pictures

Source: (http://www1.plasticsurgery.org/before_and_after_photo_gallery/?procedure=Breast_Augmentation)
The figure above shows two set of pictures of two different women before and after the breast augmentation. The difference in the physical appearance of the pictures taken before surgery and the pictures taken after the surgery is noticeable and one can clearly point out an improvement in the physical beauty of the two patients who underwent through the breast augmentation process. The difference noticeable from the visual appearance is thickness, size and shape which are key appearance vital in improving the patient self esteem.
It is advisable that patients requesting for breast augmentation realize that Medicare does not cover some cost and a clear plan of how to pay for the services is necessary. However patients with private medical insurance may get more cover such as the cost of the actual implant, the cost of surgery or reconstructive surgery and finally the cost health screening services such as ultrasound, mammography and magnetic resonance imaging (Zuckerman and Abraham, 2008)..
Medical complication
Breast Augmentation sometime goes bad, and that can cause the patient great amount of psychological and emotional pressure leading to possible depression due to drop in self- confidence. Complication can occur in the form of post –operation bleeding, Seroma, which is fluid accumulation and wound infection due to incision-site breakdown. Other possible complications common in breast augmentation are varying sensation, breast pain, clear and visible wrinkles, loss of symmetry, breast tissue thinning and breast feeding complications. Therefore, it is advisable for the patient to undergo routine MRI monitoring and frequent physical examination (Phillips and Castle, 2002). Fortunately, breast implants are long lasting, and it is believed only 20 percent of women who did cosmetic implant and 50 percent who have undergone a breast reconstruction require re-examination within ten years. Post surgery period of recovery is important in ensuring a healthy breast transplants, and normally patients are advised to take light daily exercise to help alleviate pain and improved recovery rate and outcome.
Implant rupture is another complication that might occur after treatment. Though past evidence shows that the breast implant can last more than a decade without any problem, complication is still bound to occur. When ruptures occur in an augmented breast, the saline content leaks or deflate. In the case of such experience, patients are advised to see the breast cancer expert for removal and possible replacement. Breast implant rupture is linked to causes like rupture due to injury, normal wear and tear during the implant movements, when the implant has outlived its time, X-ray/Mammography, closed capsulotomy which is a fluid stopping the breakup of the fibrous tissues and implant, possible damage of the implant, trauma and chemical degradation of the implant chemical examination. Implant rupture exhibit symptoms such as the development of lumps in the breast reduced breast size, and distorted breast shape, asymmetry and pain characterized by a burning tenderness.
Social perspective of breast Augmentation
The family relations and the social life we live have great influence on our perspective of life. Through social interactions, women start to question their image especially based on the things they see in the media or from peer groups. The teasing that peer friend normally go through can affect some people psychologically and, therefore, they begun to scrutinize themselves and psychologically feel they out to look better than they are. In other cases, social interaction can influence some women to go for breast augmentation simply because a friend underwent the same process and looked better. The feeling of what others think about my physical appearance manipulates women to live a life for others since they want to meet the expectation of other people.
Unfortunately, breast augmentation doesn’t increase women power in the society, and it exposes women weaknesses since they are manipulated by others expectation to look in a certain manner. The breast augmentation procedure alienates women from their body through the introduction of the foreign material that may fail to work as expected. There are various non-surgical methods of improving the body image that give a person more control of his body. Unfortunately, most people need quick fix methods like breast augmentation that never last a lifetime and may bring complications in the future.
Conclusion
Breast augmentation is a procedure that is gaining momentum especially in the western world with the increasing number of people has dissatisfaction with their body image. However, most of the potential candidates for breast augmentation and other cosmetic surgery procedures are not motivated to undertake the process due to health issues. Though most women want to improve the breast size, change the breast shape and also the breast texture, the breast augmentation process, the procedure is best done only due to health issues. The desertification with the physical appearance by patients is mostly exaggerated, and the patients over emphasise on such body part rather lead to loss of self-esteem.
The good news is that very high percentages of women who have undergone through breast augmentation and other cosmetic procedure report high satisfaction with the process. They further believe and report improvement in the quality of life, self-esteem and personal confidence. However, reports linking cosmetic surgeries to suicides encouraged the introduction of psychological assessment before a patient is taken through breast augmentation. According to (Dowling, Jackson and Honigman, 2012) though the outcome of breast augmentation has been indicated to bring psychological satisfaction and the breast augmentation process may experience complications such as capsular formation and contracture, implant rupture and subsequent gel leakage, gel diffusion, granulomas, finally a change in nipple and breast sensation, birth marks, breast cancer, antibodies, antibodies and possible autoimmune tissue diseases.
Due to the surgical risk, the patient is exposed to, doctors like David Wellisch, who is a psychiatrist professor at David Geffen School of Medicine advice patients to have personal reasons for undertaking breast augmentation procedure or other cosmetic surgery. This is because such procedures like cosmetic surgery have a risk like infections, scarring, bleeding and possible haematoma formation, poor wound healing, skin breakdown, possible implant misplacement, implant wrinkling, palpable implant and pain. It is therefore not worth it undergoing such as the risky procedure to impress someone who might reject you in case the process backfires.
According to Dr. Nalini Chilkov who wrote an article about 25 reasons why we should not carry out breast augmentation, the breakage of the implant is has to happen since they never last a lifetime. Studies done by FDA indicate that most implants take 7-12 years to break, though the time depends on care, the implant might take longer or very short time. Chilkov (2015) indicate that breast augmentation and other cosmetic surgery might lead to memory loss, fatigue, cognitive impairment, poor concentration, disfigurement, scar tissue, capsular contracture, hardened and misshapen breast, bacteria or mold infection, surgical risks, chronic breast pain, nipple numbness, capsular contracture and Anaesthesia risks.
Chapter 3
Research Design and Methodology
Exploratory research
This is because we are seeking for more knowledge regarding breast augmentation and how psychological relationship influences the increased in number of people undertaking cosmetic surgery. At the same exploratory research design can help in determining the best research design, data collection method and how the subject will be selected.
Research Methodology
The proposed study will use mixed research method, by combining two research methods, such as qualitative and quantitative methods, where its main aim will be to exploit the collective wisdom gathered from the extant literature. The validity of the secondary data based on the literature analysis can be verified through response from experts in the field of cosmetic surgery and the patient who have undergone through the surgical process:
Fixed research: The data collected from the field would be under scrutiny and the research will be guided by well structure questionnaire which will restrict respondent from duplication and have them respond below each question in the questionnaire.
Method of Data Collection
Source of Data: It is very important to differentiate between the sources of data as either primary or secondary when carrying out a research study. Data that are unpublished make up the primary data, that is, the data which has been gathered directly by the researcher from the population of interest. These include data from interviews, fieldwork, and unpublished work such as minutes of a meeting. On the other hand, data that have been adopted by the researcher from an already published work are referred to as the secondary data. These types of data include work that had previously been published such as newspaper articles, books or journal articles. Therefore in this research is based on both primary and secondary data. The research will be based on data from already published document, expert interview and data sourced through online interview. A well structured questionnaire will be used to collect data from the targeted respondent who has clear knowledge on breast augmentation and how it relate to psychological disorders that is linked with the recent rise in the number of people going through the breast augmentation process. Sampling method: The sampling method will be based on probability sampling technique. A further sub class of stratified random sampling will be used target experts in the line of cosmetic surgery and the relationship between cosmetic surgery and the psychological influence. However, any respondent that has the right qualification which is, cosmetic surgery related knowledge, ‘all have equal chances of being interviewed.
Target group: The research will target two groups of people who are experts in the field of cosmetic surgery and individuals who have gone through cosmetic surgery in their lifetime. This is because the respondents are expected to have clear knowledge on breast augmentation and how psychological processes has influence increase in the increase in the number of patient carrying out cosmetic surgery.
Ethical concern
The research process must meet the ethical standard expected in organizing and running research. The data sourced from secondary materials will have to be referenced and the author acknowledged. At the same time the respondent from which the data shall be obtained must be made confidential and their consent consulted in case any will be quoted. At the same time conclusion made from the research data has to be reliable and conclusive hence guesswork or manipulation need to be avoided as much as possible.
Quality
To ensure the dissertation achieve the right quality, various standard has to be observed. First the secondary sources must be from reputable sources from recognized scholars and avoid sources like Wikipedia. Secondly, the primary source the data should be from people who are qualified in terms of understanding art and have knowledge on water desalination and how solar desalination is being regarded as an option to enhance an environmentally friendly system. Lastly to achieve quality, the interpretation should be from a person with a clear mind and good understanding of the dissertation topic.
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