Abstract
Objectives: Dissatisfaction with body image is common in patients seeking corrective plastic surgery. However, surgery may not be suitable for every patient. Surgery can enhance quality of life in mentally healthy patients but those with psychopathology such as body dysmorphic disorder (BDD) tend to have poorer outcomes. For these patients, surgery is not always recommended and psychiatric care can have a useful role. This paper aimed to estimate the rates of psychopathology in a select group of elective plastic surgery candidates and discuss the role of preoperative psychoplastic referral in triaging these candidates. Method: A retrospective cohort study of patients considering elective surgery at Flinders Medical Centre in South Australia referred by their surgeon for psychoplastic evaluation from 2010 to 2016. Medical records were reviewed to determine compliance with psychiatric referral, the number and types of psychiatric diagnosis and rates of subsequent surgery. Results: We found 83 per cent (54/65) of surgical candidates assessed by our psychiatrist had a mental illness. Post-traumatic stress disorder (n=19, 34.5%) and major depressive disorder (n=19, 34.5%) were most common. Nine patients (13.6%) were diagnosed with BDD. A total of 57 (87.7%) patients were considered to need some kind of psychiatric care to improve potential surgery outcomes. Conclusions: In our study, the rate of psychopathology in patients referred for psychiatric evaluation suggests that careful screening is important for clinical decision making. A combined surgical /psychiatric approach is effective in ensuring vulnerable patients are identified and managed appropriately.
Highlights
The number of elective plastic and reconstructive surgery procedures being performed around the world is increasing
We found 83 per cent (54/65) of surgical candidates assessed by our psychiatrist had a mental illness
In our study, the rate of psychopathology in patients referred for psychiatric evaluation suggests that careful screening is important for clinical decision making
Summary
The number of elective plastic and reconstructive surgery procedures being performed around the world is increasing. According to the American Society of Plastic Surgeons (ASPS), there were 17.7 million surgical and minimally invasive procedures undertaken in the USA in 2018, an overall two percent increase compared with 2017 and a 163 percent increase from the year 2000.1 Surgery can enhance self-esteem, body image perception and quality of life in mentally healthy surgical candidates.[2] patients seeking surgery to alter a particular part or region of their body can be motivated by a high level of negative body image perception This was reported by Sarwer and colleagues who found that these patients had an increased rate of underlying psychiatric disorders including body dysmorphic disorder (BDD) and eating disorders.[3] Identification of patients with a psychiatric illness, and those who may have undiagnosed BDD in particular, is critical for plastic surgeons, as operating on these patients can present a number of risks both to the surgeon and the patient. Most elective plastic surgery procedures, including those done for predominantly functional or even oncological reasons, affect appearance, so plastic surgeons working in non-cosmetic environments still need to be aware of mental illnesses that impact body image.[7]
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