A prospective study of patients' psychological reactions to rhinoplasty.

One hundred twenty-one of 200 patients requesting a rhinoplasty completed a study designed to assess their psychological reactions to the operation. Preoperatively, each patient filled out a questionnaire about their expectations (both cosmetic and psychological), relationships, self-confidence, self-esteem, what they disliked about their noses, and other questions pertinent to an evaluation of the psychological effects of rhinoplasty. They also completed the Brief Symptom Inventory (BSI), a standardized psychological test. One month and 6 months postoperatively, they completed similar questionnaires. Preoperative and postoperative information was also obtained from the surgeon and nurse. Statistical analysis showed several interesting findings. A number of patients had increased self-confidence and self-esteem. Male patients did not show any sustained changes on the BSI, but female patients did with improved scores on the obsessive-compulsive, interpersonal sensitivity, depression, anxiety, and phobic anxiety scales. A number of patients described mild-to-moderate depression postoperatively. This was correlated with preoperatively high levels of anxiety. The surgeon was usually more critical of the surgical result than were the patients. The patients whose strong positive feelings about the results he most misjudged were actually depressed. These and other findings are noteworthy to enhance the understanding of postoperative psychological reactions and provide insight into the psychological management of rhinoplasty patients.

Growing pains: the psychological experience of breast reconstruction with tissue expansion.

The efficacy of tissue expanders in providing additional skin and muscle for breast reconstruction has been demonstrated convincingly and repeatedly. This had led to the increasing use of this technique for certain women desiring reconstruction of the breast following mastectomy for cancer. We report on the psychological experiences of 10 women who underwent breast reconstruction by means of tissue expansion.

Psychological reactions to prophylactic mastectomy synchronous with contralateral breast reconstruction.

Women who have a mastectomy for cancer and must consider the possibility of a simultaneous prophylactic mastectomy and reconstruction at the time of reconstruction of the mastectomized breast have a variety of reactions. The reactions of the women in this study ranged from terror and reluctant acceptance to eagerness to be rid of future threats of cancer. This paper describes the stages of telling the patient, reactions to anticipated loss, and the postoperative reactions to the second mastectomy. For some the second mastectomy relieved fears about developing cancer; others found the idea devastating but still acceptable. The majority more readily assimilated the immediately reconstructed breast into their body image. Immediate reconstruction appears beneficial in easing the pain of an inevitably difficult experience.

Midlife reactions to mastectomy and subsequent breast reconstruction.

The well-documented psychological disturbances that follow mastectomy have been said to be less frequent and intense in postclimacteric women. Data from our interviews with mastectomy patients, 12 of whom were postclimacteric, indicate otherwise. Their distress was often outwardly different, but inwardly still traumatic. During frequent, open-ended interviews, feelings were revealed of loss, depression, and shame about sexual feelings that the patients believed to be inappropriate to their age. These revelations were facilitated by the frequency of the interviews, the decreasing unconscious use of denial as time passed, and the knowledge of the possibility of breast reconstruction. The patients' need to pretend to themselves and others that the mastectomy was relatively unimportant added an extra burden to the usual stress of coping with midlife anxieties. Reconstruction decreased the mastectomized woman's feelings of dependence and mutilation.

A prospective psychological study of 50 female face-lift patients.

Fifty female face-lift patients were evaluated preoperatively with psychological tests and psychiatric interviews. Their postoperative psychological courses were studied for up to 6 months. Approximately 30% had postoperative depressive reactions. These reactions were primarily correlated with a preexisting, clinically detectable depression, high depressive Beck scores, or a depression-prone personality pattern. There was no statistical correlation between postoperative depressive reactions and magical expectations, post-operative complications, marital status, recent bereavement, relationships with spouse and family, or concerns about death. Preoperative depression scores were often transiently intensified postoperatively, but usually eventually stabilized at a level lower than the preoperative scores. Many women showed postoperative psychological improvement. Twenty-eight percent had an increase in self-esteem, 8% felt better able to cope with life, and 8% were more assertive and confident in their work. The desire to improve self-image and to advance in a career were reasonably reliable predictors of psychological improvement.

The psychic consequences of a reduction mammaplasty.

We studied 8 consecutive patients who had reduction mammaplasties to determine their psychological reactions. All 8 experienced pleasure with the operative results and the improvement or disappearance of their physical symptoms. Most described a general increase in self-esteem. In 5 of the 8 patients, however, there were postoperative emotional disturbances directly related to the operation, lasting from 3 weeks to 8 months. None of these would have been noted by the plastic surgeon (JMG)hand this study not been in progress.

Countertransference: a neglected subject in clinical supervision.

As an acknowledged aspect of psychotherapy, countertransference would be an anticipated subject for discussion in clinical supervision. However, the authors' review of videotapes of 24 supervisors working with second-year residents revealed that 12 made no comments on the subject, 8 approached the subject directly, and 4 approached it indirectly. The authors discuss the reasons for this avoidance of countertransference issues and note that discussion of countertransference does not necessarily change supervision into therapy.

Teaching dynamic psychotherapy by observation.

Experience with a seminar demonstrating psychotherapy, interviews with 12 of the treated patients, and a survey of 23 residents have shown the value of this teaching method and its effect on the participants. Generally the patients felt helped and residents were enthusiastic. The teaching format has many valuable features--most important being the inclusion of a faculty-observer.