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Is bigger better? Breast surgery linked to boost in self-esteem and sexuality

March 22, 2007

GAINESVILLE, Fla. — Women who undergo breast enlargement often see a sizable boost in self-esteem and positive feelings about their sexuality, a University of Florida nurse researcher reports.

Although plastic surgery should not be seen as a panacea for feelings of low self-worth or sexual attractiveness, it is important for health-care practitioners to understand the psychological benefits of these procedures, says Cynthia Figueroa-Haas, a clinical assistant professor at UF's College of Nursing who conducted the study. The findings — which revealed that for many women, going bigger is better — appear in the current issue of Plastic Surgical Nursing.

"Many individuals, including health-care providers, have preconceived negative ideas about those who elect to have plastic surgery, without fully understanding the benefits that may occur from these procedures," said Figueroa-Haas, who conducted the study for her doctoral thesis at Barry University in Miami Shores before joining the UF faculty. "This study provides the impetus for future studies related to self-esteem, human sexuality and cosmetic surgery."

In 2005, 2.1 million cosmetic surgical procedures were performed, according to the American Society for Aesthetic Plastic Surgery. That figure is expected to grow. Consider that the number of breast augmentation procedures alone increased a staggering 476 percent since 2000, according to the American Society of Plastic Surgeons. More than 2 million women in the United States have breast implants, and this year more than 360,000 American women will undergo breast augmentation.

Figueroa-Haas studied 84 women who were 21 to 57 years old, assessing their perceptions of self-esteem and sexuality before and after cosmetic breast augmentation. Study participants had been previously scheduled for breast augmentation and were undergoing the procedure solely for cosmetic purposes. Eligible candidates were mailed a consent form, a demographic questionnaire and pre-tests asking them to rate their self-esteem and sexuality. They were then mailed a similar post-test two to three months after the surgery.

Improvements in the women's self-esteem and sexual satisfaction were directly correlated with having undergone breast augmentation. Figueroa-Haas used two widely accepted scientific scales to measure self-esteem and sexuality, the Rosenberg Self-Esteem Scale and the Female Sexual Function Index, which assesses domains of sexual function, such as sexual arousal, satisfaction, experience and attitudes.

The participants' average self-esteem score increased from 20.7 to 24.9 on the 30-point Rosenberg scale, and their average female sexual function score increased from 27.2 to 31.4 on the 36-point index. Of note, after the procedure, there were substantial increases in ratings of sexual desire (a 78.6 percent increase from initial scores), arousal (81 percent increase) and satisfaction (57 percent increase). Figueroa-Haas did point out that a small number of participants showed no change in their levels of self-esteem or sexuality after surgery.

With a heightened interest in men's sexuality issues in recent years, the research sheds light on women's sexuality, and how plastic surgery can improve and enhance this important area of life, Figueroa-Haas said.

"So much attention is directed to men's sexuality issues; we have all seen countless commercials on drugs and therapy devoted to improving men's sexuality. Unfortunately, very little is discussed regarding women's sexuality issues," Figueroa-Haas said. "I strongly believe that my research shows that interventions such as cosmetic plastic surgery can address these sorts of issues for some women. For example, those women who may have breast changes due to nursing or from the inevitable natural aging process. These women may not feel as attractive, which could ultimately negatively impact their levels of self-esteem and sexuality."

Figueroa-Haas warned that women should not view plastic surgery as a cure-all for any self-esteem and sexuality woes. In fact, ethical plastic surgeons should screen for this type of behavior and rule out potential patients who may have more serious psychological issues, she said.

"There may be patients who will never be satisfied with their bodies no matter how much surgery they receive or feel that their life will completely change after plastic surgery," Figueroa-Haas said. "These are not ideal candidates for surgery and should seek further counseling to address their underlying psychological issues. But for women who seek improvements in certain physical areas, plastic surgery can be a very positive experience."

Further research should be conducted to assess significant psychosocial issues that may arise after plastic surgery, said Figueroa-Haas, adding that her study helps call attention to the need for health-care providers to be able to predict outcomes in this specialized population.

"Since plastic surgery is increasing dramatically, my intention for researching this topic was to evaluate nurses' attitudes toward cosmetic surgery patients and make recommendations for increasing awareness of the factors surrounding these patients," Figueroa-Haas said. "Nurses should display compassion and understand an individual's reason for seeking cosmetic surgery instead of dismissing or stereotyping these patients. This study shows that there are genuine psychological improvements that follow plastic surgery, and these issues must be understood and respected."

University of Florida