Marcia Kraft Goin

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.

Changing the body : psychological effects of plastic surgery

This book, written by a plastic surgeon and a psychiatrist, gives the reader a psychiatric background that can be clinically applied to the patient undergoing plastic surgery. The book is divided into two parts; part 1 is a psychiatric primer and part 2 explains the use of the material presented in part 1. The introduction of part 1 grasps the readers attention by discussing the murder of a plastic surgeon, Dr Vasquez Anon, by a dissatisfied paranoid patient. It then proceeds to dis-

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.

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 has 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.

No Cheating, No Dying: I Had a Good Marriage. Then I Tried to Make It Better

E Weil’s book No Cheating, No Dying is an amusingly written commentary on how she and her “great catch” husband of ten years briefly explored eight ways to improve their marriage. These first-hand accounts are edifying in terms of how the therapies function and how couples and individuals might experience them. An example of the humor and reality is the description of their brief experience with couples therapy. In her comments to Ms. Weil, the therapist sees Dan as an anxious neurotic rather than as a charming obsessive: “You think he (Dan) just wants something from you but on the other hand you find Dan unavailable because he’s not relating to you. You think those attentions make you feel smothered and make him feel alone.” After they leave the session, Dan says, “What’s wrong with that lady anyway? She remindsme of StephenHawking.” Thus the two move on to have a delightful day. In contrast, the author describes a personally valuable experience with a “marriage education” instructor. In the session the author is told that her job was “not to move the conversation forward but . . . to empathize.”This she found very helpful and enlightening. The next several chapters follow the couple in their explorations of sex therapy, anger management, marriage education group workshops, and something called Mastering the Impulse of Love. A novelist and erudite writer, the author fills the book with comments by well-known authors such as Joan Didion and Anton Chekhov. The book does not delve deeply into the project’s eight types of marriage therapy. Instead, one has a view into the joys and problems within the author’s marriage and a brief look at how the various therapies function. I recommend this book for those who want to learn how one might experience various therapies and for those who just want a delightful read.