Why do I need a psychological assessment prior to surgery?

By Dr Cameron Keating, Specialist Plastic Surgeon


Why do I need a psychological assessment prior to surgery?

Surgery is both a physical and an emotional journey.  Your surgeon wants you to have the best possible outcome and to be happy at the end of your recovery.  The ideal way to be prepared for cosmetic surgery is to be both at your physical and emotional best prior to surgery.

Your physical fitness includes having an appropriate body mass index for elective surgery (BMI – often less than 28-30), and to avoid smoking.  If you have hypertension or diabetes then making sure your blood pressure and blood sugars are well-controlled prior to surgery is recommended.  In a similar way, a psychological assessment helps your surgeon to make sure you are emotionally ready for surgery.   Mental health conditions are common in the community and it is important to consider whether they are optimally managed prior to surgery.  If you have a history of depression or anxiety, are your symptoms well-controlled and are your medication doses stable?  

If your diabetes is unstable then it is safest to refer you to your GP or an endocrinologist prior to surgery to adjust your medications.  In a similar way, if your depression or anxiety symptoms are not well-managed then it is safest to refer you to your GP or psychiatrist to optimise your management prior to surgery.

Having surgery is an emotional journey like grief.  You will experience an emotional roller-coaster ride including nervous excitement before surgery, relief immediately after surgery, then feelings of anxiety and  potentially guilt, once the reality of recovery, discomfort, and inconvenience sets in.  Ensuring that you are psychologically fit for surgery means that you have some emotional reserve capacity to overcome this vulnerable time after surgery. 


What does a psychological assessment measure?

A preoperative psychological assessment explores your reasons for undertaking surgery and your expectations after surgery.  Are you expecting other aspects of your life to improve after surgery other than specific physical characteristics eg. your work or social life?  If so this may be unrealistic.  Were you satisfied with previous cosmetic surgery or procedures?  How much do you think about a specific part of your body?  Do you obsess about improving that part of your body and does that concern affect you functionally eg. in your personal relationships or socialising?  What is your current level of body dissatisfaction?

Body dysmorphic disorder (BDD) is a psychiatric condition characterised by constant worrying over a perceived or slight defect in appearance.  It is treatable by cognitive behaviour therapy and medications.  Most importantly, patients with this condition are not helped by having surgery and are rarely happy after they recover.  Screening patients for this condition is now becoming a mandatory professional requirement for Specialist Plastic and Reconstructive Surgeons in Australia.

Other mental health conditions are assessed including your current level of anxiety.  Is your anxiety well-controlled or not?  Do you make considered or impulsive decisions?  Also, who will support you after surgery?

Importantly, a psychological assessment is a screening test.  It is not pass/fail and in isolation does not decide whether you do or don’t have surgery.  If red flags are identified in your assessment, these can be discussed in person with your surgeon.  Further, it may be appropriate to refer you to an independent psychologist for assessment and/or treatment.  Even if you already have a treating psychologist, a psychological screening assessment is still helpful to assess your emotional fitness for surgery.  Indeed, a support letter may be helpful from your treating psychologist, GP, or psychiatrist in describing your current emotional preparedness.  Overall, a psychological assessment is a helpful tool that your surgeon uses to give you the best possible chance to be happy and satisfied after having elective surgery.

All invasive surgery carries risk and requires a recovery period and care regime. Be sure you do your research and seek a second opinion from an appropriately qualified Specialist Plastic Surgeon before proceeding. Any details are general in nature and are not intended to be medical advice or constitute a doctor-patient relationship.

Dr Cameron Keating (MED1202462) MBBS BMedSc PGDipSurgAnat FRACS is a Specialist Plastic Surgeon, an ASAPS Board Member with extensive training and experience, and can be contacted here https://hobartplasticsurgery.com.au/


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