Dr Joanne Weston
C Psychol, Clinical Psychologist
DClinPsy, AFBPsS, PGCert, GradDip, BA(Hons)
Interview with Dr Joanne Weston, Clinical Psychologist
(Article commissioned by https://www.cosmeticsurgerysolicitors.co.uk/our-services/breast-surgery).
1. Do you think breasts have a particular emotional value for women? For example, do they feel integral to a women’s identity, more so than other areas of the body? If so, why?
Breasts are the ultimate symbol of femininity and the main focal point of the female anatomy. The portrayal of female identity as being synonymous with voluptuous breasts goes back forever! Breasts are the main female body part that we have on show, for the world to see and judge both negatively and positively. We can’t easily hide their size. They are so loaded with emotional value, and in so many different ways.
Breasts play a key role in sexual attraction as well as motherhood. In Western society, breasts are particularly heavily sexualised: women with large breasts are used as standard in the media, fashion industry, advertising campaigns, on television, in pornography. We can’t get away from it – and it’s been happening for centuries; think of the art world from the Greeks to the Renaissance period and their paintings of naked women with large breasts and hips. And growing breasts is a sign of sexual and emotional maturity and becoming a woman so we learn from puberty that breasts are a big deal. It seems like everyone has a view about them and they are loaded with different meanings – both good and bad.
Women who have small breasts and are concerned about this, often feel less of a woman because of what breasts have come to symbolise. This leaves them feeling sexually unattractive and they are reminded of it everywhere they go, even in subtle ways. For example, being restricted in the types of clothing they can wear as so many V-neck items are low cut and designed for women with average to larger breasts. Everywhere there are reminders that they not perceived by society as being “up to scratch”. Breasts are emotionally loaded in ways that other body parts aren’t, and we can’t escape from that as it’s woven into the fabric of society.
2. What would your advice be to a woman who is considering undergoing a cosmetic breast surgery?
No body is ‘perfect’ and bodies also change as we age, so really be honest with yourself about your reasons for wanting the surgery and what your expectations are about the results - both short-term and long-term. You should only be wanting the surgery for yourself, and not because you think it will change how others will see you. You are contemplating having an operation, which is a significant procedure – it involves going under anaesthetic, having something implanted into your body (if it’s an augmentation operation) and it will leave you with some scars.
And it’s not a one-off fix – implants don’t last forever, there can be complications with them, they will need replacing and the results won’t look the same forever – all breasts sag as part of the natural ageing process or will change – for example, if you have children, lose or gain a lot of weight for whatever reason, or breastfeed. You will inevitably be disappointed if you think the result you achieve will be the one that stays with you for the rest of your life with no further interventions.
Women often tend to skip over the risks involved in having surgery or don’t think about the long-term effects of implants. The allure of the short-term boost of having the breasts they always desired can cause women to underestimate the potential complications and long-term reality of having surgery. Listen to everything the surgeon is telling you – women who want implants can tend to focus on the things they want to hear and filter out the rest. Don’t be afraid to ask as many questions as you need as they might be a professional but you are the customer and need to have realistic expectations of what is on offer.
Remember as well that having cosmetic surgery isn’t going to resolve other issues in your life, such as save your marriage, cure your depression or get you a new job. It might help you to feel more confident in those areas of your life but the underlying issues are still likely to be there. If you are going through any major life events, such as a divorce or bereavement, it would also be advisable to wait until life has settled down before making such a big decision. Make sure your weight is stable and in your ideal zone, and try to maintain that long-term.
Overall, be realistic and don’t rush into the decision. Also, listen to the people around you – often women want to change their breasts as they feel insecure about their looks and worry that their partner would like them to have bigger breasts, and therefore don’t believe their partners when they reassure them that their breasts are fine as they are.
You might wish to seek some psychological therapy first with someone who specialises in body image concerns so you can make sure that you have properly thought through your rationale for wanting to change the size of your breasts purely for cosmetic reasons. This is especially important if you have a history of depression, anxiety or significant body image concerns. Having cosmetic surgery can be the best thing that some women feel they have ever done but sadly that isn’t the case for everyone.
3. If someone is committed to undergoing the procedure, how can she best prepare herself emotionally/psychologically before the surgery?
Accept that it is going to be a time of emotional volatility! It is normal for women to go through a range of emotions in this period – for example, the excitement of knowing they will finally having the breasts they want, fear of having an operation, and worry that something will go wrong during the surgery.
It is also common for women to have last-minute doubts whether they have made the right decision, which is where having taken time to make sure your reasons for undergoing surgery are rock solid is important as you can go back to these and reassure yourself. Have a good support system in place and talk to the people who are there for you.
In the weeks approaching the surgery date, keep a good daily routine, sleep well, have a healthy diet, take regular exercise and try to minimise stress in your life. Do relaxing and fun activities, learn some calming breathing techniques to help you if you are feeling anxious, and be kind to yourself. All of these things will prepare your body and mind to help them cope as well as possible with the surgery.
4. If all goes well, what can be the issues that arise in adapting to new breasts following the operation?
It’s important to remember that low mood is common following surgery, even when it does goes well. Your body has been through an operation and will feel a bit battered, bruised and in pain. This might also disturb your sleep, leading to increased fatigue and decreased tolerance to everyday stress.
Seeing the new breasts for the first time can actually be quite distressing for women as they won’t look like the finished result for some time and might look quite unnatural. This is due to the swelling, bruising and the fact that it takes time for the implants to settle into their final position. Women can panic at this point, worrying that their breasts are not the shape or size they desired and can get anxious that this won’t change over time. It’s important to remember that the body needs time to heal and adjust (it can take some months for a complete recovery) – but also your mind needs time to adjust to seeing something different when you look in the mirror.
Women’s expectations can be too great immediately following the surgery, which can then trigger unnecessary panic, disappointment and low mood. This can also lead to women relapsing into prematurely worrying about whether they made the right decision after all – but nobody can predict how their breasts will look after three weeks, three months or a year.
Negative emotions can also be exacerbated by dealing with the physical effects of healing, such as sensitive skin, noticeable changes in nipple sensitivity, numb breasts, managing wounds and dealing with scars. This can lead to anxiety or low in mood. Being physically limited at first (e.g. heavy lifting, brushing hair, daily chores) can be frustrating and make women dependent on others to help her, which can invoke feelings of helplessness and loss of independence.
5. If things don’t go as planned, for example the surgery is ‘botched’, what can be the issues that arise in the weeks, months or years following the operation?
Women in this situation tend to have issues with increased emotional distress, such as a depressed mood, anxiety, social anxiety, regret over making the decision in the first place, self-blame (“It was my fault – if I’d left my breasts alone, I’d be fine now”), anger at the surgeon for disfiguring their body, loss of trust in surgeons even if revision surgery is offered, and a desperation to try to ‘fix’ it and make it ‘right’ again.
Women can also be left feeling like their breasts aren’t their own anymore and can experience feelings similar to having their body assaulted and damaged by someone that they trusted. In the worst-case outcomes, women can develop with serious psychological issues, such as post-traumatic stress disorder, severe clinical depression and adjustment disorders.
Body image and self-esteem also tends to deteriorate following an unplanned outcome, with women reporting increased self-consciousness about their body, avoidant behaviours in relation to their appearance, distress about others seeing their breasts and difficulties with physical intimacy in relationships. In extreme cases, body dysmorphic disorder can develop if a women becomes highly distressed about the surgery outcome and cannot stop focusing on her breasts and how “ugly” she thinks they are.
6. If the surgery doesn’t go as planned (whether it worked correctly but does not meet the patient’s expectations, or if the surgery was botched), what advice would you give women who are struggling emotionally?
Seek psychological support from an experienced and properly qualified psychological therapist who specialises in this field. They can help you to process your feelings, address the psychological problems that have arisen, help you to be more accepting of your body, and empower you to get your life back on track again.
If surgery was botched, don’t suffer in silence – voice your concerns to the surgeon and see if they can offer any solutions to resolve it. Some women will need revision surgery.
If you’re still in the first few months post-operation, allow time for your body to heal and the implants to settle. To cope during this time, try to “park” your worries until a certain date (e.g. six months), absorb yourself in the rest of your life, then re-evaluate what your breasts look like at the end of the healing process.
Remember that there is more to you as a person than what your breasts look like. What feels crucially important to us is often insignificant to those around us. Our natural response to body parts that we have issues with is to keep obsessively checking them, examining every tiny detail and seeing all the perceived flaws, from every angle. Nobody else tends to view our bodies in that way! And the more we critique a disliked part of our body, the more things we notice that fit with our view that it’s ugly in some way – our minds magnify every perceived deficit and make us increasingly unhappy and fixated on the ‘problem’.
Instead, look around you, observe a wide range of women of all shapes and ages, and notice what their breasts actually look like. You’ll hopefully realise that there is no ‘normal’ and that the appearance of your breasts does not have to affect the way you feel about yourself or the way you live your life – unless you allow it to.
