Psychological Aspects of Reconstructive and Cosmetic Plastic Surgery: Clinical, Empirical, and Ethical Perspectives, Edited by David B. Sarwer; Lippincott Williams & Wilkins, 2006; 338 pgs; ISBN 0781753627.
It was with great interest that I had the opportunity to review Psychological Aspects of Reconstructive and Cosmetic Plastic Surgery: Clinical, Empirical and Ethical Perspectives. As a nurse practitioner (NP) in a busy academic practice, I attend not only to the surgical aspects of patient care, but often spend much time addressing the psychosocial concerns as well. This book is a valuable resource not only for plastic surgeons and nurses, but also for anyone involved in caring for patients who undergo or are considering plastic or reconstructive surgery. This book is a collaborative effort among well-known surgeons, psychologists, psychiatrists, and ethicists and has been edited by three plastic surgeons and three psychologists.
The first four chapters review background information related to the psychological issues of the plastic surgery patient and discuss some of the earliest experts in this area, namely plastic surgeon Milton Edgerton, MD. It is Edgerton who spent over five decades researching psychological aspects of plastic surgery, discerning a "core clinical truth of plastic surgery-namely, that having a deformity, either real or perceived, causes great emotional distress (dis-ease) and that treating this psychological suffering is the heart of the plastic surgeon's work." There is a chapter that presents the surgeon's perspective as well as two very thorough chapters on body image, physical appearance, and society.
The next nine chapters focus on psychological perspectives of reconstructive surgery. Each chapter focuses on specific clinical issues such as the burn patient, craniofacial abnormalities, facial trauma, facial cancer, hand trauma, orthodontic abnormalities, breast reconstruction, breast reduction, and genital reconstruction and gender identity disorders. The craniofacial chapter is a good overview with good inclusion about the team care approach and the use of the American Cleft Palate/Craniofacial Association's parameters of care document. There could have been more specific information regarding family (especially parents) and patient reactions to surgery to help nurses manage more effectively. The burn chapters, pediatric and adult, are loaded with good information, with good discussions regarding psychotherapeutic tasks of reconstructive and rehabilitative phases and the long-term implications of injury. The chapter on breast reconstruction included comprehensive information regarding responses to cancer diagnosis and surgery. Also, there is a good discussion of the factors that need to be considered during the initial consultation for reconstruction as well as when reconstruction is not performed.
The next section focuses on psychological perspectives of cosmetic surgery and presents a review of the psychological aspects of cosmetic surgery of the face and body. The next chapter discusses psychological assessment of cosmetic surgery patients. I believe this chapter would be very helpful for anyone working with cosmetic surgery patients, to help identify why they believe they need surgery and help establish obtainable goals, thus improving outcomes.
The last three chapters discuss ethical and professional issues in plastic surgery. The case studies in these chapters were thought-provoking. The last chapter was an excellent overview of the professional and legal considerations in the cosmetic surgery patient. This chapter stresses, like we have heard so many times before, that open communication between the healthcare providers and thorough documentation "play a central role in the maintenance of positive relationships and likely insulate surgeons from potential litigation when things go wrong."
The inclusion of case studies surrounding care of the routine and challenging patient is a nice feature, pulling together the chapters and putting the ideas into practice. I believe this will be helpful for the more junior residents while they are in training. Each chapter included questionnaires that can be used to assess the plastic surgery patients' psychological concerns, and could be incorporated into a consultation visit to lead the way into more detailed discussions.
This is a book that I would recommend for any healthcare professional working with plastic surgery patients. Information was presented in a clear and concise manner. By addressing some of the psychological issues that are associated with body image, surgeons and nurses would see improved patient satisfaction and improved outcomes. As an NP in a mostly reconstructive role, I would like to see the authors consider including chapters on psychological aspects of patients with chronic wounds and issues regarding their management and treatment in the next edition.
Valentina Lucas, RN, MS, ANP
Nurse Practitioner, Virginia Commonwealth, University Health System, Division of Plastic and Reconstructive Surgery and the Wound Healing Center, Richmond, Virginia