[The wish of a woman to alter her breast size - a contribution to dysmorphophobia]

The wish to have plastic surgery performed in order to reduce or augment the size of the breasts may be interpreted in practically all cases as a neurotic manoeuvre. The mere recording of the most important biographical data soon reveals how the patients in choosing their partners were lead to a large extent by internal principles. The pathological components of the relationships which these women establish with a man differ widely from the marital relationships among people with a different basic neurotic structure. That these differences can be shown in a relatively small number of case histories, only proves the prevalence of the internal principles which govern the biographic development. The biographies of the women who for cosmetic reason undergo plastic surgery of the breasts bear a remarkable likeness to one another and differ distinctly from the lifestyle which are prescribed by their unconscious conflicts to women with anancastic characters or manifest compulsive symptoms. The phenomenon of such a pathognomonic formula which develops into a "destiny neurosis", can be outlined only by the statistical description of external biographical events. Among the patients who wished to have the size of their breasts reduced, severe psychic disorders were significantly more frequent than among the women desiring surgery for the enlargement of their breasts. In the former group more than half the cases showed symptoms of either anorexia or bulimia. In these adolescents with severely increased impairment of their self concepts the way in which autoaggressive tendencies are to be put into action indirectly becomes particularly evident, namely by the surgeon's hand.