Child sexual abuse sequelae and body-image surgery.

Child sexual abuse is common and damages the body image. Child sexual abuse survivors may request body-image surgery. Seven patients are described in whom child sexual abuse sequelae complicated body-image surgery. Two patients viewed their surgeons as similar to sexual abusers. Yet two patients were clearly, and two possibly, helped by the surgery. Surgeons can detect and manage such patients by (1) having a child sexual abuse therapist on hand for consultation, (2) adding "abuse" to the medical history form, (3) recommending to known or suspected child sexual abuse patients preoperative therapy or a self-help book, (4) obtaining specific permission for any body contact, (5) stating belief in abuse, if revealed, (6) explaining the surgery in unusual detail, (7) recognizing the high-risk child sexual abuse groups, and, (8) declining to operate on the angry child sexual abuse patient.