Medical team feet

Psychological assessment before surgery

Psychological assessment can be an important part of surgical care. It offers an opportunity for you to discuss surgery in the context of your current concerns.

It can assist with any treatment planning and can provide recommendations on how to manage post-operative care.

Purpose of assessment before surgery

You may be considering having surgery or other less invasive procedures. This could be to alter your appearance, such as cosmetic surgery or laser treatment, to reduce your risk of disease, such as risk reducing mastectomy, or to improve function, such as targeted muscle re-innervation or osseo-integration. As part of this process a psychologist may be recommended to you or you may feel it would be helpful to see a psychologist.

A good surgeon will want to treat you as a person, in a holistic way. For example, it is very rare that you would see a surgeon and only be concerned with the physical change in that part of the body. Usually, you also expect other changes. For example, that you may wish that you are more able to do certain activities, be less worried, feel more confident, and so on. If these other hopes are not explored, you may not understand what surgery may not give you. Similarly, outcomes from surgery are not guaranteed and a period of adjustment following major surgery is needed. Understanding how you may cope with surgery is helpful in your care. A better appreciation of you from a psychological perspective is therefore important.

Occasionally, though not necessarily, a surgeon may have concerns about your emotional well-being or aspects that could undermine a good outcome from an intervention. In fact, in the area of cosmetic surgery, the British Association of Aesthetic and Plastic Surgeons and the Royal College of Surgeons suggest that a surgeon should assess the person’s psychological state and refer on for further assessment and treatment where there are concerns.

What psychological assessment will cover

Decision making

I will ask about how you make decisions and how you weigh up the pros and cons of surgery. I will be interested to hear about any doubts you may have. I will also explore to what extent surgery is consistent with your beliefs about yourself and how you react to information that supports or dissuades you from surgery.


We will discuss your reasons for wanting the surgery. There are usually many factors that lead us to consider surgery as an option and understanding these are important. This might include information about the difficulties you are experiencing at the moment, advice you have been given or others' views on your problem.

Psychological issues

We will discuss current and past stresses and their impact on your emotional well-being. I will also explore any risk issues, alongside current and past treatment you may have had for your mental health, including medication. I am also keen to discuss your usual coping strategies and resilience to stres

Body image

Many of the referrals I receive are where a person is interested in surgery that also involves a change to their appearance, either as a necessary by-product of surgery or because the aim of surgery is to change appearance. I will explore your body image, any appearance concerns you may have or have had and how these relate to past or current experiences and difficulties.

Other surgery

I will always ask about other surgery you have had and what changes this produced. I am interested to hear about how you experienced the interactions with the health care professionals at these times. This is important information as it will influence how you relate to your surgeon, how you make use of the information and your expectations.


We will discuss your understanding of the proposed procedure, including any risks and complications you are aware of. I want to hear about the functional and physical changes you hope surgery would create and how you may expect life to be thereafter. This also includes how you might adjust to changes in appearance or function, if the surgery goes as anticipated or if there were to be complications.

My experience with assessments prior to surgery

Alongside my private practice, I have worked in surgical services in the NHS for over 13 years. This means I have a good understanding of what various surgeries entail, including cosmetic surgery, breast reconstruction surgery, other reconstructive procedures as well as osseo-integration.

My background in rehabilitation and also work in cancer services, alongside reconstructive surgery, means I am well placed to explore aspects specific to your surgical procedure.

I am also part of two private multi-disciplinary teams that offer surgical interventions to patients: Relimb - a prosthetic reconstruction service - and the London Scar Clinic - who offers multiple treatments for scars, including non-surgical interventions. I also work closely with several plastic surgeons in private practice.

I teach regularly at UCL and UEL on assisting medical decision-making and have also presented at international conferences on aspects of psychological assessment in the context of surgery.

Dr Esther Hansen


Please use the contact form to ask questions or arrange appointments. Alternatively you can email Please note that data submitted in the contact form and via email will be processed by 3rd parties.

If you wish to discuss personal or sensitive information then you may prefer to call on (0044) 020 3637 0796.

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Private Patients, Royal Free Hospital
Pond Street



+44 (0)20 3637 0796