I think you are partially right. I always felt that the 2 biggest reasons for the plastic surgery disasters are:

1. The disconnect between the real girl and the porn whore. Mangling the face means people won't recognize Katie from sophmore math getting DPd; it's Mercedes the porn star.

2. Self confidence. Just like a teenage boy that wishes he had 2 more inches of dick, a chick with cute lil boobs feels the need to go DD in order to feel more confident. However this is usually as fruitless as finding denial in a bottle of gin, since the problem is between the ears, not on the chest.

Now we come to the chicken and the egg argument. Do they hate themselves for being insecure, or are they insecure because they hate themselves? That is for the shrink to figure out.