From Our 2007 Archives

Cosmetic Breast Surgeries Tied to Increased Suicide Risk

By Kathleen Doheny
HealthDay Reporter

THURSDAY, Aug. 9 (HealthDay News) -- Women who undergo cosmetic breast augmentation surgeries are three times as likely to commit suicide as those who don't have surgically enhanced breasts, a new study finds.

The increase in suicide risk does not emerge until about 10 years or more after women receive the implants, the research shows.

This latest study adds to a growing body of research finding that women with cosmetic breast implants are much more likely to take their own lives, said study lead investigator Loren Lipworth, a senior epidemiologist at the International Epidemiology Institute in Rockville, Md. "It's one of five studies that have consistently shown an increased risk of suicide among women with cosmetic breast implants," she noted.

There's nothing about the breast implant itself that leads to increased likelihood of suicide, added Lipworth, who is also an assistant professor of preventive medicine at Vanderbilt University Medical Center in Nashville, Tenn. "Some women who get them are more likely to have psychiatric problems leading to suicide," she speculated.

The study is published in the August issue of Annals of Plastic Surgery

Breast augmentation was the most popular cosmetic surgery procedure in the United States in 2006, according to the latest statistics released by the American Society of Plastic Surgeons. An estimated 329,000 breast augmentation procedures were performed, with the average surgeon charging about $3,600 per procedure, the society found.

In the most recent study, Lipworth's team tracked outcomes for more than 3,500 Swedish women who underwent cosmetic breast implant surgery in the years 1965 to 1993. They used death certificate information to analyze the causes of death among women with the implants and compared it to data for the general female population.

After a follow-up of almost 19 years, the suicide rate was three times higher for women with implants compared with the general population. There were 24 suicides in the implant group. The risk of suicide was nearly seven times higher for women who got their implants at age 45 or older, the researchers found.

The excess in risk didn't become significant until 10 years after the implants were placed.

As to why the risk became statistically significant only later on, Lipworth speculated that, "it's possible that some women who may have had psychiatric illness prior to the implant may experience improvement in psychological functioning in the short term [after implant], but it's not sustained. So, 10 or 20 years out, there may be a recurrence or worsening of psychiatric problems."

Lipworth said the five other studies that also found similar trends were done in five different countries: the United States, Sweden, Denmark, Canada and Finland.

Besides the suicide risk, women with enhanced breasts had higher rates of death from psychiatric disorders, including a threefold increase in deaths caused by alcohol or drug dependence. In all, 38 deaths (about a fifth of the total) in the breast implant group were linked with suicide, psychological problems, or drug or alcohol abuse or dependence, Lipworth said.

A spokesperson for the American Society of Plastic Surgeons, Dr. Richard D'Amico, a plastic surgeon in Englewood, N.J., and president-elect of the society, pointed out that "there is no cause-effect relationship between breast implants and suicide" found in the study.

Plastic surgeons are aware, he added, that some potential plastic surgery patients may not be appropriate candidates. "Our members screen for psychological problems as well as medical," he said. If there are any "flags," he added, the plastic surgeon would refer the potential patient to help. That is routine practice among plastic surgeons, D'Amico said.

Another expert, David B. Sarwer, associate professor of psychology at the Center for Human Appearance, University of Pennsylvania School of Medicine, Philadelphia, wrote the "invited discussion" that accompanied the study.

In it, he urged physicians to heed the study results and to assess patients before they undergo cosmetic breast implants and other procedures, in particular looking for psychiatric problems. If a woman is under psychiatric treatment, Sarwer also urged the plastic surgeon to contact her mental health professional to assess whether she is stable enough for the surgery.

In an interview, Sarwer said "women thinking about breast implants or any form of cosmetic surgery should ask themselves three basic questions," including, What is the nature of my concern? Are the areas I want to improve modest defects that others don't even see when they are mentioned?

The woman should also ask if her motivation is internal or external. For example, if she is getting a breast augmentation to gain a promotion or save a marriage, that's not a good sign, he said. However, if she believes the breast change will improve her appearance in a reasonable way, that's a better sign.

Women should also be asked if they have realistic post-op expectations. Those who agree with statements such as "People will find me much more attractive" or "I'll have more friends" may be in for difficulties later, Sarwer said.

The news isn't all bad, he added. "Clearly, there are psychological benefits associated with cosmetic surgery and breast implants," he said. "But, a small minority of patients have these very unfortunate outcomes."

SOURCES: Loren Lipworth, Sc.D., senior epidemiologist, International Epidemiology Institute, Rockville, Md., and Vanderbilt University Medical Center, Nashville, Tenn.; Richard A. D'Amico, M.D,, president-elect, American Society of Plastic Surgeons, and plastic surgeon, Englewood, N.J.; David B. Sarwer, Ph.D., associate professor, psychology, Center for Human Appearance, University of Pennsylvania School of Medicine, Philadelphia; August 2007, Annals of Plastic Surgery

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