Breast implants and risk of suicide

Women who undergo breast augmentation surgery are nearly three times as likely to commit suicide, according to a study published in the August issue of Annals of Plastic Surgery.

This research confirms previously seen links between breast implants and a strikingly high risk of suicide, as well as deaths from alcohol or drug dependence.

The study, led by Loren Lipworth, Sc.D., assistant professor of Preventive Medicine at Vanderbilt University Medical Center and the International Epidemiology Institute in Rockville, Md., documented the increased suicide risk. The strong risk of suicide suggests plastic surgeons should consider mental health screening and follow-up for women who seek breast implants.

Lipworth and colleagues performed an extended follow-up study of 3,527 Swedish women who underwent cosmetic breast implant surgery between 1965 and 1993. Death certificate data were used to analyze causes of death among women with breast implants, compared to the general female population.

At an average follow-up of nearly 19 years, the suicide rate was three times higher for women with breast implants, compared to the general population (based on 24 deaths). The risk was greatest—nearly seven times higher—for women who received their breast implants at age 45 or older. (The average age at breast implant surgery was 32 years.)

Suicide risk did not increase significantly for the first 10 years after implant surgery. However, suicide risk increased with time after surgery—the risk was 4.5 times higher from 10 to 19 years' follow-up and six times higher after 20 years.

Women with breast implants also had higher rates of death from mental disorders, including a threefold increase in deaths from alcohol and drug dependence. Several additional deaths, classified as accidents or injuries, might have been suicides or involved psychiatric disorders or drug and alcohol abuse as a contributing cause.

"Thus, at least 38 deaths (22 percent of all deaths) in this implant cohort were associated with suicide, psychological disorders and/or drug and alcohol abuse/dependence," according to the researchers.

There was no increase in the risk of death from cancer, including breast cancer, among women with breast implants, according to Lipworth, a faculty member of the Vanderbilt-Ingram Cancer Center. Increases in deaths from lung cancer and respiratory diseases, such as emphysema, likely reflected higher smoking rates among women with breast implants.

Several epidemiological studies have found an increased suicide rate among women with cosmetic breast implants. The current study provides extended follow-up data on a previous nationwide study of Swedish women with breast implants, more than doubling the number of deaths analyzed.

The increases in suicide and in deaths related to alcohol and drug dependence suggest that a "nontrivial proportion of women undergoing breast augmentation may bring with them—or develop later—serious long-term psychiatric morbidity and eventually mortality," Lipworth and colleagues write. Since the study includes only deaths, the true rates of psychological and substance abuse problems among women with cosmetic implants are likely much higher. The researchers conclude, "Such findings warrant increased screening, counseling, and perhaps post-implant monitoring of women seeking cosmetic breast implants."

The Vanderbilt-Ingram Cancer Center is a National Cancer Institute Comprehensive Cancer Center, one of only 39 in the country and the only one in Tennessee to earn this highest distinction. Its nearly 300 faculty members generate more than $130 million in annual federal research funding, ranking it among the top 10 centers in the country in competitive grant support, and its clinical program sees more than 4,000 new cancer patients each year. Vanderbilt-Ingram recently joined with 21 of the world's leading centers in the National Comprehensive Cancer Network, a non-profit alliance dedicated to improving cancer care for patients everywhere. For more information, visit http://www.vicc.org.

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