Women who have cosmetic breast implant surgery are three times more likely to commit suicide compared with women in the general population, suggests a new study of women in Sweden. The researchers said surgeons should carry out pre-surgery mental health screening and follow up monitoring of patients in receipt of cosmetic breast implants.
The research is published in the August issue of the Annals of Plastic Surgery and was led by Dr Loren Lipworth, of the International Epidemiology Institute in Rockville, Maryland, and the Vanderbilt University Medical Center in Tennessee, both in the US.
Other studies have also reported higher suicide rates among women with cosmetic breast implants. In this study Lipworth and colleagues did a more detailed extended follow up of an earlier study of a nationwide sample of 3,527 women in Sweden who had had cosmetic breast implant surgery between 1965 and 1993.
Using data from death certificates and Swedish national health care records, they compared the number and causes of deaths among the cosmetic breast implant cohort with the number expected among the same age group in the general female Swedish population.
The mean follow up after surgery was 18.7 years (range was 0.1 ro 37.8 years). The results showed that:
- There were 175 deaths overall among women with breast implants compared with an expected 133.4 (standardized mortality ratio (SMR) was 1.3).
- Among women with implants there was a statistically significant three-fold higher rate of suicide (SMR 3.0, based on 24 deaths among implant recipients).
- The risk was nearly seven times higher for women who received their breast implants when they were aged 45 or older. (The average age at breast implant surgery was 32.)
- There was a similar increase in deaths from alcohol or drug dependence among this group (SMR 3.1) which also showed an excess of deaths from accidents and injuries consistent with drug dependence and abuse.
- The increased suicide risk was not apparent until 10 years after implantation surgery.
- After 10 years, however, suicide risk rose with time since surgery. Suicide risk was 4.5 times higher between 10 and 19 years later, and 6 times higher after 20 years.
- The rate of breast cancer deaths was no higher among the implant group compared with the general population.
- Deaths from cancer overall were also close to expectation (SMR 1.1).
- The implant group did however show an elevated risk of death from lung cancer and chronic respiratory diseases.
Lipworth and colleagues wrote that “At least 38 deaths (22 per cent of all deaths) in this implant cohort were associated with suicide, psychologic disorders, and/or drug and alcohol abuse/dependence.”
The researchers concluded that:
“The excess of deaths from suicides, drug and alcohol abuse and dependence, and other related causes suggests significant underlying psychiatric morbidity among these women.”
The increase in death by these causes suggests that a “nontrivial proportion of women” who have breast augmentation surgery may already have, or later develop, serious long term psychiatric problems, said the researchers. Plus, because they only examined deaths, it may well be that the incidence of psychiatric conditions among women who have cosmetic breast implants is much higher than the general population.
“Such findings warrant increased screening, counseling, and perhaps postimplant monitoring of women seeking cosmetic breast implants,” suggested Lipworth and colleagues.
“Excess Mortality From Suicide and Other External Causes of Death Among Women With Cosmetic Breast Implants.”
Lipworth, Loren; Nyren, Olof; Ye, Weimin; Fryzek, Jon P; Tarone, Robert E; McLaughlin, Joseph K.
Annals of Plastic Surgery, 59(2):119-123, August 2007
Written by: Catharine Paddock