The long-term risk of suicide is tripled for women who have undergone cosmetic breast implant surgery, concludes a study in the August Annals of Plastic Surgery, published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

This long-term study further confirms the link between breast implants and a strikingly high risk of suicide and other related causes of death.

The increased suicide risk — together with a similar increase in deaths from alcohol or drug dependence — suggests that plastic surgeons should consider mental health screening and follow-up for women who seek breast implants, according to the new study, led by Loren Lipworth, Sc.D., of the International Epidemiology Institute in Rockville, Md, and the Vanderbilt University Medical Center, Nashville, Tenn.

Dr. 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 among implant recipients). The risk was greatest — nearly seven times higher — for women who received their breast implants at age 45 or older. (The average age for breast implant surgery was 32 years.)

Suicide risk was not significantly increased for the first 10 years after implant surgery. After that, however, suicide risk increased with time since surgery — 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 psychiatric disorders, including a three-fold increase in deaths resulting from alcohol and drug dependence. Several additional deaths, classified as accidents or injuries, might have been suicides or involved psychiatric disorders or drug/alcohol abuse as a contributing cause. "Thus at least 38 deaths (22 percent of all deaths) in this implant cohort were associated with suicide, psychologic disorders, and/or drug and alcohol abuse/dependence," the researchers write.

There was no increase in the risk of death from cancer, including breast cancer, among women with breast implants. 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 use of Swedish national healthcare and death certificate records ensures near-complete identification of women undergoing breast implant surgery and information on causes of death.

The increases in suicide and in deaths related to alcohol and drug dependence suggest that a "nontrivial proportion of women undergoing cosmetic breast augmentation may bring with them — or develop later — serious long-term psychiatric morbidity and eventually mortality," Dr. 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."

In an invited discussion, David B. Sarwer, Ph.D., associate professor of psychology at the University of Pennsylvania School of Medicine recommends that plastic surgeons assess the mental health status and history of women desiring breast augmentation.

In addition to mood disorders such as depression, screening should focus on body image disorders, such as body dysmorphic disorder. "In cases where the patient is currently in mental health treatment, the surgeon should contact the mental health professional to confirm that the patient is psychiatrically stable and appropriate for surgery at this time," Dr. Sarwer writes. "Until we know more about the relationship between breast implants and suicide, this conservative approach is recommended with both the patient's and surgeon's well-being in mind."

Note, this story was originally headlined "Breast Implants Triple Suicide Risk". which I think is misleading, since it implies that merely GETTING breast implants triples the suicide risk and does not reflect the fact that perhaps many of those who have breast implants may be more prone towards suicide to begin with.  Cosmetic surgery is very often an indication that a person is not completely satisfied with themselves, so there is often an element of unhappiness to begin with .  No doubt, the complications and often horrible side effects that can take years to manifest themselves contribute to many implant recipients unhappiness and thus SOME of the resultant higher incidence of suicide, but not ALL - DQ