Breast Implants Linked to Higher Long-Term Suicide Risk

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 at breast implant surgery was 32 years.)

Suicide risk was not significantly increased for the first ten 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% 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 health care and death certificate records ensures near-complete identification of women undergoing breast implant surgery and information on causes of death.