Cosmetic Breast Augmentation and Suicide

This article discusses the unexpected relationship between cosmetic breast implants and suicide that has been found in six epidemiological investigations completed in the last several years.

METHOD: The epidemiological studies are reviewed.

The American Society of Plastic Surgeons reported that 329,396 women underwent cosmetic breast augmentation in the United States in 2006. This represents an increase of 55% since 2000 and over 300% in the past decade. These numbers, while substantial, may underestimate the number of women who receive breast implants in the United States each year for several reasons. First, they do not account for women who receive breast implants as part of surgical breast reconstruction following mastectomy. (This article will focus solely on women who receive breast implants for cosmetic purposes.) Second, these statistics do not capture breast augmentation procedures being performed by physicians who are not plastic surgeons. Furthermore, the number of American women who undergo cosmetic breast augmentation is expected to increase, given the Food and Drug Administration’s (FDA’s) November 2006 decision to reapprove silicone gel-filled breast implants for general cosmetic use.

The growth in the popularity of cosmetic breast augmentation is all the more remarkable considering that in 1992 the FDA issued a moratorium on the use of silicone gel-filled implants. Then-FDA Commissioner Dr. David Kessler called for further study of the physical safety and psychological benefits of breast implants. Comprehensive reviews have concluded that silicone breast implants are not associated with significant long-term health problems. Since that time, six epidemiological studies have found an unexpected relationship between cosmetic breast augmentation and suicide.

Possible Explanations of the Relationship Between Cosmetic Breast Implants and Suicide

The six epidemiological studies produced few clues to the nature of the relationship between cosmetic breast implants and suicide. These studies primarily were designed to investigate all-cause mortality. They were not prospectively planned to investigate the unexpected association with suicide and, as a result, provide only limited information on the potential causal relationship between breast implants and suicide.

There are several possible explanations for the relationship between breast implants and suicide that, while not yet specifically investigated, have some support from related literatures. These explanations include the role of preoperative personality characteristics and psychopathology, motivations and expectations for surgery, and the impact of postoperative complications.

Demographic and descriptive characteristics

The stereotypical breast augmentation patient is widely believed to be a single Caucasian woman in her early to mid-20s who is interested in breast augmentation surgery as a way to facilitate the development of a romantic relationship. Reviews, however, have suggested that the typical patient differs from this stereotype. She is most often Caucasian but is frequently in her late 20s or early 30s, is married, and has children. Although these characteristics may describe the "typical" patient, women from their late teens to mid-40s of varying ethnic backgrounds and relationship status present for breast augmentation surgery. As found in several of the epidemiological studies, women age 40 years and older who undergo breast augmentation appear to be at increased risk of suicide.