Cosmetic Breast Augmentation and Suicide - Research and Clinical Recommendations

As suggested by the six epidemiological studies, there appears to be an association between cosmetic breast augmentation and suicide. The specific nature of this relationship, however, is unknown. It is at least theoretically possible that some biological characteristic of the breast implants may be contributing to neurological changes that lead to suicidal behavior. Nevertheless, most of the focus on understanding the relationship between cosmetic breast implants and suicide has fallen upon the psychological characteristics and preexisting psychopathology of the women.

Clearly, additional research is needed. The epidemiological investigations to date have provided only limited information on the psychosocial status of women with breast implants. As proposed by McLaughlin and colleagues, a case-control study within a large existing cohort of women with breast implants could provide an ideal comparison for the preoperative characteristics and related psychosocial variables that may differentiate between women who died by suicide and those who did not. Such studies would be difficult, if not impossible, to conduct without the use of medical data registries as are often found in European countries.

These studies would likely provide the best opportunity to determine if the increased suicide rate is associated with preoperative psychopathology. As part of the FDA’s recent decision to reapprove silicone breast implants, manufacturers are required to track and report on any suicides in their postmarket approval studies. These reports may provide additional information on the occurrence of suicide in women who receive breast implants.

Although numerous studies have investigated the preoperative characteristics and symptoms of psychopathology found in breast augmentation candidates, they typically have used substandard psychometric measures. Large prospective studies that include standardized assessment methods such as the Structured Clinical Interview for the DSM-IV are needed to most appropriately characterize the relationship between preoperative psychopathology and postoperative outcome. Use of other measures of suicide risk, such as hopelessness and suicidal ideation, also are warranted.

While we wait for additional research on the relationship between breast implants and suicide, the results of the existing studies should be considered in the clinical care of women interested in cosmetic breast augmentation. Given the popularity of the procedure, all of the psychiatric diagnoses are likely found within the patient population. With the exception of body dysmorphic disorder, there is a dearth of information on the relationship between preoperative psychopathology and postoperative outcomes. Furthermore, a relatively large body of research suggests that most women are satisfied with their postoperative outcomes and experience improvements in some psychosocial domains, particularly body image. As a result, there is currently little evidence to support a recommendation that all women who present for cosmetic breast augmentation be required to undergo a psychiatric evaluation before surgery.