Breast Implants Tied to Suicide and Other Mortality Rates

NASHVILLE, Tenn., Aug. 8 -- Women with breast implants were three times more likely to commit suicide or to die from drug or alcohol-related causes than other women, researchers found.
And at least 22% of deaths among Swedish women with breast implants reflected psychiatric morbidity or a substance abuse or dependence disorder, reported Loren Lipworth, Sc.D., of Vanderbilt University Medical Center, here, and colleagues.
The cause is unlikely to be the silicone implants themselves, the authors acknowledged in the August issue of the Annals of Plastic Surgery.
Rather, "a nontrivial proportion of women undergoing cosmetic breast augmentation may bring with them -- or develop later -- serious long-term psychiatric morbidity and eventually mortality," they wrote.
"Such findings warrant increased screening, counseling, and perhaps post-implant monitoring of women seeking cosmetic breast implants," they added.
Previous studies have also found a two- to threefold higher risk of suicide among women with breast implants but the cause was unclear, the researchers noted.
So, they extended their earlier study of a nationwide cohort of Swedish women for up to almost 38 years of follow-up using the country's essentially complete hospital discharge and death registries.
The investigators followed 3,527 women who underwent cosmetic breast implantation from 1965 to 1994 at an average age of 32. Among them, 66% were followed for 15 years or more and 22% for at least 25 years.
After a mean 18.7 years of follow-up, there were 175 deaths. This was a 30% higher than expected all-cause mortality rate (standardized mortality ratio 1.3, 95% confidence interval 1.1 to 1.5).
The major contributors to excess mortality were suicide and psychiatric problems.
Suicide was threefold more common among women with implants than expected from the general population (24 deaths, SMR 3.0, 95% CI 1.9 to 4.5).
Death related to mental disorders was likewise elevated among women with breast implants with a standardized mortality ratio (SMR) of 2.6, (95% CI 1.1 to 5.4). Deaths from substance dependence or abuse specifically (five of the seven deaths in this category) were more than threefold more common among women with breast implants compared with the general population (SMR 3.1, 95% CI 1.0 to 7.3).
Mortality related to injuries and accidents was higher than expected as well, but not significantly so (SMR 1.5, 95% CI 0.9 to 2.6). Notably, most of the 13 deaths in this category had drug or alcohol involvement or could have been suicides.
Overall, at least 38 deaths (22%) were associated with suicide, psychological disorders, drug and alcohol abuse or dependence, or some combination thereof.
"The extent to which our findings reflect misdiagnosed or unrecorded suicides or more extensive underlying psychiatric morbidity is unclear," they noted.
Women with cosmetic implants did, however, have clearly elevated lung cancer mortality risk (SMR 2.6, 95% CI 1.6 to 3.9), which the researchers said was likely linked to higher smoking rates as reported in other studies.
Women have self-reported high levels of satisfaction and improvements in psychological functioning after breast implantation, the researchers said.
But, "latent psychiatric instability prior to or following augmentation cannot be ruled out and any immediate psychologic stabilization following the operation may lessen with time," they cautioned.
It's safe to assume that an excess of deaths linked to psychiatric problems and suicide likely represents "a much larger number of living women in this cohort and elsewhere who are likely suffering from these problems," Dr. Lipworth and colleagues noted.
Further study should be done to assess the need for psychological or psychiatric screening for women seeking cosmetic implant surgery and whether postimplant surveillance is warranted, they added.
The study was funded by the International Epidemiology Institute, which in turn received funds from the Dow Corning Corporation. Primary source: Annals of Plastic SurgerySource reference: Lipworth L, et al "Excess Mortality From Suicide and Other External Causes of Death Among Women With Cosmetic Breast Implants" Ann Plast Surg 2007;59:119-123.