Cosmetic Breast Implants Linked With Later Risk of Suicide in Swedish Study

Marlene Busko

August 16, 2007 — Swedish women who received cosmetic breast implants had suicide rates that were 3 times higher than other women; the risk appeared 10 years after surgery. Deaths due to drug and alcohol abuse also increased 3-fold in the women who received breast augmentation.
These findings are based on data from a cohort of Swedish women who received breast implants from 1965 to 1993 and were followed for an average of almost 19 years. This study, which has an 8-year longer follow-up than an earlier study of this cohort, is published in the August issue of the Annals of Plastic Surgery.
"Women and doctors should be aware that there is a group of women [seeking cosmetic breast implants] who may be suffering from severe psychiatric illness, which may put them at risk later on for suicide or death from drug and alcohol abuse," lead author, Loren Lipworth, ScD, from Vanderbilt University, in Nashville, Tennessee, told Medscape.
The group concludes that "screening for preimplant psychiatric morbidity and postimplant monitoring among women seeking cosmetic breast implants may be warranted."
Five Studies Showed Suicide Risk
The researchers explain that 5 previous epidemiologic studies looked at mortality patterns among 5 cohorts of women in Sweden, Denmark, Finland, Canada, and the United States who received cosmetic breast implants. These studies all reported an approximately 2- to 3-fold higher rate of suicide in the women who received implants compared with other women.
The current study aimed to gain further insight into the relationship between implants and suicide by looking at a cohort of 3527 Swedish women who had previously been followed for a mean of 11.3 years, extending this follow-up to a mean of 18.7 years (range, 0.1 – 37.8 years).
The women, identified by a national registry of hospital discharges, had undergone cosmetic breast augmentation (mostly silicone gel implants) for the first time from 1965 to 1993. The women had a mean age of 32 at the time of surgery.
Overall, 175 women with implants died during follow-up, vs 133.4 expected deaths based on mortality rates of age-matched Swedish women. A total of 24 women with implants committed suicide, vs 8 expected deaths from suicide (standardized mortality ratio = 3; 95% CI, 1.9 – 4.5). The elevated rate of suicide was seen after 10 years. Suicides were higher in women who were aged 45 years and older at the time of breast augmentation.
An additional 14 women with implants died during follow-up from mental disorders or injuries and accidents related to alcohol and or drug dependence or abuse.
Compared with women in the general population, the women with implants had higher rates of death from lung cancer and chronic respiratory disease, largely related to smoking, but they did not have higher rates of breast cancer.
"The large excesses of suicide, as well as alcohol- and drug-dependence-related deaths, 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," the group writes, adding that this might warrant increased screening, counseling, and possibly postimplant monitoring of women seeking this procedure.
Dr. Lipworth explained there were more than 300,000 cosmetic breast implants in the United States in 2006, and it remains to be seen whether that number will increase now that the Food and Drug Administration has approved the sale of silicone breast implants after their removal from the market from 1992 to 2006.
The study was funded by the International Epidemiology Institute, in Rockville, Maryland, which in turn received funds from the Dow Corning Corporation. The Dow Corning Corporation was not involved in any aspect of the study design, data collection, data analysis, data interpretation, or writing of this manuscript. Corresponding study author Joseph K. McLaughlin, PhD, from the International Epidemiology Institute, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Annals of Plastic Surgery. 2007;59:119-123. Abstract