Women With Breast Implants Have Elevated Suicide Rate

OTTAWA, Ontario, Sept. 21 -- A large study of women with cosmetic breast implants found they had a suicide rate over two decades that was 73% higher than the general population.

But the suicide rate was similar to that of women who had other cosmetic plastic surgery procedures. Moreover, women who had cosmetic breast implants had an overall mortality rate during that time that was 26% lower than the general population.

Overall, the findings do not support the view asserted by some that the implants have direct negative health consequences, reported Yang Mao, M.Sc., Ph.D., of the Public Health Agency of Canada here, and colleagues, in the Aug.15 issue of the American Journal of Epidemiology.

The explanation for these findings likely lies with the general health, socioeconomic status, and mental health of women who undergo breast implants and other types of cosmetic surgery, the researchers said.

Previous studies have also shown a tendency for increased suicide rates in women with breast implants, but these studies were "severely limited" by their small sizes, which ranged from about 2,000 to about 13,000 participants, the investigators said.

The current study included more than 24,000 women who underwent breast implant surgery in the provinces of Ontario and Quebec from 1974 to 1989. Of these, 18% received saline implants and 66% received silicone gel implants. The implant type was not known for the remaining women.

The study also included a surgical control group of nearly 16,000 women who underwent other cosmetic surgery during the same time period, including face-lifts, rhinoplasty, and eyebrow and forehead lifts.

Some women were followed for up to 24 years, but the typical follow up was 14 to 15 years. During that time, 480 deaths occurred in the breast implant group. A comparison with mortality rates in the general population revealed reduced mortality risk in the implant group (standardized mortality ratio=0.74; 95% confidence interval=0.68 to 0.81).

This reduced overall mortality risk was largely driven by reduced risk for any type of cancer (SMR=0.76; 95% CI=0.66 to 0.86), breast cancer (SMR=0.45; 95% CI=0.32 to 0.62), and coronary heart disease (SMR=0.50; 95% CI=0.35 to 0.69).

However, risk of mortality from suicide was significantly higher in the breast implant group compared with the general population (SMR=1.73; 95% CI=1.31 to 2.24).

Similarly, the surgical control group also had decreased overall mortality risk (SMR=0.68; 95% CI=0.61 to 0.75) but increased suicide mortality risk (SMR=1.55; 95% CI=1.07 to 2.18) compared with the general population.

No significant differences were found in mortality rates between the implant group and surgical control group for 20 causes of death examined, including suicide, infectious diseases, respiratory diseases, and endocrine diseases.

The lower mortality rate, among women with breast implants, largely because of a lower than expected number of deaths from cancer and circulatory diseases, is likely a result of selection bias, the authors said.

"First, a woman must be in relatively good health to undergo breast implant surgery," said co-author Jacques Brisson, M.D., D.Sc., of Laval University in Quebec City. "Also, women who receive breast implants tend to be of higher-than-average socioeconomic status. Thus, women who undergo breast augmentation surgery are more likely to be in better health than the general population."

As far as the increased suicide risk, previous studies suggested that women who undergo breast implantation are more likely to have undergone psychotherapy, have low levels of self-esteem, and have higher prevalences of depression and mental illness, the authors noted.

"Recently, it was suggested that complications experienced by women who received breast implants could contribute to increased despair, which may increase the chance of suicide," the authors said.

"However, our findings to not support this hypothesis because we found no increase in the standardized mortality ratio for suicide with increasing length of follow-up," they said. "Additionally, there were no differences in suicide rates between implant patients and other plastic surgery patients."

That is not to say that breast implant surgery does not come without risks, the authors pointed out. Known complications from breast implant surgery include pain, disfigurement, serious infection, capsular contraction, and implant rupture, they said.

Cosmetic surgeons need to pay more attention to the reasons women seek breast implants and to be vigilant for signs of depression or mental illness, Dr. Brisson and colleagues advised.

"If this reveals problems that cannot be treated with plastic surgery, doctors should refer these patients to mental health professionals," Dr. Brisson said.