Breast Implant/Suicide Link Confirmed

Women have an overall threefold higher risk of suicide
after getting breast implants -- a risk that keeps going up over time, a new
study shows.

Loren Lipworth, ScD, Joseph K. McLaughlin, PhD, and colleagues analyzed data
on 3,527 Swedish women. The women had voluntary cosmetic silicone
breast-implant surgery an average of 19 years earlier.

"It appeared there was no excess risk of suicide in the first 10 years
after receiving a breast implant," Lipworth tells WebMD. "But after
that, the risk went up and continued to go up. There was a 4.5-fold risk for 10
years after surgery and a sixfold risk for 20 or more years."

The women also had a threefold higher risk of alcohol or drug dependence and
an excess of drug/alcohol-related deaths from accident or injury.

Nobody is saying that silicon breast implants themselves make women commit
suicide, although scientists cannot yet totally rule out that remote
possibility, says Louise A. Brinton, PhD, MPH, chief of the hormonal and
reproductive epidemiology branch of the U.S. National Cancer Institute.

"Probably this is not related to silicone toxicity, but we cannot
entirely rule that out. It probably is more likely that it is an underlying
psychological predisposition," Brinton tells WebMD.

Lipworth, along with every expert contacted by WebMD, agrees that the most
likely explanation is that a small but substantial proportion of women seeking
cosmetic breast implants have deep-seated psychological problems.

"What our data suggests to us is there is a subset of women choosing to
get cosmetic breast implants who have psychiatric illness prior to
implantation. This results in high risk of unnatural cause of death -- suicide
and deaths related to alcohol dependence and drug abuse," says Lipworth, an
assistant professor of medicine at Vanderbilt University, Nashville, Tenn.

The findings appear in the August issue of Annals of Plastic
Surgery.

Plastic Surgery No Substitute for Mental Health Treatment

The current study isn't the first to find an increased
risk of suicide after cosmetic breast augmentation surgery . Other
studiesB too, show a
link between breast implants and suicide .

Brinton led the first study to detect an increased risk of suicide in
breast-implant patients.

"There could be a host of explanations," Brinton tells WebMD.
"It could be these women have unrealistic expectations about how implants
are going to change their lives. There could be complications of breast
implants that affect quality of life. Or there could be underlying personality
predispositions that lead both to seeking implants and to suicide. We can't
tell which, although anecdotal evidence points to the third
possibility."

Despite this link, it's clear that
breast augmentation results in improved self-esteem for many women, notes
Atlanta plastic surgeon Foad Nahai, MD, president of the American Society for
Aesthetic Plastic Surgery.

"The flip side of this is a number of studies that show improvement in
self-esteem and self-worth following breast augmentation. It has that effect,
but it is not a substitute for mental health care," Nahai tells WebMD.

"For the great majority of women, there seem to be psychological
benefits associated with cosmetic surgery," clinical psychologist David B.
Sarwer, PhD, tells WebMD.

Sarwer, associate professor of psychology at the University of
Pennsylvania's Center for Human Appearance, says any rise in self-esteem after
breast augmentation cannot permanently offset underlying suicidal
tendencies.

"I would not want to say breast implants fix this underlying
predisposition to suicide," Sarwer says. "We do not say plastic surgery
is a treatment for any kind of illness."

Psychological Screening for Women Seeking Breast Implants?

Sarwer has analyzed the research linking breast implants to suicide. He
notes that the dta come from silicone breast-implant safety studies. At the
time researchers designed the studies, they were mainly looking for evidence of
cancer and immune dysfunction.

The studies were reassuring about those worries. But when evidence of a
suicide link emerged, it left researchers with very little information on the
women's mental state and psychiatric history of psychiatric treatment.

What little evidence there is suggests that prior psychiatric
hospitalization -- a major risk factor for suicide -- is disproportionately
common among women who get cosmetic breast implants.

"Plastic surgeons need to do a better job of screening patients for
psychological illnesses," Sarwer says. "My colleagues at the University
of Pennsylvania and I have recently reviewed these findings, and we argue that
plastic surgeons should evaluate the psychological status of all patients. If
they encounter a patient in psychiatric treatment or with a history of
psychiatric hospitalization, they should insist that those patients get a
mental health consultation prior to surgery."

Nevertheless, Sarwer admits that there's too little evidence right now to
develop specific screening guidelines. Lipworth agrees.

"I really don't know what screening would look like," she says.
"We really need to describe these underlying disorders to know what to look
for. So there is more work to be done before making recommendations."

Nahai, a leading plastic surgeon, says that plastic surgeons evaluate
patients based on two major factors. The first is motivation for having the
procedure.

"If a woman is getting breast implants to save a marriage, or they want
to attract more men when they go into a singles bar, this isn't going to
work," he says. "But if a woman is doing it for herself, for her
self-esteem, and wants to look better in her clothes, we are seeing someone who
is doing it for the right reasons."

The second factor is a woman'sB expectation.

"The key things are whether the patient has realistic expectations about
the implants," Nahai says. "Does this patient understand that having
her breasts enlarged is not going to change her life? Because it is only what
she does with the change in appearance that can change her
life."

Nahai also says it is the responsibility of the plastic surgeon to assess
every patient.

"Frankly, most of the women who come in to see us for breast implants
are on some sort of mood-elevating drug, and it becomes a little difficult to
sort them out," he says. "Sometimes I ask them, 'Have you discussed
this with your psychiatrist?' If I have a high level of suspicion that you may
have a psychological problem, I will also ask the patient for permission to
discuss this with your therapist and ask whether this is the right thing for
you at this time of your life."

Lipworth, however, does not think that all plastic surgeons maintain Nahai's
high standards.

"With over 300,000 women getting implants in the U.S. last year, I am
not sure how much screening is going on," she says.

By Daniel DeNoon
Reviewed by Louise Chang
B)2005-2006 WebMD, Inc. All rights reserved