Women who receive implants for breast enhancement are three times more likely to commit suicide, according to a new report that offered a sobering view of an increasingly popular surgery.
Deaths related to mental disorders, including alcohol or drug dependence, also were three times higher among women who had the cosmetic procedure, researchers said.
The report in the Annals of Plastic Surgery's August issue was the most recent to detect a higher suicide rate among women who had their breasts enlarged, providing a gloomy counterpoint to studies that showed women felt better about themselves after getting implants.
Though the study did not look at the reasons behind the suicides, senior author Joseph McLaughlin, a professor of medicine at the Vanderbilt University School of Medicine, said he believed that many had psychological problems before getting implants and that their conditions did not improve afterward.
Previous studies have shown that as many as 15% of plastic surgery patients have body dysmorphic disorder, a condition marked by severe distress over minor physical flaws. People with the disorder have a higher rate of suicidal thoughts and rarely improve after surgery.
Breast augmentation is the most popular cosmetic surgery in the U.S., followed by liposuction and eyelid surgery. Last year, 329,396 enlargements were performed, up 13% from 2005, according to the American Society of Plastic Surgeons.
Controversy has long dogged the surgery. Last year, the Food and Drug Administration lifted a 14-year ban on silicone-filled implants after finding little evidence they were unsafe. But the agency required manufacturers to run 10-year studies of 10,000 women each to look for long-term consequences, including possible suicides.
The latest study analyzed data from 3,527 Swedish women who got implants between 1965 and 1993. Breast cancer patients who received reconstructive implants were not included.
Scientists tracked the women for as long as 29 years after their implant surgeries and found the suicide risk increased over time. There was no higher risk in the first 10 years afterward, they said, but the risk was 4.5 times higher after 10 to 19 years and six times higher after 20 years.
David B. Sarwer, a University of Pennsylvania psychologist who wrote a commentary accompanying the report, said the results suggested that women experienced psychological improvement after surgery, but that it was not sustained.
Researchers said the results may have limited applicability to women today because breast augmentation is more acceptable than it was 40 years ago.
McLaughlin said the study underscored the need for the psychological screening of women seeking breast enhancement.
Allergan Inc. of Irvine, manufacturer of Inamed brand implants, "is a big advocate" of counseling beforehand, spokeswoman Caroline VanHove said.
She said women should have realistic ideas of how the procedure would change their lives.