Implants and suicide

[Guest guest]

Another study linking implants to suicide

By Sid Kirchheimer

Reviewed By Brunilda Nazario, MD

on Monday, September 15, 2003

WebMD Medical News

Sept. 12, 2003 (Philadelphia) -- A second study in only seven months

shows that women who get breast implants commit suicide three times

more often than women who don't - but at least one expert cautions

that the findings could be misleading.

Both of these studies, done in Europe and together involving nearly

6,000 women who had the popular cosmetic surgery, follow a 2001

report on American women suggesting that those who get breast

implants for augmentation face a nine-fold increased risk of suicide

compared to women who don't get the procedure, and that they commit

suicide four times more often than those who have other types of

plastic surgery.

" All three studies suggest the need for surgeons who are doing these

procedures to conduct thorough pre-operative psychological screening

of patients, " says B. Sarwer, PhD, an assistant professor of

psychology in psychiatry and surgery at the Center for Human

Appearances at the University of Pennsylvania School of

Medicine. " But very few are doing that. "

He presented these findings Friday at the American Medical

Association's annual Science Reporters Conference held here.

The latest study -- to be published in the upcoming issue of ls

of Plastic Surgery -- finds that 2,166 women who had breast implant

surgery for augmentation of breast size in Finland between 1970 and

2000 had a rate of suicide three times higher than the general

population.

It echoes another study, published in the British Medical Journal in

March, which finds the same three-fold rate of suicide among Swedish

women who had breast implants for augmentation compared to those who

didn't. That report involved 3,521 women who had the surgery between

1965 and 1993. In both studies, all causes of death were compared

between women who had breast implants and those who didn't.

" To be honest, I don't think we know the exact reason why these women

have a higher rate of suicide, but it's very possible that a small

minority who come in for breast augmentation are trying to solve

significant psychological problems, " Sarwer tells WebMD.

" I think some women come in with unrealistic expectations, that this

surgery will make more popular, get them the promotion they haven't

gotten, or save a failing marriage. But it's a large leap to suggest

that not meeting those expectations would result in their attempting

suicide. "

More likely, Sarwer says, the increased rate of suicide may occur in

women suffering from body dysmorphic disorder, a psychiatric

condition characterized by a profound preoccupation with the

slightest or even imagined defects in appearance, even when others

reassure them they look fine. Breast size is a common source of

obsession in these women, along with skin and other facial features;

men with this condition often obsess over their muscle size.

" Our research shows that between 7% and 15% of those who have plastic

surgery have this condition, " Sarwer tells WebMD. " These are the

patients we need to be concerned about. They generally do not respond

well to cosmetic surgery -- 80% or more have no change or even a

worsening of psychiatric symptoms after surgery and many become

suicidal or take legal action against their surgeon. "

B. Fodor, MD, a plastic surgeon in Los Angeles and president-

elect of the American Society for Aesthetic Plastic Surgery, says the

new Finnish study still doesn't offer any indication that getting

breast implants increases a woman's risk of suicide. In March, his

association issued a press release criticizing the Swedish study.

" We don't think this or the March study were well-done, and we are in

the process of designing one that will be credible and statistically

significant, " he tells WebMD. " Overall, the longevity of women in the

Finnish study who had breast augmentation was the same as those who

didn't. So you can't make the correlation that suicide is greater

because of the presence of breast implants. "

As in the March study, he criticized the researchers for not

examining patient histories or lifestyle before breast surgery to

determine variables known to be associated with increased risk of

suicide, such as panic disorder, depression, and alcoholism.

" People who have body dysmorphic disorders may commit suicide whether

they have surgery or not, " says Fodor.

Despite the controversy, the number of women getting breast implants

has skyrocketed in the past decade according to the American Society

of Plastic Surgeons -- from about 32,000 in 1993 to nearly 237,000

last year.

For anyone considering any type of plastic surgery, here are some

warning signs, according to Sarwer, that a person may be getting

plastic surgery for the wrong reason:

Seeing defects that others don't. " The biggest indication is when

you're concerned about a feature that others have a difficult time

identifying. For instance, you say, 'my breasts are too small' and

others say they look fine, " Sarwer says.

The wrong motivation. " Is it an internal motivation that you're

trying to improve your self esteem by restoring your breast to the

shape that they were before you had children? Or are you looking to

please a partner with this or become more popular? " The latter can be

a recipe for unhappiness, according to Sarwer.

Your expectations. It's reasonable if you go into surgery realizing

that plastic surgery is unlikely to dramatically change your lot in

life. " It's unlikely to get you promoted or save a troubled

marriage, " he says.

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