March 6, 2003 -- Women with breast implants are three times more likely than other women to kill themselves.
The finding comes from a study of 3,521 Swedish women who had breast implants from 1965 to 1993. By the end of 1994, 15 of these women committed suicide. Only five suicides would have been expected based on Sweden's female suicide rate. The findings appear in the March 8 issue of the British Medical Journal.
Women seeking breast implants thus seem to have a higher-than-average risk of underlying psychological problems, concludes study leader Veronica C.M. Koot, MD, PhD, a clinical epidemiologist at the Julius Center for Health Sciences and Primary Care at the University Medical Center in Utrecht, Netherlands.
"I think it is important to know that if someone goes to a doctor and asks for breast implants, the doctor should check to see if there is an underlying problem," Koot tells WebMD. "It is very important to check. We must screen these women. If we just do breast implants, we won't help them."
The findings apply only to women who have breast implants for cosmetic reasons. Women who had implants after breast cancer surgery were not included in the study.
A 2001 U.S. study also found an increased risk of suicide among women who had breast implants. Moreover, it found that women with breast implants killed themselves four times more often than women who had other types of plastic surgery.
Koot warns surgeons to be on the lookout for women with low self-esteem or distorted body image. She says plastic surgeons should refer such patients to a psychologist or psychiatrist before offering breast implants.
Psychiatrist Mark I. Levy, MD, of the University of California in San Francisco, says women all too often look for surgical answers to problems that are more than skin deep.
"The rush to plastic surgery is often an effort to correct, on the outside, flaws perceived on the inside," Levy tells WebMD. "It is usually an ill-conceived quest."
How might this lead to suicide?
"The slippery slope is if you go to a surgeon to solve self-esteem problems they will not be fixed," Levy says. "Now there is a double problem. Before surgery, they could say, 'If only my breasts were larger I would be loved more.' And, of course, it doesn't happen. Whatever happens, they don't feel any more valuable -- they feel just as devalued as they ever did, because ultimately they devalue themselves. ... They have gone to the point of mutilating their bodies and yet don't feel any better about themselves."
Women seeking breast implants should ask themselves an important question: What is it they are trying to fix? Finding the answer may require professional help.
"And it's important to get to the heart of their fantasy -- how do they think they will feel once their breasts are larger?" Levy says.
Should women stop by a psychologist's office before seeing a plastic surgeon? Koot says that's not usually necessary. Levy says it's not a bad idea -- but that few women seeking a surgical cure for their problems will do so.
"It would be good to have a professional to talk this though with," he says. "But the nature of the problem is that people don't want to look at things. So there is a lot of resistance to looking at the real issues when a person is looking for a surgical remedy."