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."
Peter 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.