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 David 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 Annals 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."
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.
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.