Women who get breast implants are more likely than other women to commit suicide, new research suggests.

But they are also more likely to have a previous mental illness that could predispose them to taking their own life.

Three previous studies have shown a roughly threefold increase in suicide among women with cosmetic breast implants. The newly published study of Danish women shows a similar increase in risk and also shows that the women were more likely to have prior admissions to psychiatric hospitals.

Compared with women who had breast reductions or other cosmetic surgeries, breast implant recipients were more than one-and-a-half times as likely to have a history of admission to a psychiatric facility.

“The thinking has been that the increase in suicides was due to pre-existing psychological problems and not the surgery itself, but until now there really hasn’t been research to back that up,” study researcher Joseph K. McLaughlin, PhD, tells WebMD.

Eight Percent Had Prior Psychiatric Admission

The study, published in the Dec. 13/27 issue of the journal Archives of Internal Medicine, included more than 2,700 women who had cosmetic breast implants between 1973 and 1995. These women were compared with 9,000 women who had breast reductions or other cosmetic surgeries.

Overall, breast implant patients were nearly 1.5 times as likely to have died. But when the researchers looked at specific causes of death, they found that these women were about three times as likely to have died from suicide or respiratory illnesses, such as asthma and emphysema.

Eight percent of the implant patients had been in a psychiatric facility before having plastic surgery, compared with 4.7 percent of women who had breast reduction surgery and 5.5 percent of women who had other cosmetic procedures.

Although the latest research strengthens the link between breast implants and suicide, more study is needed to understand the association, McLaughlin suggests.

Body image expert David B. Sarwer, PhD, agrees that more research is needed to better understand the specific issues that women who seek cosmetic breast implants are struggling with.

It has been suggested that a psychiatric condition known as body dysmorphic disorder may explain the elevated suicide risk among breast implant recipients.

Earlier research by Sarwer and colleagues suggested that as many as 15 percent of plastic surgery patients have the condition, characterized by a profound preoccupation with small or imagined defects in appearance.

Psychiatric symptoms often worsen for body dysmorphic disorder patients after cosmetic surgery. While people with the psychiatric condition do have abnormally high rates of suicidal thoughts and attempts, Sarwer says it is not clear if this explains the higher frequency of suicides among breast implant recipients. Sarwer is an assistant professor of psychology in psychiatry and surgery at the Center for Human Appearances, University of Pennsylvania School of Medicine.

“It could just as easily be the result of depression that is undiagnosed prior to surgery or unmet expectations among women who don’t have the disorder,” he says. “If a woman thinks that breast implants are going to save her failing marriage or find her that elusive romantic partner and it doesn’t happen, the disappointment could be part of the story.”

Today’s Patients Are Different

St. Louis plastic surgeon Leroy Young, MD, tells WebMD that it is not clear if the findings from the Danish study and the other European investigations have any relevance for the women in the U.S. who are having breast augmentation surgeries today.

“In the 1960s and '70s, women in the U.S. who had breast augmentation tended to smoke, drink alcohol, and report other risk-taking behaviors more often than the general population, but our findings suggest that this is no longer the case,” he says.

A recent survey of 5,000 women in the U.S. who had either received breast implants or were considering them found that the women were less likely to drink alcohol and smoke than the general population. Young says these women had a lower frequency of signs of depression than did the earlier generation of American implant recipients and the women in the European studies.

“These days, the average woman seeking breast augmentation is married with two children, is of relatively normal weight, and is less likely to smoke or drink than the general population,” says Young, who leads the breast surgery committee of the American Society for Aesthetic Plastic Surgery. “Most of these women seem to be pretty happy with the rest of their body. They may have some decrease in self-esteem related to their breast size, but in general their unhappiness is corrected by surgery.”

By Salynn Boyles, reviewed by Michael W. Smith, MD

SOURCES: Jacobsen et al. Archives of Internal Medicine, Dec. 13/27, 2004; vol 164: pp 2450-2455. Joseph K. McLaughlin, PhD, president, International Epidemiology Institute, Rockville, Md.; professor, Vanderbilt University Medical Center, Nashville, Tenn. David B. Sarwer, PhD, assistant professor of psychology in psychiatry and surgery, Center for Human Appearances, University of Pennsylvania School of Medicine. Leroy Young, MD, chairman, breast surgery committee, American Society for Aesthetic Plastic Surgery.