Breast Implants and Mental Health

The long-term risk of suicide is tripled for women
who have undergone cosmetic breast implant surgery,
concludes a study in the August Annals of Plastic
Surgery, published by Lippincott Williams & Wilkins,
a part of Wolters Kluwer Health.

This long-term study further confirms the link
between breast implants and a strikingly high risk
of suicide and other related causes of death.

The increased suicide risk -- together with a similar
increase in deaths from alcohol or drug dependence --
suggests that plastic surgeons should consider mental
health screening and follow-up for women who seek
breast implants, according to the new study, led by
Loren Lipworth, Sc.D., of the International Epidemiology Institute in Rockville, Md, and the Vanderbilt
University Medical Center, Nashville, Tenn.

Dr. Lipworth and colleagues performed an extended
follow-up study of 3,527 Swedish women who underwent
cosmetic breast implant surgery between 1965 and 1993.
Death certificate data were used to analyze causes of
death among women with breast implants, compared to the
general female population.

At an average follow-up of nearly 19 years, the suicide
rate was three times higher for women with breast
implants, compared to the general population (based
on 24 deaths among implant recipients). The risk was
greatest -- nearly seven times higher -- for women who
received their breast implants at age 45 or older.
(The average age for breast implant surgery was
32 years.)

Suicide risk was not significantly increased for the
first 10 years after implant surgery. After that,
however, suicide risk increased with time since
surgery -- risk was 4.5 times higher from 10 to 19
years' follow-up, and six times higher after
20 years.

Women with breast implants also had higher rates of
death from psychiatric disorders, including a three-fold
increase in deaths resulting from alcohol and drug
dependence. Several additional deaths, classified as
accidents or injuries, might have been suicides or
involved psychiatric disorders or drug/alcohol abuse
as a contributing cause. "Thus at least 38 deaths
(22 percent of all deaths) in this implant cohort
were associated with suicide, psychologic disorders,
and/or drug and alcohol abuse/dependence," the
researchers write.

There was no increase in the risk of death from cancer,
including breast cancer, among women with breast
implants. Increases in deaths from lung cancer,
and respiratory diseases such as emphysema likely
reflected higher smoking rates among women with breast
implants.

Several epidemiological studies have found an
increased suicide rate among women with cosmetic
breast implants. The current study provides
extended follow-up data on a previous nationwide
study of Swedish women with breast implants, more
than doubling the number of deaths analyzed.

The use of Swedish national healthcare and death
certificate records ensures near-complete identification
of women undergoing breast implant surgery and
information on causes of death.

The increases in suicide and in deaths related to
alcohol and drug dependence suggest that a
"nontrivial proportion of women undergoing cosmetic
breast augmentation may bring with them -- or develop
later -- serious long-term psychiatric morbidity and
eventually mortality," Dr. Lipworth and colleagues
write. Since the study includes only deaths, the
true rates of psychological and substance abuse
problems among women with cosmetic implants are
likely much higher. The researchers conclude,
"Such findings warrant increased screening,
counseling, and perhaps post-implant monitoring
of women seeking cosmetic breast implants."

In an invited discussion, David B. Sarwer, Ph.D.,
associate professor of psychology at the University
of Pennsylvania School of Medicine recommends that
plastic surgeons assess the mental health status
and history of women desiring breast augmentation.

In addition to mood disorders such as depression,
screening should focus on body image disorders,
such as body dysmorphic disorder. "In cases where
the patient is currently in mental health treatment,
the surgeon should contact the mental health
professional to confirm that the patient is
psychiatrically stable and appropriate for surgery
at this time," Dr. Sarwer writes. "Until we know
more about the relationship between breast implants
and suicide, this conservative approach is recommended
with both the patient's and surgeon's well-being in mind."

According to Robert O. Young, Ph.D., "breast implants
are just another disturbing acidic contributor to the
alkaline design of the body. All breast implants are
perceived as foreign matter and will trigger and then
activate the immune response to begin removing this
foreign matter. This is why so many breast implants
end up encapsulated and ALL breast implants will
eventually fail after ten years."

"To maintain emotional and physical health you must
maintain the alkaline design of your body. This can
happen with an alkaline lifestyle and diet free from
an acidic contributors, including breast implants."

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