September 17, 2006

Breast Implants and Suicide

I'll give you the punch line first:   In each of the Danish, Swedish, Finnish, American,  and Canadian  studies,  appx. 0.4% of breast implant patients killed themselves, representing a two to threefold higher risk than the general population.  In some studies, the risk of suicide was increased to 1.5 times for any type of plastic surgery. Getting implants over 40 may also be a risk for suicide.


2761 Danish women who got breast implants from 1973-1995 were compared to 7071 women who got breast reduction, and 11736 who were considered controls.  Median age was about 31.

14 (0.5%) breast implants committed suicide, 3 times more than expected (i.e. standardized mortality ratio=3).   7 of them  had been previously psychiatrically hospitalized.  220 (8%) of all implants were psychiatrically hospitalized.  

22 (0.3%) breast reduction committed suicide, 1.6 times more than expected. 6 of them had been previously psychiatriically hospitalized.  329 (4.7%) of all reductions were previously psych  hospitalized.

0 controls committed suicide. 96 (5.5%) were previously psychiatrically hospitalized.

A U.S. study  followed 12144 implant patients (mean age 31) and 3614 other plastics patients (mean age 40) from 1970-2002.  29 (0.24%) implant patients suicided vs. 4 (0.1%) other plastics patients.  Thus, the 29 suicides were 1.6 times more than expected (SMR=1.6).

Interestingly, the risk of suicide was increased only after ten years;  22/29 died after 10 years.  And while the majority killed themselves before 35 (16/29, SMR=1.4), the biggest risk was for >40 year olds. (SMR=3.4)

Really interestingly, the authors found that for breast implants there was no excess risk for any kinds of accidents-- why should there be, they were accidents-- except car accidents.  Hmmm. 10 MVA deaths (occurring 15 years post implant) vs. 0 for other plastic surgery.  The authors speculate these may not have been accidents.

Swedish study, prospective but no comparator group, of 3521 women (mean age 31) found 15 (0.4%) suicides, SMR 2.9.  

Finnish study of 2166 breast implant women from 1970-2000 were studied (retrospectively) until 2001; there were 10 (0.4%) suicides, SMR 3.  6/10 happened in the first five years (in contrast to the U.S. study.)  (Accidents here were 14, SMR 2.1.  No explanation given for this.)

Canadian study:  24558 women with breast implants vs.  15893 women with other plastic surgery from 1974-1989, studied through 1997.  Mean age 32.  Once again, overall all-cause mortality was lower for breast implant women, except in suicide: 58 (0.24% SMR 1.73) ) suicides vs. 33 (.20%, SMR 1.55)  for other plastic surgery.  Like the U.S. study, women over 40 with implants carried the greatest risk of suicide (SMR 2.3), but no relationship to how far after surgery suicides occurred.

So in these studies, appx. 0.4% of breast implant patients killed themselves, representing a threefold higher risk than the general population. In some studies, the risk of suicide was increased to 1.5 times for any type of plastic surgery.  At least in North America, getting implants over 40 is a risk for suicide.   It goes without saying that the number of actual suicides was very small, and this could all be bunk.

All studies excluded implants for breast cancer surgery. 

You may be interested in knowing that suicide is the only serious risk that has been regularly  associated with breast implants-- silicone included-- and supported by real evidence, so far.  Everything else is either no greater risk, or less risk.  For example, there is a higher risk of lung cancer, but it most likely is related to  smoking, not the implant.

The obvious next step is to see if there is a causative link between implants and suicide (likely impossible) or the implant is a clue to something else (poor self image, depression, drinking, etc.)


Something else: the stereotypical breast implant recipient (e.g. 20 year old coed in Playboy) is not really the typical recipient.  The average recipient is older (mean age 34,); is more affluent; is married (75%) and has two kids; had kids at younger ages; has had abortions; and smokes.  I mention this so that you have the right person in mind when you go looking for risks.

Other fun facts:

80% are cosmetic, 20% are breast cancer surgery reconstructions.

290,000+ breast implant surgeries done last year (compared to 130,000 in 1998).  25% are replacement surgeries for ruptures, pain, etc.  Compare to 324k liposuction and 300k nose jobs.

10% of US women have implants. (This seems wrong.)  95% are white.

10% did it in California. 


Since we're on the subject of implants and suicide, it seems to me an easy maneuver to fill breast implants with liquid explosives, puncture and mix. I am not sure why no one has tried this, actually-- or, more specifically, why no one at the TSA is looking for this as they stop to search my stupid tube of toothpaste.   Not that there's any good way of checking, of course.