THURSDAY, March 6, 2003 (HealthDayNews) -- Having voluptuous breasts with the help of a plastic surgeon does not guarantee happiness. In fact, the opposite may be true.
Swedish women with breast implants turned out to be 50 percent more likely to commit suicide than women without them, says a study appearing in the March 8 issue of the British Medical Journal.
"This is not the first study to suggest that suicide rates might be higher," says Dr. David L. Feldman, director of plastic surgery at Maimonides Medical Center in Brooklyn, N.Y. "I think their conclusions are reasonably valid."
Not everyone agrees with that assessment, however. "That just doesn't compute with the information that we have in this country," says Dr. James Wells, president of the American Society of Plastic Surgeons. "We don't know that we have a cause-and-effect relationship."
Part of the problem, Wells suggests, is inherent in looking at people from two different societies, in this case, the United States and Sweden.
The authors of this study delved into the medical records of 3,521 Swedish women between the ages of 15 and 69 who had received breast implants between 1965 and 1993. They compared the number of actual deaths in this group of women with the number of deaths that would be expected in a similarly sized portion of the general population. The women were followed for just over 11 years.
While 58.7 deaths were expected, 85 women in the implant group died -- 26 more than expected. The extra deaths were primarily in the categories of suicide -- 15 women killed themselves, which was 10 more than had been expected -- and cancer, particularly lung cancer due to smoking.
The authors suggest the extra deaths might be attributable to underlying psychiatric problems, something that plastic surgeons are generally on guard for. Dr. Victoria Koot, one of the study's authors and a clinician at the University Medical Center in Utrecht, The Netherlands, said that "body dysmorphic disorder or very low self-esteem" may be at play.
"Not too many people go to a doctor wanting to have an operation. We're physicians first, and we have an obligation to make sure that the patient is fit to have that operation physically and mentally," Feldman says. "People are deluded into thinking that having larger breasts will change their life. It won't. It'll change their breasts."
Wells estimates that plastic surgeons turn away clients roughly 2 percent to 5 percent of the time. "There's an evaluation process by the physicians to try to identify those patients who seem a little unstable. Their job history isn't stable, they're bouncing from relationship to relationship," he says. "We need to spend time listening to the patient. Surgeons have a responsibility to say no as much as they have a responsibility to say yes." Koot agreed that different screening procedures could account for a difference in risk, depending on the country.
If the profile of the unsuitable plastic surgery candidate sounds like most of Hollywood, that makes sense. In fact, the most common person seeking breast augmentation is happily married in a stable relationship with several children, Wells says. "She is looking to reverse what pregnancy did in terms of her breasts and appearance," he says.
Still, identifying the "right" person can be as much art as science. "We try to avoid operating on somebody who has this propensity, but this is a tough call and some people will sift through the cracks," Feldman says. "It does point out our obligation to do a full evaluation and not just rush a person off to the operating room."
More information
For more on breast enlargement, visit the American Society of Plastic Surgeons or the American Society for Aesthetic Plastic Surgery.
