Same Mortality But Higher Suicide Rate Among Women With Breast Implants

Université Laval's Jacques Brisson and Louis Latulippe and their colleagues collected information on 17,400 women from the province of Quebec and 7,200 from Ontario who had received breast implants for cosmetic purposes between 1974 and 1989. These women, who had undergone the surgery at an average age of 32, were the subject of regular follow-ups during a 15 year period. A total of 480 women with breast implants died during that period, and cross-referencing with the Canadian Vital Statistic Database was performed to determine the cause of death.

Researchers did not observe any increase in the mortality rate of women with breast implants. In fact, that rate was 26% lower than in the control group. Fewer deaths from cancer--notably breast cancer--and heart disease accounted for most of the discrepancy. The researchers insist that this lower mortality rate is not the result of the breast augmentation procedure itself, but rather of a double selection bias. "First, a woman must be in relatively good health to undergo breast implant surgery," points out Dr. Brisson. "Also, women who receive breast implants tend to be of higher-than-average socioeconomic status. Thus, women who undergo breast augmentation surgery are more likely to be in better health than the general population."

To put this explanation to the test, the research team analyzed a group of 16,000 women who had undergone plastic surgery procedures other than breast augmentation. As in the breast implant group, the mortality rate was lower (32%) and the suicide rate higher (55%) than in the general population.

Previous studies have observed that the psychological profile of women who receive breast implants is characterized by low self-esteem, lack of self-confidence, and more frequent mental illnesses such as depression. According to Dr. Brisson, sound medical practice should encourage surgeons to pay particular attention to the reasons why women want to undergo breast augmentation. "If this reveals problems that cannot be treated with plastic surgery, doctors should refer these patients to mental health professionals," he adds.

The debate over breast implant safety is far from being settled, warns Dr. Brisson. "Our study shows that there is no relation between breast implants and mortality rate. It also demonstrates that the risk of cancer--particularly breast cancer--is not higher in women with breast implants. But our study does not assess the impact of breast implants on other aspects of women's health. We know there are local complications due to implant degradation, which can sometimes lead to implant replacement. Women must take those facts into consideration when determining whether or not they want to receive breast implants," concludes the researcher.

In addition to Jacques Brisson and Louis Latulippe, the research team was composed of Paul J. Villeneuve, Lin Xie, Anne-Marie Ugnat et Yang Mao from the Public Health Agency of Canada, and Eric J. Holowaty from Cancer Care Ontario.