By Lisa Ellis
InteliHealth News Service

PHILADELPHIA — Women with cosmetic breast implants are more likely to commit suicide, a new study says, and an expert on body image and plastic surgery says plastic surgeons should screen these patients for psychological problems before agreeing to operate.

The new study, being published in the October issue of the Annals of Plastic Surgery, found that a group of 2,166 Finnish women who received implants had more than three times the average suicide rate for their population group.

This is the third study with similar results published in the last two years, said David B. Sarwer, Ph.D., an assistant professor of psychology at the University of Pennsylvania's Center for Human Appearance.

An article by Sarwer on breast implants and suicide will be published along with the study. He was not involved with the study.

Sarwer spoke about the study during the annual American Medical Association Science Reporters Conference.

Other recent research includes a United States study from 2001. It found that a group of women with implants had nine times the suicide rate of a comparison group of women without implants, Sarwer said. A Swedish study published this year reported three times the average suicide rate in another group of implant patients, he said.

These studies do not indicate that cosmetic breast-implant surgery causes suicide, Sarwer said. Rather, it is more likely that psychological problems already existed before surgery, he said.

"It may be that for a small percentage of women they are trying to address psychological problems through plastic surgery," he said. When this doesn't work, he said, some may commit suicide.

"I think surgeons need to do a better job of assessing the psychiatric status of their patients" before operating, he said.

Sarwer studies the psychological aspects of plastic surgery and works with people who have body dysmorphic disorder — an intense, life-restricting preoccupation with a slight or imagined defect in appearance.

Previous research has indicated that about 7 percent to 15 percent of people who get plastic surgery may have this disorder, Sarwer said. But surgery usually does not help them to feel better about their appearance. Rather, nearly three-quarters have no change in symptoms and about 16 percent get worse, he said.

Numerous studies have examined whether women who get cosmetic breast implants are more likely than average to have psychological problems, but the results have been mixed, Sarwer said.

Numerous studies do indicate that implant patients are more likely to engage in risky behavior than most women, he said. For example, they have higher-than-average rates of early pregnancy, smoking and alcohol use.

Breast-implant surgery has increased rapidly in the last decade, Sarwer said. In 1992, the year that the U.S. government banned silicone implants because of safety concerns, 32,000 procedures were performed in the United States. In 2002, the number was 236,888, he said. Saline implants now are the type most often used.

Sarwer attributed this more than 700-percent increase to several factors, including the following:

Popular images of the ideal body type for women have become increasingly unrealistic, he said. It's not only considered desirable to be thin but also somewhat muscular and large-breasted.

"When you think about it, it's a combination of features that really doesn't occur often in nature without a lot of help," he said.

Sarwer said plastic surgeons could help to screen out patients who need therapy, not surgery, if they asked about:

Surgeons also should be wary of any odd behavior during office visits, he said.

If surgeons have any concerns, he said, they should not hesitate to refer the patient to a mental-health professional. "We in the medical community need to do a better job of destigmatizing mental illness."