Sunday, December 17, 2006

What to make of suicide rates and breast augmentation patients?

A trend has been identified in several studies of patients with implants which briefly merited some attention last summer, namely that increased suicide rates has been observed among implant patients in some of the large European databases.

Does this suggest that implants actually cause suicide? Absolutely not.

Rather, it likely reflects selection bias (a phenomena where accurate conclusions from statistical analysis is undermined) in the studied patient groups.

What's that in this instance?
An increased incidence of mental illness and depression among prospective patients.

One of the Danish studies reported that the women with breast implants had almost double the rate of psychiatric morbidity as those in the control groups. This data is easier studied in countries with centralized health care as exists in Canada & Western Europe, and is where most of this information comes from.

It has been suggested that a psychiatric condition, body dysmorphic disorder may explain the elevated suicide risk among breast implant recipients. Earlier research from the University of Pennsylvania Center for Human Appearances (Yes, there actually is such a thing!)suggested that as many as 15% of cosmetic surgery patients have the condition, characterized by preoccupation with small or imagined defects in appearance.

About 80 percent of breast implants in the United States are for cosmetic reasons and 20 percent for breast reconstruction after breast cancer surgery. Dr. Leroy Young, a Plastic Surgeon from St. Louis,one of the world's experts on silicone implants and a respected basic scientist speculated a few years ago that the data trickling in may in fact no longer be applicable to today's breast augmentation patient

In the 1960s and '70s, women in the U.S. who had breast augmentation tended to smoke, drink alcohol, and report other risk-taking behaviors more often than the general population, but our findings suggest that this is no longer the case,”.

A recent survey of 5,000 women in the U.S. who had either received breast implants or were considering them found that the women were less likely to drink alcohol and smoke than the general population. Young says these women had a lower frequency of signs of depression than did the earlier generation of American implant recipients and the women in the European studies

Is there a plausible explanation for breast implants causing suicide?
Not really. Some anti-implant activists are suggesting something along the lines that implants cause so much psychic or physical pain that it must be driving these women to killing themselves.

Jacques Brisson, M.D., D.Sc., of Laval University in Quebec City and lead author of the largest study which has noted this phenomena had this to say:
"Recently, it was suggested that complications experienced by women who received breast implants could contribute to increased despair, which may increase the chance of suicide," the authors said.

However, our findings to not support this hypothesis because we found no increase in the standardized mortality ratio for suicide with increasing length of follow-up," they said. "Additionally, there were no differences in suicide rates between implant patients and other plastic surgery patients

The most recent such study, presented by Dr. Brisson, was performed in a population much larger then the others in a group of Canadian women. (see here for a blog entry I did on this last summer) Like the other work, there was an elevated suicide rate. However, the suicide rate was similar to that of women who had other cosmetic plastic surgery procedures which further strengthens the belief that breast augmentation (and indeed all cosmetic surgery) has a correlative relationship to depression/mental illness rather then a causative one to suicide.

Will today's patients have similar such rates or will observations like Dr. Young's ultimately prove correct. Check back in 10-15 years.

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