Friday, March 02, 2007

Breast Implants and suicide redux

The correlation between patients with breast implants and slightly higher suicide rates is something I touched on previously (see here).

To most observers this is a fairly easy phenomena to explain: higher rates of psychiatric issues and depression among cosmetic surgery patients would expect to result in a corresponding suicide rate increase. An excellent review of this literature was published in the February issue of Plastic & Reconstructive Surgery, the world's flagship scholarly journal for Plastic Surgery.

Still, among the cadre of anti-implant activists , there lingers the suggestion that these observed suicide rates are from either psychic or physical pain from their implants. This was voiced recently by the actress/ant-implant crusader, Sally Kirkland (see photo), who speculated that Anna Nicole Smith's death by drug overdose was from her breast implants. (As opposed to her reported history of depression, psychiatric problems, alcoholism, and drug abuse/dependency.)

"Dr." Kirkland's observations aside, an interesting addition to the literature popped up this week which asked the logical question of whether the increase in suicide rates was also seen in breast cancer patients. Surprising no one, the answer is no in a National Cancer Institute funded review of cancer registries. The skeleton of this study can be read here.

Hopefully this puts the stake in the flawed assertion that breast implants causes suicide, and redirects the attention towards more effective screening out of potential patients who would benefit from psychiatry rather then surgery.


Anonymous said...

I understand it's not the breast implants themselves that cause the suicides. IT IS the side effect -leaching of the formaldehyde and platinum etc. that works it way into the lymph system and organs creating an immune reaction which in turn produces unbearable pain throughout the body. This pain is a deep cancer-like pain and is a never ending nightmare 24/7. Even narcotics only take the edge off the pain. Most women do not get adequate pain relief necessary to even get some sleep. Sleep deprivement is a form of torture that weakens the human phyche. Industry funded studies are coaching the medical community to not take the situation seriously and proper pain relief is often not being prescribed. After fighting this battle for years in some cases, ending your life seems the only way out. This hoplessness is compounded because the media and idustry produced scientific studies have been well-spun indicating these women are all drama queens and of feeble mind.
Having the implants removed will not cure the already poisoned body but in some cases can prevent the ongoing load of toxin stressing the liver. I am writing this comment as someone who is experiencing silicone toxicity first hand so believe me, I know how it is. SO if Anna Nicole had leaking or ruptured implants, she'd have been in this deep level of pain and probably not even aware of the cause. Taking more and more pain relievers to try to escape the agony is not unheard of.

Dr. Rob Oliver said...

With all due respect, a great deal of research does not support the supposition that silicone, platinum, nor related elements in the manufacturing process cause these conditions.

It is fairly well established that the complications from ruptured silicone gel implants are confined to the breast/chest wall and increasingly rarely the lymph node basin in the armpit (axillae). As the cohseive nature of the implant filler has increased, even fewer instances of gel migration are being seen outside of implant capsules. The high cohesive gels pending approval here in the US (and already used everywhere else) seem likely to eliminate this issue of gel migration completely.

Capsular contracture and passive stretch of the 4th intercostal nerve can indeed cause pain, although this tends to be not such on the scope you suggest.

Physicians and others who suggest that you can be "detoxified" (of a process not even believed to exist in the first place) by some proprietary regimine of herbs/vitamins sold thru their practice are not serving people well who believe themselves to have some systemic problem and are akin to snake-oil peddlers.

No one suggests that complaintants are "feeble-minded" en mass, but we do know that issues of depression are signifigantly higher among people seeking cosmetic surgery. Psychosomatic relationships to physical symptoms have been noted among many different areas of medicine including patients with depression, inflamatory bowel disease, migraine headache, fibromyalgia, carpal tunnel, and others.
I think it's fair to criticize Plastic Surgeons and other cosmetic surgeons who operate on people like Anna Nicole Smith, Michael Jackson, and others with so much psychopathology on clear display. The observations of these suicide rate increase has drawn a great deal of attention in our specialty on trying to select these patients out to avoid surgery upon. This study I highlighted is important as it supports what we already suspected ie. it's likely the patient rather then the device driving this process.

Anonymous said...

Chronic pain often leads the suffering to suicide.

Breast implant problems often lead to chronic pain.

You figure it out.

Dr. Rob Oliver said...

Your hypothesis, while logical, has not been validated by research. We just haven't seen patterns in epidemiologic studies that would support this. Keep in mind though, we're talking small numbers of people out of tens or even hundreds of thousands of patients that have been considered in these studies.

It would be very difficult as a practical matter, to exclude or confirm what you suggest. The authors of the 25,000 patient long term Canadian SBI study last year made a comment that there was no trend to support suggestions like that.

It also begs a "chicken or the egg" question about depression, chronic pain, and how both issues relate to suicidal ideation.

Thanks for the thought provoking comments!


Anonymous said...

Apparently you're not interested in posting my last I'll ask again, but in shorter format.

Having taken an oath, after promising to "first, do no harm", why would you consider implanting a *non-medically necessary* and still unproven (safety-wise) item into another human beings body?

Dr. Rob Oliver said...

You propose a philosophic question about "how safe is safe enough?" to justify an elective procedure. Dr. Marcia Angel, former editor of the New England Journal of Medicine, wrote an eloquent editorial (and later a book) about the ethical issues of that question and how politics triumphed over scientific evaluation of breast implants in the silicone crisis of the late 19080's-early 90's.

This philosopic & ethical theorem has been asked and answer by dozens of countries in re. to breast implants after comprehensive reviews of the science and published literature, and there are no countries restricting use of these devices anymore.

I'd disagree with your characterization of implant science as "unproven". In point of fact, combining different pools of study patients has a cohort of several hundred thousand patients, some with nearly 3 decades of well-documented follow up. There have been a few dozen international large studies which consistantly have not identified patterns of disease. While you can't prove a negative, after you demonstrate the lack of something so often we can make fairly informed recomendations at this point.

What's more, we see fewer local complications as we refine our techniques and continue to work with better designed implants. Form stable devices from Inamed & Mentor, which should be available in the US this year, have very low rates of capsule problems and rupture rates so low that there are no data points to project estimates.

Anonymous said...

"What's more, we see fewer local complications as we refine our techniques and continue to work with better designed implants."

This implies that the women who receive implants are test cases.

Understandable, within reason, for a medically necessary (life saving) procedure, but IMHO not for breast implants.

Dr. Rob Oliver said...

I think you misunderstand that statement re. advances in technique & technology.

The clearly identifiable problems from years past had to do with thin shell/thin gel implants of that era as well as the idea that the surgery should be done with blunt disection rather then precision surgery.

Improved devices combined with atraumatic insertion techniques and attention to patient's anatomical characteristics have produced reoperation rates well into the low single digits in several recent large series.

Anonymous said...

Taken from the FDA's own website regarding silicone implants:

"As of the date of this handbook, no company has PMA approval for a silicone gel-filled breast implant. *Therefore, all silicone gel-filled breast implants are considered investigational.* For a woman to receive a silicone gel-filled breast implant in the U.S., she must enroll in an IDE study or an adjunct study."

Sounds like women are being used as test cases to me.

Dr. Rob Oliver said...

The sentence you point to is from a publication that would predate the FDA reclassification last fall, but I think you misunderstand it anyway.

There were no PMA (post-market approval) studies because they were still under the auspices of the internal review board-directed FDA "core" & "adjunct" studies at that time. The data from these & reviews of dozens of other studies from the US & abroad was what made for such a compelling case for reapproval. Remember Health Canada (the Canadian FDA) had gone thru this same process and reached similar findings just one month before the FDA announcement.

These were "test" cases in the same way that any drug or medical device during clinical trial phases. A great deal of animal & human data had already been collected up to this point as well.