CC BY-NC 4.0 · Arch Plast Surg 2015; 42(02): 131-142
DOI: 10.5999/aps.2015.42.2.131
Review Article

Characteristics of Women Who Have Had Cosmetic Breast Implants That Could Be Associated with Increased Suicide Risk: A Systematic Review, Proposing a Suicide Prevention Model

Nikolaos Manoloudakis
Faculty of Social Sciences, Hellenic Open University, Cambridge, UK
Plastic and Reconstructive Surgery Department, East and North Hertfordshire NHS Trust, Lister Hospital, Stevenage, UK
,
Georgios Labiris
Faculty of Social Sciences, Hellenic Open University, Cambridge, UK
,
Nefeli Karakitsou
Cambridge and Peterborough NHS foundation Trust, Fulbourn Psychiatric Hospital, Cambridge, UK
,
Jong B Kim
Plastic and Reconstructive Surgery Department, East and North Hertfordshire NHS Trust, Lister Hospital, Stevenage, UK
,
Yezen Sheena
Plastic and Reconstructive Surgery Department, East and North Hertfordshire NHS Trust, Lister Hospital, Stevenage, UK
,
Dimitrios Niakas
Faculty of Social Sciences, Hellenic Open University, Cambridge, UK
› Author Affiliations

Literature indicates an increased risk of suicide among women who have had cosmetic breast implants. An explanatory model for this association has not been established. Some studies conclude that women with cosmetic breast implants demonstrate some characteristics that are associated with increased suicide risk while others support that the breast augmentation protects from suicide. A systematic review including data collection from January 1961 up to February 2014 was conducted. The results were incorporated to pre-existing suicide risk models of the general population. A modified suicide risk model was created for the female cosmetic augmentation mammaplasty candidate. A 2-3 times increased suicide risk among women that undergo cosmetic breast augmentation has been identified. Breast augmentation patients show some characteristics that are associated with increased suicide risk. The majority of women reported high postoperative satisfaction. Recent research indicates that the Autoimmune syndrome induced by adjuvants and fibromyalgia syndrome are associated with silicone implantation. A thorough surgical, medical and psycho-social (psychiatric, family, reproductive, and occupational) history should be included in the preoperative assessment of women seeking to undergo cosmetic breast augmentation. Breast augmentation surgery can stimulate a systematic stress response and increase the risk of suicide. Each risk factor of suicide has poor predictive value when considered independently and can result in prediction errors. A clinical management model has been proposed considering the overlapping risk factors of women that undergo cosmetic breast augmentation with suicide.



Publication History

Received: 26 June 2014

Accepted: 26 July 2014

Article published online:
05 May 2022

© 2015. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • REFERENCES

  • 1 National Institutes of Health. Statistics [Internet]. Rockville: National Institute of Mental Health; cited 2014 Jul 28 Available from: https://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml#risk
  • 2 Centers for Disease Control and Prevention. Injury prevention & control: data & statistics [Internet]. Atlanta: Centers for Disease Control and Prevention; 2014. cited 2014 Jul 28 Available from: https://www.cdc.gov/injury/wisqars/index.html
  • 3 Brinton LA, Lubin JH, Burich MC. et al. Mortality among augmentation mammoplasty patients. Epidemiology 2001; 12: 321-326
  • 4 Koot VC, Peeters PH, Granath F. et al. Total and cause specific mortality among Swedish women with cosmetic breast implants: prospective study. BMJ 2003; 326: 527-528
  • 5 Pukkala E, Kulmala I, Hovi SL. et al. Causes of death among Finnish women with cosmetic breast implants, 1971-2001. Ann Plast Surg 2003; 51: 339-342
  • 6 Jacobsen PH, Holmich LR, McLaughlin JK. et al. Mortality and suicide among Danish women with cosmetic breast implants. Arch Intern Med 2004; 164: 2450-2455
  • 7 Brinton LA, Lubin JH, Murray MC. et al. Mortality rates among augmentation mammoplasty patients: an update. Epidemiology 2006; 17: 162-169
  • 8 Villeneuve PJ, Holowaty EJ, Brisson J. et al. Mortality among Canadian women with cosmetic breast implants. Am J Epidemiol 2006; 164: 334-341
  • 9 Lipworth L, Nyren O, Ye W. et al. Excess mortality from suicide and other external causes of death among women with cosmetic breast implants. Ann Plast Surg 2007; 59: 119-123
  • 10 Morgan E. Suicide after breast augmentation. Epidemiology 2008; 19: 520-521
  • 11 Sher L. Cosmetic breast implants and suicide. Plast Reconstr Surg 2004; 114: 601-602
  • 12 McLaughlin JK, Lipworth L, Tarone RE. Suicide among women with cosmetic breast implants: a review of the epidemiologic evidence. J Long Term Eff Med Implants 2003; 13: 445-450
  • 13 Joiner Jr TE. Does breast augmentation confer risk of or protection from suicide?. Aesthet Surg J 2003; 23: 370-375
  • 14 Crerand CE, Infield AL, Sarwer DB. Psychological considerations in cosmetic breast augmentation. Plast Surg Nurs 2009; 29: 49-57
  • 15 Sarwer DB, Brown GK, Evans DL. Cosmetic breast augmentation and suicide. Am J Psychiatry 2007; 164: 1006-1013
  • 16 The Cochrane Collaboration [Internet]. Oxford: The Cochrane Collaboration; 2014. cited 2014 Jul 28 Available from: https://www.cochrane.org/cochrane-reviews
  • 17 PRISMA statement [Internet]. 2014. cited 2014 Jul 28 Available from: https://www.prisma-statement.org/statement.htm
  • 18 Oxman AD. Checklists for review articles. BMJ 1994; 309: 648-651
  • 19 Littell JH, Corcoran J, Pillai VK. Systematic reviews and meta-analysis. Oxford: Oxford University Press; 2008
  • 20 Higgins JP, Green S. Cochrane Collaboration. Cochrane handbook for systematic reviews of interventions. Chichester: Wiley-Blackwell; 2008
  • 21 McLaughlin JK, Wise TN, Lipworth L. Increased risk of suicide among patients with breast implants: do the epidemiologic data support psychiatric consultation?. Psychosomatics 2004; 45: 277-280
  • 22 Schlebusch L, Levin A. A psychological profile of women selected for augmentation mammaplasty. S Afr Med J 1983; 64: 481-483
  • 23 Edgerton MT, Meyer E, Jacobson WE. Augmentation mammaplasty. II. Further surgical and psychiatric evaluation. Plast Reconstr Surg Transplant Bull 1961; 27: 279-302
  • 24 Shipley RH, O'Donnel JM, Bader KF. Psychosocial effects of cosmetic augmentation mammaplasty. Aesthetic Plast Surg 1978; 2: 429-434
  • 25 Sihm F, Jagd M, Pers M. Psychological assessment before and after augmentation mammaplasty. Scand J Plast Reconstr Surg 1978; 12: 295-298
  • 26 Beale S, Hambert G, Lisper HO. et al. Augmentation mammaplasty: the surgical and psychological effects of the operation and prediction of the result. Ann Plast Surg 1985; 14: 473-493
  • 27 Kilmann PR, Sattler JI, Taylor J. The impact of augmentation mammaplasty: a follow-up study. Plast Reconstr Surg 1987; 80: 374-378
  • 28 Meyer L, Ringberg A. Augmentation mammaplasty--psychiatric and psychosocial characteristics and outcome in a group of Swedish women. Scand J Plast Reconstr Surg Hand Surg 1987; 21: 199-208
  • 29 Young VL, Nemecek JR, Nemecek DA. The efficacy of breast augmentation: breast size increase, patient satisfaction, and psychological effects. Plast Reconstr Surg 1994; 94: 958-969
  • 30 Rankin M, Borah GL, Perry AW. et al. Quality-of-life outcomes after cosmetic surgery. Plast Reconstr Surg 1998; 102: 2139-2145
  • 31 Cash TF, Duel LA, Perkins LL. Women's psychosocial outcomes of breast augmentation with silicone gel-filled implants: a 2-year prospective study. Plast Reconstr Surg 2002; 109: 2112-2121
  • 32 Sarwer DB, Infield AL, Baker JL. et al. Two-year results of a prospective, multi-site investigation of patient satisfaction and psychosocial status following cosmetic surgery. Aesthet Surg J 2008; 28: 245-250
  • 33 Schlebusch L. Negative bodily experience and prevalence of depression in patients who request augmentation mammoplasty. S Afr Med J 1989; 75: 323-326
  • 34 Cook LS, Daling JR, Voigt LF. et al. Characteristics of women with and without breast augmentation. JAMA 1997; 277: 1612-1617
  • 35 Brinton LA, Brown SL, Colton T. et al. Characteristics of a population of women with breast implants compared with women seeking other types of plastic surgery. Plast Reconstr Surg 2000; 105: 919-927
  • 36 Fryzek JP, Weiderpass E, Signorello LB. et al. Characteristics of women with cosmetic breast augmentation surgery compared with breast reduction surgery patients and women in the general population of Sweden. Ann Plast Surg 2000; 45: 349-356
  • 37 Kjoller K, Holmich LR, Fryzek JP. et al. Characteristics of women with cosmetic breast implants compared with women with other types of cosmetic surgery and population-based controls in Denmark. Ann Plast Surg 2003; 50: 6-12
  • 38 Breiting VB, Holmich LR, Brandt B. et al. Long-term health status of Danish women with silicone breast implants. Plast Reconstr Surg 2004; 114: 217-226
  • 39 Lipworth L, Kjoller K, Holmich LR. et al. Psychological characteristics of Danish women with cosmetic breast implants. Ann Plast Surg 2009; 63: 11-14
  • 40 Nikolic J, Janjic Z, Marinkovic M. et al. Psychosocial characteristics and motivational factors in woman seeking cosmetic breast augmentation surgery. Vojnosanit Pregl 2013; 70: 940-946
  • 41 Bondurant S, Ernster VL, Herdman R. et al. Safety of silicone breast implants. Washington, D.C.: Institute of Medicine; 1999
  • 42 McGrath MH, Burkhardt BR. The safety and efficacy of breast implants for augmentation mammaplasty. Plast Reconstr Surg 1984; 74: 550-560
  • 43 Barton FF, Tebbetts JB. Augmentation mammaplasty. Sel Read Plast Surg 1989; 5: 1-26
  • 44 Brandt B, Breiting V, Christensen L. et al. Five years experience of breast augmentation using silicone gel prostheses with emphasis on capsule shrinkage. Scand J Plast Reconstr Surg 1984; 18: 311-316
  • 45 Winding O, Christensen L, Thomsen JL. et al. Silicon in human breast tissue surrounding silicone gel prostheses. A scanning electron microscopy and energy dispersive X-ray investigation of normal, fibrocystic and peri-prosthetic breast tissue. Scand J Plast Reconstr Surg Hand Surg 1988; 22: 127-130
  • 46 Rudolph R, Abraham J, Vecchione T. et al. Myofibroblasts and free silicon around breast implants. Plast Reconstr Surg 1978; 62: 185-196
  • 47 Argenta LC. Migration of silicone gel into breast parenchyma following mammary prosthesis rupture. Aesthetic Plast Surg 1983; 7: 253-254
  • 48 Eisenberg HV, Bartels RJ. Rupture of a silicone bag-gel breast implant by closed compression capsulotomy: case report. Plast Reconstr Surg 1977; 59: 849-850
  • 49 Huang TT, Blackwell SJ, Lewis SR. Migration of silicone gel after the "squeeze technique" to rupture a contracted breast capsule. Case report. Plast Reconstr Surg 1978; 61: 277-280
  • 50 National Institute of Mental Health. Suicide in America: frequently asked questions [Internet]. Rockville: National Institute of Mental Health; cited 2014 Jul 28 Available from: https://www.nimh.nih.gov/health/publications/suicide-in-america/index.shtml
  • 51 Hawton K, Harriss L. The changing gender ratio in occurrence of deliberate self-harm across the lifecycle. Crisis 2008; 29: 4-10
  • 52 Qin P, Agerbo E, Westergard-Nielsen N. et al. Gender differences in risk factors for suicide in Denmark. Br J Psychiatry 2000; 177: 546-550
  • 53 White A, Holmes M. Patterns of mortality across 44 countries among men and women aged 15-44 years. J Mens Health 2006; 3: 139-151
  • 54 Palladino CL, Singh V, Campbell J. et al. Homicide and suicide during the perinatal period: findings from the National Violent Death Reporting System. Obstet Gynecol 2011; 118: 1056-1063
  • 55 Samandari G, Martin SL, Kupper LL. et al. Are pregnant and postpartum women: at increased risk for violent death? Suicide and homicide findings from North Carolina. Matern Child Health J 2011; 15: 660-669
  • 56 Murray D, Cox JL, Chapman G. et al. Childbirth: life event or start of a long-term difficulty? Further data from the Stoke-on-Trent controlled study of postnatal depression. Br J Psychiatry 1995; 166: 595-600
  • 57 Gissler M, Hemminki E, Lonnqvist J. Suicides after pregnancy in Finland, 1987-94: register linkage study. BMJ 1996; 313: 1431-1434
  • 58 Gissler M, Berg C, Bouvier-Colle MH. et al. Injury deaths, suicides and homicides associated with pregnancy, Finland 1987-2000. Eur J Public Health 2005; 15: 459-463
  • 59 Steinberg JR, Becker D, Henderson JT. Does the outcome of a first pregnancy predict depression, suicidal ideation, or lower self-esteem? Data from the National Comorbidity Survey. Am J Orthopsychiatry 2011; 81: 193-201
  • 60 Morgan CL, Evans M, Peters JR. Suicides after pregnancy. Mental health may deteriorate as a direct effect of induced abortion. BMJ 1997; 314: 902
  • 61 Thorslund J. Ungdomsselvmord og moderniseringsproblemer blandt Inuit i Grønland [dissertation]. Holte: SocPol; 1992
  • 62 Kjaer TK, Jensen A, Dalton SO. et al. Suicide in Danish women evaluated for fertility problems. Hum Reprod 2011; 26: 2401-2407
  • 63 da Silva RA, da Costa Ores L, Jansen K. et al. Suicidality and associated factors in pregnant women in Brazil. Community Ment Health J 2012; 48: 392-395
  • 64 Brent DA, Perper JA, Moritz G. et al. Familial risk factors for adolescent suicide: a case-control study. Acta Psychiatr Scand 1994; 89: 52-58
  • 65 Murphy GE, Wetzel RD. Family history of suicidal behavior among suicide attempters. J Nerv Ment Dis 1982; 170: 86-90
  • 66 Gould MS, Fisher P, Parides M. et al. Psychosocial risk factors of child and adolescent completed suicide. Arch Gen Psychiatry 1996; 53: 1155-1162
  • 67 Sahn EE, Garen PD, Silver RM. et al. Scleroderma following augmentation mammoplasty. Report of a case and review of the literature. Arch Dermatol 1990; 126: 1198-1202
  • 68 Spiera H. Scleroderma after silicone augmentation mammoplasty. JAMA 1988; 260: 236-238
  • 69 Schumann D. Health risks for women with breast implants. Nurse Pract 1994; 19: 19-20 3-5, 9-30
  • 70 Brozena SJ, Fenske NA, Cruse CW. et al. Human adjuvant disease following augmentation mammoplasty. Arch Dermatol 1988; 124: 1383-1386
  • 71 Kumagai Y, Shiokawa Y, Medsger Jr TA. et al. Clinical spectrum of connective tissue disease after cosmetic surgery. Observations on eighteen patients and a review of the Japanese literature. Arthritis Rheum 1984; 27: 1-12
  • 72 Oberle K, Allen M. Breast augmentation surgery: a women's health issue. J Adv Nurs 1994; 20: 844-852
  • 73 Maijers MC, de Blok CJ, Niessen FB. et al. Women with silicone breast implants and unexplained systemic symptoms: a descriptive cohort study. Neth J Med 2013; 71: 534-540
  • 74 Overholser JC, Braden A, Dieter L. Understanding suicide risk: identification of high-risk groups during high-risk times. J Clin Psychol 2012; 68: 349-361
  • 75 Implants, IoMUCotSoSB. Bondurant S, Ernster V. et al. Safety of silicone breast implants. Washington (DC): The National Academies Press; 1999
  • 76 Immunology of silicone [Internet]. Washington (DC): National Academies Press (US); 1999. cited 2014 Jul 28 Available from: https://www.ncbi.nlm.nih.gov/books/NBK44795/
  • 77 Stisi S, Cazzola M, Buskila D. et al. Etiopathogenetic mechanisms of fibromyalgia syndrome. Reumatismo 2008; 60 (Suppl. 01) 25-35
  • 78 Russell IJ, Vaeroy H, Javors M. et al. Cerebrospinal fluid biogenic amine metabolites in fibromyalgia/fibrositis syndrome and rheumatoid arthritis. Arthritis Rheum 1992; 35: 550-556
  • 79 Engstrom G, Alling C, Blennow K. et al. Reduced cerebrospinal HVA concentrations and HVA/5-HIAA ratios in suicide attempters. Monoamine metabolites in 120 suicide attempters and 47 controls. Eur Neuropsychopharmacol 1999; 9: 399-405
  • 80 Nordstrom P, Samuelsson M, Asberg M. et al. CSF 5-HIAA predicts suicide risk after attempted suicide. Suicide Life Threat Behav 1994; 24: 1-9
  • 81 Roy A, De Jong J, Linnoila M. Cerebrospinal fluid monoamine metabolites and suicidal behavior in depressed patients. A 5-year follow-up study. Arch Gen Psychiatry 1989; 46: 609-612
  • 82 Asberg M, Traskman L, Thoren P. 5-HIAA in the cerebrospinal fluid. A biochemical suicide predictor?. Arch Gen Psychiatry 1976; 33: 1193-1197
  • 83 Lidberg L, Tuck JR, Asberg M. et al. Homicide, suicide and CSF 5-HIAA. Acta Psychiatr Scand 1985; 71: 230-236
  • 84 Arango V, Huang YY, Underwood MD. et al. Genetics of the serotonergic system in suicidal behavior. J Psychiatr Res 2003; 37: 375-386
  • 85 Wilson KG, Kowal J, Henderson PR. et al. Chronic pain and the interpersonal theory of suicide. Rehabil Psychol 2013; 58: 111-115
  • 86 Sher L. Cosmetic breast implants and suicide. Plast Reconstr Surg 2004; 114: 601-602
  • 87 Holmich LR, Lipworth L, McLaughlin JK. et al. Breast implant rupture and connective tissue disease: a review of the literature. Plast Reconstr Surg 2007; 120: 62S-69S
  • 88 Janowsky EC, Kupper LL, Hulka BS. Meta-analyses of the relation between silicone breast implants and the risk of connective-tissue diseases. N Engl J Med 2000; 342: 781-790
  • 89 Hajdu SD, Agmon-Levin N, Shoenfeld Y. Silicone and autoimmunity. Eur J Clin Invest 2011; 41: 203-211
  • 90 Caldeira M, Ferreira AC. Siliconosis: autoimmune/inflammatory syndrome induced by adjuvants (ASIA). Isr Med Assoc J 2012; 14: 137-138
  • 91 McBeth J, Silman AJ. The role of psychiatric disorders in fibromyalgia. Curr Rheumatol Rep 2001; 3: 157-164
  • 92 Bell IR, Baldwin CM, Schwartz GE. Illness from low levels of environmental chemicals: relevance to chronic fatigue syndrome and fibromyalgia. Am J Med 1998; 105: 74S-82S
  • 93 Richards S, Cleare AJ. Fibromyalgia: biological correlates. Curr Opin Psychiatry 2000; 13: 623-628