Suicide among women with cosmetic breast implants: a review of the epidemiologic evidence.

Recent epidemiologic studies of women with cosmetic breast implants indicate a statistically significant 2- to 3-fold increase in suicide risk when compared with the general population. Over the last decade, of the large number of epidemiologic studies on various long-term adverse health outcomes among implant recipients, this excess of suicide is the only serious adverse effect supported by credible research. But an association of suicide with cosmetic breast implants based on comparisons with the general population does not by itself support a cause-and-effect relationship regarding the role of implants. Etiologic epidemiologic research is urgently needed to evaluate whether the association between breast implants and suicide is spurious (e.g., reflecting increased prevalence of underlying psychopathology and other risk factors for suicide in women seeking implants) or reflects an actual role for implants in suicide. As a first step, sound epidemiologic nested case-control studies are required to characterize the preimplant psychiatric history of women with implants who commit suicide compared with women with implants from the same cohort who do not commit suicide. Second, large-scale retrospective cohort studies are needed to compare suicide rates among women with implants versus those among women without implants matched on preimplant diagnoses of psychiatric disorders, year of diagnosis, year of birth, family history of psychiatric admissions, and other relevant factors that influence suicide risk. This type of large-scale complex epidemiologic research may be difficult to complete in countries with restrictive privacy laws and widespread litigation, but only after such appropriate etiologic research is completed can any credible cause-effect inference be made regarding the role, if any, of cosmetic breast implants in suicide.