Breast augmentation is one of the most commonly performed plastic surgery procedures. It is estimated that approximately 2 million women in the United States have breast implants. Since 1992, an explosion of scientific data has shown breast implants to be safe and efficacious. Although breast augmentation patients are generally similar to other women, some investigators have reported that the suicide rate in breast augmentation patients is higher than that of the general population.

Each year in the United States, approximately 5700 women commit suicide, for an overall annual suicide rate of approximately 4 women per 100,000. If breast augmentation patients were fully representative of the general US population of women, their suicide rate would also be expected to be approximately 4 per 100,000 annually. However, breast augmentation patients differ slightly from the general population of women with respect to certain important variables. Crucially, small differences on important variables can combine to produce substantial differences in suicide rates, and virtually every issue on which breast augmentation patients differ from the general population is highly relevant to suicide.

The question, then, is not whether the suicide rate among breast augmentation patients differs from that of the general population; as this study will show, we would expect it to differ, given the differences on key variables between breast augmentation patients and other women. The critical questions are, given the demographic and other characteristics of breast augmentation patients, what should their suicide rate be, what is it, and what are the implications of any difference between these rates?

Methods

The literature was reviewed in an attempt to characterize the demographic, behavioral, and other qualities of the prototypical breast augmentation patient compared with those of the general population of US women. These were used to develop a formal estimate of the expected rate of suicide among breast augmentation patients, which was then compared with established estimates of its actual rate.

Results

Characteristics of the prototypical breast augmentation patient compared with women in general

Race

Breast augmentation patients in the United States are overwhelmingly white. Estimates of the percentage of whites among women undergoing breast augmentation exceed 95% in one study, so few nonwhite patients were available that the researchers were forced to focus only on white women. By contrast, the general US population is racially diverse and becoming more so. Recent estimates indicate that approximately 75% of the US population is white.

Age

Breast augmentation patients generally range in age from 25 to 44 years.In the study by Cook and colleagues, [7] 79% of breast augmentation patients were in this age range; the figure was 81% in a study by Brinton and colleagues. [6] A similar proportion was reported among Swedish women. Naturally, the ages of women in the general population are far more variable.

Marital status

Although it is somewhat less clear than race and age differences, there appears to be a tendency for a higher percentage of breast augmentation patients than other women to be divorced or separated. In the report by Cook et al,28.8% of breast augmentation patients were divorced, separated, or widowed (presumably very few were widowed, given the young average age of the women), relative to 18.1% in the comparison group. This difference produces a significant ?2 statistic (?2 = 5.87, degrees of FREEDOM = 1, N = 3570). We must emphasize that although the relative difference in divorce rates between breast augmentation patients and other women is important, the absolute rates of divorce among breast augmentation patients do not appear particularly high. This same point applies to the other variables reviewed below (eg, smoking, alcohol use, depression). Important relative differences exist between breast augmentation patients and other women with regard to these variables, but the absolute rates of these problems are low in breast augmentation patients, most of whom do not experience these problems