Total and cause specific mortality among Swedish women with cosmetic breast implants: prospective study
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7388.527 (Published 08 March 2003) Cite this as: BMJ 2003;326:527All rapid responses
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Perhaps one of the reasons for low self esteem might be a plastic
surgeon inorming you (after double mastectomies!) that "you don't have to
go through life looking like THIS".
Those of us with no problems with our self esteem started thinking
something horrible was wrong with us; then to be assured, and reassured,
that the implants were/are safe, and "no, you are not being used as a
guinea pig." Which is exactly what we were/are being used for.
When I found one breast collapsed (both implants were ruptured, but
only one scar tissue capsule had collapsed), three plastic surgeons tried
to "sell" me on replacements with saline filled implants-- only they did
not use the correct designation: silicone implants with saline filling,
rather than with silicone gel filling!!
This world needs a few doctors willing to emulate Raoul Westenberg
(remember him from World War II?)-- to try to find some answers to this
chemical poisoning that we have been subjected to..Worldwide, there are
millions of us..
Competing interests:
Silicone implant survivor
Competing interests: No competing interests
This study's authors miss the most important clue to the reasons a
disproportionately large number of women with breast implants choose
suicide.
Most breast implants fail over time, even though for decades they
were sold as a "lifetime" device.
With this extremely high rupture rate comes additional surgeries,
infections, and frequently the ultimate loss of the implant along with
breast tissue. Commonly, women suffer from the very painful fibromyalgia
and other often undefined diseases.
The denial of the medical profession as to their illnesses as well as
families experiencing their once healthy and vibrant mother, wife, sister,
or daughter now in chronic pain with no medical solution in sight, leaves
the women feeling more isolated and desperate.
She often then loses her job, her insurance, and the downward spiral
continues.
To ignore the enormous physical harm from ruptured implants and
drawing the fuzzy psychological conclusions the authors have, makes me
wonder about their open minded scientific approach to this growing medical
tragedy.
Ilena Rosenthal
Director, Humantics Foundation for Women
http://www.BreastImplantAwareness.org
FDA Rupture Studies
http://www.fda.gov/cdrh/breastimplants/extracapstudy.html
http://www.fda.gov/cdrh/breastimplants/studies/biinterview.html
Competing interests:
Author:
Breast Implants: The Myths, The Facts, The Women
Founder of Support group: Breast Implants: Recovery & Discovery
Competing interests: No competing interests
I could not help but be interested in the article about suicide and
breast implants.
As a psychology student I am interested in all areas of clinical
depression. The article associate breast implants and suicide, suggesting
a connections. I agree on this point, but I think the suicides come after
the disappointing results and repeated surgeries and the frustration of
not being taken seriously when giving symptoms to the physicians. After
and not before the implantation, does the depression set in.
I also write as a silicone survivor, implanted in 1968 after a
bilateral mastectomy(age 22). With 14 implants in 18 years behind me, I
speak from experience. The depression came after the promise of "newer,
better implants" and the "won't get hard" line.
The high suicide rate does not surprise me. What does surprise me is
that the medical community still thinks that stuffing sacks of silicone
into women's chest is a procedure that will promote good mental health.
Competing interests:
None declared
Competing interests: No competing interests
Perhaps these good doctors will take the word of those women who have
had breast implants for more than 20 years; most of the studies done in
the US have been bought and paid for by manufacturers and plastic surgeons
-- those who profit monetarily from trumped up studies covering only
those women who had the implants for less than 8 years..Had they included
women who had the implants for 15 years or more, AND had they told the
truth, the published story would be a totally different one. As one who
has recently been diagnosed with "silicone induced multiple sclerosis",
and one who has had these symptoms for several years, and been told by
doctors that everything is "okay" - and when I finally was allowed to have
an MRI, was untruthfully told that there were some lesions on the brain,
but a normal amount for someone my age (72 years -- 28 years with
implants); another doctor (looking at the same film) has now told me there
are more than 20 lesions, far more than a "normal amount".Is this cause
for depression??
Lets stop the cover up and lies! Those are the reasons
there are so many suicides -- because doctors seem to be afraid to tell
the truth; we are constantly being lied to -- or offered
tranquilizers..Will making us tranquilized zombies solve the problem?? I
think not - they only deepen the depression and cause more suicides.
Competing interests:
I am a silicone survivor
Competing interests: No competing interests
I decided to get silcone breast implants in 1978 at the age of 29
because I was not happy with my small "B" size breasts. After receiving
the implants, I was elated by the way I looked in my cloths and without
cloths. Around 1984, I was experiencing a host of different health
problems like, unexplained rashes, a constant low-grade fever, joint pain,
hair loss and fatigue. I seen over 20 doctors in an 18 month time period,
hoping one of them could find out what was happening to me. But none of
them could.
By 1990, my health problems continued to grow worse and
included constant infections, muscle weakness,numbness and tingling in
extremities, gastrointestinal problems, dry eyes and mouth, cold
sensitivity, tender-points on my body,cognitive problems such as memory
loss, inability to concentrate, and even clumsiness. My breasts were hard
and painful.I was told I might have Lupus. I was relieved, I finally had a
diagnoses of my symptoms.
In 1993, I was unable to hold a job because of
missing too much work for my health problems. It was like having the flu
everyday. Both my breasts were hard and had mis-shapened, one was moving
up toward my shoulder and had what felt like a bubble on the side near my
armpit.
In November 1993 I had the implants removed. Both implants were
grossly ruptured as well as the scar capsules that surrounded the
implants, spilling silicone into my chest cavity. My natural breast tissue
had to be removed because silicone was inter-mingled throughout my breast
tissues and planes. Because I wanted and got breast implants, I was left
with no breasts at all and the deformity is simliar to having breast
cancer.I did have a nipple reconstruction because silicone had to be
scraped out from behind them, leaving them folded over and sunkin into my
chest. My health has gradually returned to almost normal except now my
lungs are turning fibrosis causing difficulty in breathing and a heavy
feeling in my chest. I have never smoked cigarettes. I am 53 years old now
and at a new place in my life, older and wise enough to know that breast
size really doesn't matter. Having bigger breasts are not really important
in life, good health and loving relationships are what really matters. I
just wish I would have realized that when I was 29.
Sincerely,
Diana Reynolds
Competing interests:
Personal experience of a woman that had silicone breast implants for 15 years.
Competing interests: No competing interests
To the Editor of the British Medical Journal:
I am responding to the recent study, Total and cause specific
mortality among Swedish women with cosmetic breast implants: prospective
study, published in the March 8, 2003 edition of the in the British
Medical Journal.
http://bmj.com/cgi/content/full/326/7388/527?eaf
Finding fault with those who have been harmed is a strategy used to
discredit the injured. It is the same strategy used by trial lawyers to
discredit women injured by other harmful acts like rape. If this study is
to be taken seriously, then one has to believe that millions of women from
around the world, who have had implants, must all have low self-esteem or
be mentality unstable.
We live in a world society where "image is everything" and that
message is constantly being fed to us in news reports, on billboards,
perfume and clothing ads in every magazine and newspaper. Doctors and
surgeons, in their direct advertising to the public, are also selling and
promoting their latest and greatest technology, which they assert helps
you feel better about being you.
We see extreme makeovers on television where the recipients of
plastic surgery exclaim how happy they are with the results and proudly
tell the world what a boost to their confidence the surgery gave them.
Everyone I know desires, to some degree, to improve their appearance, does
that make everyone mentally unstable?
The results of this study appear to me as a maneuver to deflect the
attention from some of the real problems of breast implants and other
medical devices. A few of the problems I have with the study are as
follows:
1.The study only included women who had breast implants for less than
one year. This is a major statistical flaw that impairs and prevents
factual analysis and accurate results. Suicide from having breast implants
does not happen within one year but over a period of years.
2.The fact that women have to endure multiple surgeries to correct
common complications as a result of ruptures and contractures and that
these complications increase over time would should be included in a study
on suicide and wasn't here.
3.Elastomers particles from the shell and silicone gel leaking from
ruptured implants migrate to distant organs include the lungs and liver. A
foreign body reaction to these materials and other complications like
cancer were also overlooked.
Perhaps the increase incident of suicide, once women have received
implants, was from exposure to platinum or other chemicals used in the
manufacturer and leach out from aging and degrading implants over a period
of time?
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd
=Retrieve&db=PubMed&list_uids=12589499&dopt=Abstract
If the women were mentally unstable before receiving implants, then
what does that say about the judgment and ethical conduct of the doctors
who put these products into unstable women? Couldn’t that be viewed as
exploiting vulnerable women for profit?
I cannot help but see this study for what it is, just another tactic
in the ongoing discrimination to trivialize, discredit and demean women
injured by breast implants.
Sincerely,
Ruby Rahn
5740 NW Union Chapel Road,
Parkville, MO 64152
rubyrm@yahoo.com
Competing interests:
I was harmed by breast implants
Competing interests: No competing interests
I hope this study will help to confirm the fact that implants carry
more serious risks than now thought. However, this comment really gets
to me.
"Given the well documented link between psychiatric disorders and a
desire for cosmetic surgery, the increased risk for death from suicide may
reflect a greater prevalence of psychopathology rather than a causal
association between implant surgery and suicide.3 "
I have seen this allusion several times in regards to the women who
have committed suicide after getting implants. Of course, we may not know
the real reasons the women have killed themselves, but I can tell you that
almost every single one of the women I have spoken to or communicated with
that was sick has thought of suicide at one time or another. I think that
most women don't carry out the actual act of killing, and so the numbers
of suicidal women are way higher than these studies show. I speak from
personal experience, as I was often suicidal, or had thoughts of wanting
to die during my illness. Since I no longer feel that way, I take
exception to the idea that I am psychopathic to begin with. That is simply
not the case. I am a normal, average human being. The plain and simple
truth is that the illness we suffer from, when our immune systems are
destroyed and we cannot even function, is what causes us to have suicidal
thoughts. We no longer feel the desire to struggle through each day. We
no longer have motivation to live. We feel no hope or way out. We want
our suffering to end. We don't see an end in sight, when doctors keep
telling us that our illness is in our heads when we know darn well that
there is something wrong but no one can tell us what or why or how to get
better. I have had discussions with other women that confirms this
tendency to suicidal thought, and I am astounded at how many have said
they wanted to commit suicide because of their illness, but have not done
so because of husbands, children or parents. This idea that we are
psychopaths already and that is why there are more suicides is just plain
wrong! It is the illness that makes us want to die, not a mental
dysfunction that was already in place. How can we get that idea across?
How can we make others understand just how devastating this illness is to
us when all the other tests come out normal? How can this suicidal
tendency from breast implants be quantified? This is one piece of the
puzzle that needs answering, so professionals can understand just how
devastating breast implants are for those that become ill, because all we
ever hear is how much of a confidence builder breast implants are--and
THAT IS TRUE UNTIL WE GET SICK. I had much more confidence in myself
after I got breast implants. I was happier than I had ever been in my
life. I was not a psychopath! But my illness at its worst took away my
desire to live, and I felt like a social paraiah. I remember those dark
days well, though I would rather forget.
Thankfully, I am doing so well today that I am almost back to normal.
I do have Hashimoto's, thanks to implants. I will have to take thyroid
meds for the rest of my life, and go back regularly for blood work to
tweek my dosages. It isn't fun. But I think I walked away from my breast
implant nightmare a lucky lady, relatively speaking. It was only by the
grace of God that I didn't commit suicide and become one of those numbers.
Competing interests:
Founder of Saline Support breast implant support group on Yahoo groups
Competing interests: No competing interests
Dear Sir/Madam,
I think it has something to do with all the hype surrounding breast
implants. Many of these women are suffering from "poor self image" and are
easily attracted by the media created hype. They start thinking that it is
the end of all their problems, which however is not true. Not
unexpectedly, implants fall short of their expectactions. We know that
implants are not a solution to this problem. More effort should be
concentrated on helping them improve their self image and not in
reinforcing the myth. They should be actively discouraged from choosing
this option and must instead be taught to respect their "body".
Competing interests:
None declared
Competing interests: No competing interests
The findings provide an interesting comparison and are for the most
part consistent with a study by the National Cancer Institute in the U.S.
conducted by Dr. Louise Brinton et al. However, the Brinton et al study
found an increase in suicides and some cancers compared to other plastic
surgery patients. If women who undergo plastic surgery have more
psychological problems than the general population, that would not explain
the difference between suicide rates of breast augmentation patients
compared to other women who underwent liposuction, rhinoplasty, and other
plastic surgery at a similar age.
The Brinton results suggest that the increased vulnerability of
plastic surgery patients is not the only explanation for the increased
risk of suicide. Compared to most other plastic surgery patients, implant
patients suffer from complications that tend to increase over time.
Implant manufacturers report that many implant patients need additional
surgery within the first three years, and that ruptures and other
complications continue to increase over time. Our Center receives letters
every week from women whose implants are broken and who are unable to
afford to have them removed. Many of these women are quite desperate,
especially in cases where silicone is migrating to other organs. Other
women describe deformities and pain caused by their implants. Although
Swedish women apparently have better access to medical care if
complications arise, some of these complications are extremely difficult
to fix. It is certainly possible that such problems may cause an increase
in suicides.
It is also important to note that the Brinton study found that
augmentation patients were three times as likely to die from lung cancer
and other respiratory diseases compared to other plastic surgery patients,
even though augmentation patients were no more likely to smoke than other
plastic surgery patients. Although the augmentation patients who died of
lung cancer were all smokers, augmentation patients who smoked were more
likely to die than other plastic surgery patients who smoked. Since
silica exposure is linked to lung cancer, it is possible that leakage from
silicone implants increases the risk of lung cancer among smokers by
irritating or damaging the lungs. It is unfortunate that the Koot et al
study apparently did not statistically control for smoking, because it is
possible that they too would have found an increased risk of lung cancer
linked to breast implants, even among smokers.
A flaw of the Koot et al study is that it included women who had
breast implants for less than one year. This certainly weakens the power
of the statistical analysis, since one would not expect implants to cause
mortality in such a short time. In contrast, the Brinton et al study
included women who had breast implants for at least 8 years. Even that is
not ideal; it would be more appropriate for a study of implants and cancer
to only include women who had breast implants for at least 10-15 years.
Diana Zuckerman, Ph.D.
President
National Center for Policy Research (CPR) for Women & Families
1901 Pennsylvania Avenue, NW
Suite 901
Washington, DC 20006
202 223-4000
www.center4policy.org
Competing interests:
None declared
Competing interests: No competing interests
Body Dysmorphic Disorder?
To Whom It May Concern,
Koot et. al. recently reported an increased risk of suicide amongst
patients who received cosmetic breast implants (1). The Somatoform
Disorder known as Body Dysmorphic Disorder involves a preoccupation with a
defect in appearance and the defect is either imagined, or, if a slight
physical defect is present, the patient's concern is markedly excessive
with subsequent impairment of social or occupational functioning (2). The
patient's distress may lead to suicidal ideation, suicide attempts, and
completed suicide (2,3). It has been estimated that between 6% to 15% of
cosmetic surgery and dermatology patients suffer from this disorder (2).
Consequently, it behooves cosmetic surgeons to seek psychiatric
consultations preoperatively for the purpose of ruling out Body Dysmorphic
Disorder and have it treated if present. Perhaps only then can the
elevated suicide rate associated with breast implants be diminished.
References
1.Koot VCM, Peters PHM, Granath F, Grobbee DE, and Nyren O. Total and
cause specific mortality among Swedish women with cosmetic breast
implants: prospective study. British Medical Journal. 326:527-528.
2.Diagnostic and Statistical Manual of Mental Disorders, Fourth edition,
Text Revision. American Psychiatric Association. American Psychiatric
Press. Washington, D.C. 2000
3.Phillips KA, McElroy SL, Keck PE, Pope HG, Hudson JI. Body Dysmorphic
Disorder: 30 Cases of Imagined Ugliness. American Journal of Psychiatry.
150:2 302-308.
Competing interests:
None declared
Competing interests: No competing interests