Healthy Skepticism Library item: 6355

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Publication type: news

Hanes A.
In the bosom of death
National Post 2006 Oct 11
http://www.canada.com/nationalpost/news/bodyandhealth/story.html?id=23a024e2-5fe5-4c3d-b511-2478a2f399d4

Full text:

In the bosom of death
Suicide risk is high among breast implant recipients, Canadian study says

Allison Hanes
National Post

Wednesday, October 11, 2006

New research pointing to the high risk of suicide among breast augmentation
patients is generating debate as Health Canada reviews its restrictions on
silicone implants.

In 2000, P.J. Brent was dismissed as an anecdotal anomaly when she testified
before the U.S. Food and Drug Administration about the chronic health
problems she suffered from her breast implants.

The 49-year-old mother of seven became a sad statistic two months later when
she leapt to her death from a five-storey parking garage in Atlanta, Ga.

Just how significant a statistic became apparent when a new Canadian study
published in the latest edition of an American medical journal reported a
73% higher rate of suicide among women with breast implants than the general
population.

Although the number of suicides was just a handful from among tens of
thousands of subjects, the Canadian research echoes the results of half a
dozen recent studies from the United States and Scandinavia. It has experts
speculating on the psychological, sociological and physiological
explanations for the alarming trend.

The news has reignited a debate about the safety of implants in the midst of
a Health Canada review of its restrictions on silicone implants, which were
pulled from general use in 1992 amid safety concerns.

Published in the latest issue of the American Journal of Epidemiology, the
Canadian study compared mortality rates for 24,558 women in Ontario and
Quebec who received breast implants between 1974 and 1989, as well as 15,893
women who had other types of plastic surgery, with those in the general
population.

The average age of the subjects was 32, and all the implants were done for
cosmetic reasons, as opposed to post-mastectomy reconstruction.

The good news, said Jacques Brisson, a Universite Laval breast cancer
specialist and one of the authors of the study, is that women with implants
had a 26% lower mortality rate overall. There was also a reduced incidence
of breast cancer, he said, likely due to the women having less breast
tissue.

The bad news is the elevated suicide risk.

Women with implants were 73% more likely to take their own lives than the
general population, while women who underwent liposuction, facelifts or
tummy tucks faced a 55% higher risk.

Dr. Brisson pointed out the total number of suicides was quite low — only
58 women with implants killed themselves, versus 33 who had other types of
cosmetic surgery. “It is still a small number, so the risk is still small.”

But the results have prompted questions about whether some women who opt for
breast augmentation may be predisposed to suicide because of underlying
emotional problems, or whether the implants themselves are to blame.

Richard Warren, a member of the Canadian Society of Plastic Surgeons and a
clinical professor of plastic surgery at the University of British Columbia,
said patients seeking nose surgery traditionally have been considered most
at risk to suffer mental distress.

“The thing that’s different about breast surgery is that it tends to be a
slightly younger person [undergoing] it,” Dr. Warren said. “There are
issues, such as are there other people involved in that person’s life who
may or may not want them to do this? Are they thinking that having changed a
secondary sexual characteristic that their relationships with men will
change?”

Plastic surgeons are trained to be on the lookout for psychological
troubles, but Dr. Warren says there is currently no formal screening
process, adding it all comes down to the doctor-patient relationship.

“My personal experience with sending patients to a psychiatrist for an
assessment … is I have been successful sometimes, but it is quite often
taken as an insult,” Dr. Warren said. “At that point, you are out of the
loop.”

Joyce Attis says attributing the suicide rate among breast implant patients
to mental deficiency is simply blaming the victim.

“It’s very insulting, it’s very demeaning,” said the president and founder
of the Breast Implant Line of Canada and the lead plaintiff in a
class-action lawsuit against Health Canada.

To Ms. Attis, who had a silicone prosthetic inserted in 1972 and removed 20
years later, the more likely explanation for the suicides is the despair
women feel when their implants ruin their health. Ms. Attis had her right
breast done because it had never developed due to a congenital condition.

By the late 1970s, her implanted breast had hardened and was extremely
painful and she was experiencing a range of debilitating symptoms that
stumped her doctors. One even inserted a steel rod in her spine in an
attempt to ease chronic pain in her back and rib cage. But nothing helped
and no one could conclusively diagnose her ailments.

When she had her implant removed in 1992, it was discovered to have ruptured
earlier, leaking silicone throughout her body.

Today, Ms. Attis suffers from fibromyalgia, lupus syndrome and osteoporosis.
She is on heavy pain medication.

“A lot of women are tortured because of the amount of physical pain that
they go through,” she said. “They’re not getting answers, and many women are
put off and told there is nothing wrong with them. That, I would say, is the
cause for the suicides. And at that point, yes, they are psychologically
affected and psychologically dysfunctional.”

P.J. Brent is a prime example.

After she jumped to her death on May 29, 2000, an autopsy found platinum, a
component of the implants, in her heart, lungs and brain.

Her husband, Ed Brent, remembers the pathologist’s words: “He said, ‘A woman
with that much platinum in her brain could not have been thinking
rationally.’ “

Mr. Brent said his wife was in despair over the sickness her implants caused
herself and her two youngest daughters.

She had her breasts done in 1982 in a futile bid to save her failing first
marriage. When she remarried Mr. Brent, she breast-fed two more daughters
despite her implants. The health of all three subsequently deteriorated.

On her best mornings, she woke up feeling as if she had the flu. Her joints
hurt, her fingers swelled, she had lupus-like symptoms and she was diagnosed
with chronic fatigue syndrome.

Her youngest daughters have a disorder that makes swallowing difficult. The
eldest of the pair has suffered gastrointestinal ailments, wore leg braces
as child and today relies on a wheelchair.

It wasn’t low self-esteem that drove Mrs. Brent to take her own life, her
husband said. “It was guilt, it was pain, it was looking for a way out.”

Anne Rochon Ford, co-ordinator of the Women and Health Protection Group,
fears the suicide rate will only go up as younger and younger women opt for
surgery – sometimes as soon as they turn 18.

“It’s become institutionalized and it’s just the norm to think there’s
nothing wrong, there’s nothing harmful about undergoing these procedures,”
Ms. Rochon Ford said.

“The larger societal issue is, how is it that we’re breeding this population
of girls and women who are so dissatisfied with how they look?”

A GUIDE TO IMPLANTS

Since 1992, silicone gel-filled breast implants have been available in
Canada only through Health Canada’s Medical Devices Special Access Program.
The patient’s surgeon or doctor must demonstrate that conventional therapies
have failed, are unavailable or are unsuitable. There have been no refusals
of special access program requests for silicone implants since December,
2004. Last year’s approval rate was 100%. The department granted requests in
8,513 cases last year, although it cannot confirm that all operations were
carried out. Health Canada

There were 364,610 breast augmentations performed in the United States last
year, up 9% from 2004. Of those, 83.4% involved saline implants and 16.6%
were silicone. American Society of Aesthetic Plastic Surgery

Nearly 175,000 adolescents in the United States aged 18 or under had
cosmetic surgery in 2005, with breast augmentation being one of the most
popular procedures. Breast implants are frequently requested as a high
school graduation gift. National Research Center for Women and Families

Breast implants are not considered to be lifetime devices. Whether implant
surgery is for the purpose of reconstruction or augmentation, you will
likely need additional surgeries and visits to your surgeon over time. At
some point, your implants will probably have to be removed, and you will
have to decide whether or not to replace them. Some women believe breast
implants cause systemic illnesses such as autoimmune disease or connective
tissue disease. To date, there is no definite proof that this is the case.
Health Canada’s “It’s Your Health — Breast Implants” Web site

Canadian provincial health insurance programs do not cover the cost of
breast augmentation for cosmetic reasons; however, the cost of the surgery
can be a personal income tax deduction. The average cost of breast implant
surgery in Canada is $5,500 to $6,500. Canadian Society for Aesthetic
Plastic Surgery

POSSIBLE COMPLICATIONS ASSOCIATED WITH BREAST IMPLANTS:

- May interfere with detection of breast cancer;

- Can rupture during mammograms;

- Can leak or deflate;

- Hardening of the surgical incision scar, causing pain, distortion or
displacement of the implant;

- Varying degrees of pain;

- Infection;

- Change or loss of nipple sensation;

- Dead tissue around the implant;

- Atrophy of breast tissue;

- Possible risk of connective tissue disease;

- Calcium deposits that can interfere with mammograms;