Women who get cosmetic breast implants are nearly three times as likely to commit suicide as other women, US researchers reported.

The study, published in the Annals of Plastic Surgery, reinforces several others that have shown women who have breast enlargements have higher suicide risks.

Loren Lipworth of the Vanderbilt University Medical Center in Tennessee and colleagues followed up on 3,527 Swedish women who had cosmetic breast implant surgery between 1965 and 1993. They looked at death certificates to analyze causes of death among women with breast implants.

Only 24 of the women had committed suicide after an average of 19 years, but this worked out to triple the risk compared to the average population, they reported. Doctors who perform cosmetic breast surgery may want to monitor patients closely or screen them for suicide risk, Lipworth said.

'The increased risk of suicide was not apparent until 10 years after implantation,' the researchers wrote.

Lipworth said she believes that some women who get implants may have psychiatric problems to start with, perhaps linked with lower self-esteem or body image disorders.

'I think we don't even know how big of a problem it is because we cannot even pinpoint what proportion of women have psychiatric disorders,' Lipworth said in a telephone interview.

'There could be a whole lot of different disorders.'

Women with breast implants also had a tripled risk of death from alcohol and drug use.

'Thus, at least 38 deaths (22 per cent of all deaths) in this implant cohort were associated with suicide, psychological disorders and/or drug and alcohol abuse/dependence,' the researchers wrote.

They found no increase in the risk of death from cancer, including breast cancer. Women with implants were more likely to die from lung cancer and respiratory diseases, such as emphysema, but this is probably because they were more likely to smoke, the researchers said.

Last year, Canadian scientists also found a higher risk of suicide among women who got breast implants, although they had lower rates of other diseases, including cancer.

In November, the US Food and Drug Administration okayed the sale of silicone breast implants for the first time in 14 years, after years of hearings on their safety.

The FDA said independent research over the past decade has found no convincing evidence that breast implants were associated with connective tissue diseases or cancer.

While silicone implants were banned, women could only use saline-filled breast implants. Plastic surgeons say women prefer the silicone ones, and Lipworth said most of the women in her study had silicone implants.

In 2006, 383,886 US women had breast augmentation, according to the American Society for Aesthetic Plastic Surgery. It was the second-most common surgical cosmetic procedure, after liposuction.Reuters