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Women who receive implants for breast enhancement are three times more likely to commit suicide, according to a new report that offered a sobering view of an increasingly popular surgery.

Deaths related to mental disorders, including alcohol or drug dependence, also were three times higher among women who had the cosmetic procedure, researchers said.

The report in the August issue of the Annals of Plastic Surgery was the most recent to detect a higher suicide rate among women who had their breasts enlarged, providing a counterpoint to studies that showed women felt better about themselves after implants.

While the study did not look at the reasons behind the suicides, senior author Joseph McLaughlin, a professor of medicine at the Vanderbilt University School of Medicine, said he believed that many of the women had psychological problems before getting breast implants and that their condition didn't improve afterward.

Controversy has long dogged the procedure. Last year, the Food and Drug Administration ended a 14-year ban on silicone-filled implants after finding little evidence the devices were unsafe. But the agency required manufacturers to conduct 10-year studies of 10,000 women each to look for long-term health consequences, including possible suicides.

The latest study analyzed data from 3,527 Swedish women who got implants between 1965 and 1993. Scientists tracked the women for years after their implant surgeries and found the risk of suicide increased over time. There was no increased risk during the first 10 years after surgery, researchers said. Suicide risk was 4.5 times higher 10 to 19 years after surgery and six times higher after 20 years.

Researchers said the results might have limited applicability today because breast augmentation is more socially acceptable than it was 40 years ago.