Women asking for breast implants should be screened for subtle signs of mental problems, says a study linking them to an increased suicide risk.
Breast implant surgery is a common operation
The research, carried out by Dutch scientists, found that there were almost three times the rate of suicides among women who had received breast implants compared with the population at large.
They say that a desire for breast augmentation may, in some women, be a symptom of a far deeper insecurity and low self esteem which, in extreme cases, could trigger a suicide attempt.
The vast majority of breast implants are carried out privately in the UK, and it is established good practice for doctors to evaluate the psychological state of the patient who wants to undergo the procedure.
The researchers, from the University Medical Centre in Utrecht, looked at records of 3,521 Swedish women aged between 15 and 69 who had had breast implants between 1965 and 1993.
The causes of any deaths in the group were analysed, and compared with the death rate in a similar group of women from the general population.
They found that the majority of causes of death were found in the same amount in both groups.
However, there were 15 suicides in the breast implant group compared with five expected in the other group.
These women should first seek help for their psychological problems before seeking cosmetic surgery
Dr Veronica Koot, University Medical Centre, Utrecht
Dr Veronica Koot, who led the study, told BBC News Online that the consultation prior to the operation was an opportunity to make sure that the patient did not have any underlying mental health problems.
She said: "We think that some of the women who ask for cosmetic surgery - for instance breast implants - actually do have another problem, and if you operate, it won't help them.
"These women should first seek help for their psychological problems before seeking cosmetic surgery."
She said that she felt that in the Netherlands, cosmetic surgeons were now far better at spotting women who might be at risk.
However, she added: "There should be some kind of training for these doctors - they are not experienced psychologists."
The study was published in the British Medical Journal.