Women who receive implants for breast enhancement are an much more likely to commit suicide, according to a new report.

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 gloomy counterpoint to other studies that showed women felt better about themselves after getting 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 did not improve afterward.

Previous studies have shown that up to 15 percent of plastic surgery patients have body dysmorphic disorder, a psychological condition marked by severe distress over minor physical imperfections.

People with the disorder have a higher rate of suicidal thoughts and rarely improve after plastic surgery.

The latest study analyzed data from 3,527 Swedish women who got implants between 1965 and 1993. Cancer patients who received implants as part of breast reconstruction surgery were not included.

Scientists tracked the women for up to 29 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.