Bilateral breast reduction surgery in England: a postcode lottery

Area of Science:

• Plastic Surgery
• Health Services Research

Background:

• Bilateral breast reduction (BBR) offers proven benefits but is often deemed cosmetic and subject to rationing.
• National guidelines exist, but local implementation by Primary Care Trusts leads to variations.

Purpose of the Study:

• To survey and analyze the funding criteria for BBR across all English Primary Care Trusts.
• To identify variations in local implementation of national guidelines for BBR.

Main Methods:

• A survey was distributed to all 303 Trusts in England regarding their BBR funding criteria.
• A response rate of 81% (245 Trusts) was achieved.

Main Results:

• Only 11 Trusts accurately followed national NHS guidelines.
• Significant variations in criteria were observed, including maximum BMI (198 trusts), accepted indications like musculoskeletal symptoms (187) and intertrigo (117), and bra requirements (31).
• Many Trusts imposed additional restrictive criteria beyond national guidelines.

Conclusions:

• Considerable variation in local funding criteria for BBR leads to inequalities in provision, exemplifying the UK's healthcare 'postcode lottery'.
• The reconfiguration of Trusts presents an opportunity to rationalize BBR provision.
• Findings and guidelines will be distributed to new Trusts and NICE to promote standardization.