Summary
Introduction
There is good evidence for the benefits of bilateral breast reduction (BBR). However,
such surgery is often considered cosmetic and is rationed. The NHS Modernisation Agency
and the British Association of Plastic Surgeons (as was) have produced national guidelines,
but Primary Care Trusts adapt these for local implementation.
Methods
We surveyed the funding criteria for BBR of all 303 Trusts in England. 245 (81%) responded.
Results
The NHS guidelines were followed accurately by only 11 Trusts. 198 trusts specified
a maximum BMI (range 25 to 32; guideline 30). 187 accepted musculoskeletal symptoms
as an indication and 117 accepted intertrigo. 31 required a professionally fitted
bra.
Many Trusts included other restricting criteria that are not in the NHS guidelines.
Some Trusts mentioned the American Society of Plastic Surgeons' guidelines, but did
not follow them wholly.
Conclusions
Even with explicit guidelines, considerable variation in local funding criteria exists
with resultant inequalities in provision. The so-called ‘postcode lottery’ of healthcare
in the UK is rife within Plastic Surgery.
The recent reconfiguration of English Primary Care Trusts provides an excellent opportunity
for the rationalisation of BBR provision and to this end we will distribute our findings
and the NHS guidelines to the new Trusts and to the National Institute for Health
and Clinical Excellence.
Keywords
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Article info
Publication history
Published online: May 10, 2007
Accepted:
March 6,
2007
Received:
January 16,
2007
Footnotes
☆This paper was presented at the Winter Meeting of the British Association of Plastic, Reconstructive and Aesthetic Surgeons at the Royal College of Surgeons of England, London on 8 December 2006.
Identification
Copyright
© 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
