title: Bilateral breast reduction surgery in England: a postcode lottery.
abstract: BACKGROUND
  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.
authors.affiliation: Department of Plastic Surgery, Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex RH19 3DZ, UK. will.wraight@doctors.org.uk
authors.forename: William M
authors.initials: WM
authors.lastname: Wraight
authors.forename: Sherilyn K L
authors.initials: SK
authors.lastname: Tay
authors.forename: Charles
authors.initials: C
authors.lastname: Nduka
authors.forename: John A
authors.initials: JA
authors.lastname: Pereira
mesh_terms: D000886:Anthropometry; D015992:Body Mass Index; D001940:Breast / Q000473:pathology; D004739:England; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D015276:Health Care Rationing / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D016462:Mammaplasty / Q000191:economics / Q000523:psychology / Q000592:standards*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D013222:State Medicine / Q000592:standards