title: The "postcode lottery" for the surgical correction of gynaecomastia in NHS England.
abstract: BACKGROUND
  Action On Plastic Surgery (AOPS) criteria for funding of gynaecomastia surgery are: the patient should be post-pubertal, have a BMI ≤ 25 kg/m(2), endocrine and drug causes and breast cancer should be excluded and the patient should demonstrate psychological distress. We evaluated how NHS funding for gynaecomastia surgery varies between Clinical Commissioning Groups (CCGs) in England and whether there is a "postcode lottery".
  
  
  METHODS
  The gynaecomastia surgery policies for 211 CCGs in NHS England were reviewed against the AOPS criteria and grouped according to their funding policies: group 1 (if criteria met, funding approved); group 2, (if criteria met, prior approval required); group 3 (no criteria, individual funding request only) and group 4 (no funding).
  
  
  RESULTS
  Policies were available for all CCGs. Fifty-nine (28.0%) CCGs were in group 1, 87 (41.2%) in group 2, 44 (20.9%) in group 3 and 21 (10.0%) in group 4. Of those in groups 1 and 2, five (3.4%) CCGs used all six AOPS criteria. Approximately 70% CCGs with criteria (in groups 1 and 2) stipulated that the patient should be post-pubertal, have a BMI ≤ 25 kg/m(2) and endocrine and drug causes should be excluded. Breast cancer should be excluded in 51.4% and the patient should show psychological distress in 13.7% CCGs. Of those in groups 1 and 2, 118 (80.8%) CCGs specified additional criteria.
  
  
  CONCLUSIONS
  CCGs do not use the AOPS criteria uniformly and restrict surgery according to their own criteria. Overall, there is a "postcode lottery" for gynaecomastia surgery within NHS England.
authors.affiliation: Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK. Electronic address: rjgs@doctors.org.uk.
authors.forename: Roger J G
authors.initials: RJ
authors.lastname: Stevens
authors.affiliation: Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
authors.forename: Samantha G
authors.initials: SG
authors.lastname: Stevens
authors.affiliation: Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Rusby
mesh_terms: D004739:England; D006177:Gynecomastia / Q000601:surgery*; D006291:Health Policy; D006801:Humans; D008297:Male; D018579:Patient Selection; D013222:State Medicine
keywords: Clinical Commissioning Group; Funding; Gynaecomastia; National Health Service