Northumberland Health Authority guidelines for referral

Reduction mammoplasty surgery: guidance on potential referrals The following conditions apply to all cases:

  1. 1 Absolute weight limit of 75 kg This is imposed because of a 90% complication rate in patients above this weight.
  2. Upper BMI limit of 27
    This is because of variation in breast volume associated with overall body fat.
  3. Minimum breast volume as assessed by bra size
    There is agreement between surgeons that there should be a minimum of 500 gm tissue removed from each breast for the procedure to be justifiable. This is difficult to assess in practice, and so has been translated into minimum bra cup sizes for different chest measurements.
     
    Chest measurement (in) Cup size
    32/34 >=E
    36 >=EE
    38 >=F
    40/42 >F

    (once women have reached size 40/42, they are likely to have a significant weight problem which should be addressed prior to surgery anyway)

Where physical symptoms are the reason for surgery:

  1. Well fitting bra
    Neck, back and shoulder pain are frequently attributed to breast volume, but are more likely to be due to an ill-fitting bra. There is a tendency to wear a bra with an inadequate cup size and which is too large around the chest, which consequently offers no support. A well fitting bra should be acquired and worn prior to consideration of referral.
  2. Physiotherapy for back pain
    Where back pain is the main reason for requesting the surgery, it is suggested that poor posture is often associated with embarrassment regarding breast volume. In such cases, it is worth tying physiotherapy prior to considering suitability for surgery.

Where psychological reasons are the reason for surgery:

  1. Objective evidence of severe disabling psychological distress directly attributable to breast volume
    The general guidelines apply and significant treatment requirements (drugs or otherwise) are taken as an objective indicator of the severity of distress.