Should breast reduction surgery be rationed? A comparison of the health status of patients before and after treatment: postal questionnaire survey

BMJ 1996;313:454-457 (24 August)

Papers

Should breast reduction surgery be rationed? A comparison of the health status of patients before and after treatment: postal questionnaire survey

Anne Klassen, research officer,^a Ray Fitzpatrick, professor of public health and primary care,^b Crispin Jenkinson, deputy director,^a Tim Goodacre, consultant plastic surgeon ^c

^a Health Services Research Unit, Department of Public Health and Primary Care, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE, ^b Department of Public Health and Primary Care, University of Oxford, ^c Department of Plastic and Reconstructive Surgery, Radcliffe Infirmary, Oxford OX2 6HE

Correspondence to: Professor Fitzpatrick.

Abstract

Objectives: To assess the health status of patients before andafter breast reduction surgery and to make comparisons withthe health status of women in the general population.
Design: Postal questionnaire survey sent to patients beforeand six months after surgery.
Setting: The three plastic surgery departments in the OxfordRegional Health Authority, during April to August 1993.
Subjects: 166 women (over the age of 16 years) referred forbreast reduction; scores from the "short form 36" (SF-36) healthquestionnaire completed by women in the 1991-2 Oxford healthylife survey.
Main outcome measures: Health status of breast reduction patientsbefore and after surgery as assessed by the SF-36, the 28 itemgeneral health questionnaire, and Rosenberg's self esteem scale;comparisons between the health status of breast reduction patientsand that of women in the general population; outcome of surgeryas assessed retrospectively by patients.
Results: Differences between the health status of breast reductionpatients and that of women in the general population were detectedby the SF-36 both before and after surgery. Breast reductionsurgery produced substantial change in patients' physical, social,and psychological function. The proportion of cases of possiblepsychiatric morbidity according to the general health questionnairefell from 41% (22/54) before surgery to 11% (6/54) six monthsafter treatment. Eighty six per cent (50/58) of patients expressedgreat satisfaction with the surgical result postoperatively.
Conclusion: The study provides empirical evidence that supportsthe inclusion of breast reduction surgery in NHS purchasingcontracts.

Key messages

The predominant reason for a breast reduction referral was physical, although social, psychological, and practical reasons also had a role
The health status of breast reduction patients differed significantly from that of the general female population before and after treatment
The patients who underwent surgery experienced substantial improvements in physical, social, and psychological functioning
The study shows the need for and benefits of breast reduction surgery and provides supporting evidence for including this form of plastic surgery in purchasing contracts

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