Breast reduction

Borders Ref Help Toolkit
NHS Borders

Some women have symptoms and problems associated with their large breasts, especially if they are out of proportion to their overall figure.

Breast reduction surgery may help control these symptoms, if large breasts are the main cause. For example, back pain may be due to other causes. In order for patients to have breast reduction surgery, the criteria below in the referral guidelines section require to be met in addition to maximum BMI of 27.

Alternatives to surgery

All surgery involves some risk. Weight loss may reduce breast size and, having reduced weight (a guideline body mass index is 27 or less), some women may find they do not need surgery. Correctly fitting underwear and clothing can improve comfort and appearance. Cognitive behavioural therapy can be effective for body image problems and therefore it is good practice to offer the patient referral for psychological counselling.

The consultation

The surgeon shall ask about general health, what symptoms the patient suffers from and what concerns they have about the size and shape of their bust. The surgeon will need to examine the patient’s bust and overall figure to assess proportions. If, after careful assessment, the patient is suitable for breast reduction surgery expect to discuss the type of surgery, principles of the operation, likely outcomes and potential risks of surgery. There may have more than one consultation. It is very difficult to take on board all the information at just one consultation, and it is important that the patient has time to think about the information they have heard and a chance to ask any questions. Key points to discuss include:

‣ Goals, expectations and the expected outcomes of surgery

‣ Benefits to the patient of the surgery

‣ Any risks, complications or limitations

‣ Any family history of breast cancer

‣ Patients aged 40 years old and above shall need a screening mammogram prior to onward referral to a plastic surgeon.

 

Who to refer, who not to refer, how to refer

Who to Refer:

Patients with symptoms of gigantomastia including,

‣ Pain in the back, neck, shoulder and breast

‣ Grooving of the shoulders caused by bra straps

‣ Inflamed reddened skin under the breast

‣ Difficulty finding a suitable bra that fits and supports the breast correctly

‣ Difficulty finding clothes that fit – often needing much larger size tops compared to bottoms

‣ Difficulty undertaking exercise owing to pain and discomfort caused by the movement of their heavy breasts

‣ A loss of confidence in their appearance and feeling people are staring at their bust.

 

Who not to Refer:

Patients with BMI >27

 

How to refer:

Please note, since July 2024 BGH are no longer offering breast reduction procedures and the breast surgeon shall therefore make an onward referral to an NHS Plastic Surgeon at St John’s Hospital.

Alternatively, once above criteria have been verified the patient may be referred directly NHS plastic surgery unit at St John’s Hospital via postal service.

Please refer via SCI Gateway as follows:

SCIGateway -> Lothian -> Lothian Non-GP Locations/Providers ->St John's Hospital -> Plastic Surgery

Primary care management

Please calculate the patient’s BMI and refer to Breast Surgeon at St John’s Hospital when BMI is 27 or less. Patient can be advised to optimise their BMI by the time they receive their appointment.

To avoid disappointment and mitigate long waits, please advise patients that NHS waiting lists for benign conditions are longer and there is also the option for a patient to book their consultation in a private clinic.

Please do a breast exam to exclude any incidental pathology and check that NHS breast screening mammograms are up to date.

If patients are aged 50-70 years and have not attended Breast Screening in the last three years, for whatever reason, the patient or her GP can phone 0131 537 7400 to arrange an appointment outwith the normal screening dates.

Resources and links

British Association of Plastic Surgeons

Breastcancernow.org

 

Editorial Information

Last reviewed: 15/08/2024

Next review date: 15/08/2025

Author(s): Dominique Twelves.

Author email(s): dominiquetwelves@borders.scot.nhs.uk.