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Melissa Ashcroft has endured chronic pain for many years as a consequence of the size of her breasts, and she now feels that obtaining breast reduction surgery on the NHS is more distant than ever. The 30-year-old mother from Blairgowrie describes her size 36M breasts, which weigh approximately two and a half stone (16kg), as causing significant discomfort and distress. At times, the pain is so severe that she struggles with basic tasks, such as lifting her newborn daughter out of her cot.
Earlier this year, Melissa was informed that her Body Mass Index (BMI) of around 35 exceeded the NHS threshold for qualifying for breast reduction surgery. This situation presents a vicious cycle for her—her large breast size impedes her ability to exercise regularly, which could otherwise help her reduce her weight. She has shared the difficulties she faces when attempting to work out, explaining to BBC Radio Scotland’s Mornings programme, “I find it hard to exercise because I have pain in my shoulders and lower back.” Additionally, she expressed feeling self-conscious when exercising in public, saying, “I feel really embarrassed and sexualised, like people are watching me, and I don’t want that when I’m just trying to exercise.”
To remain active despite these challenges, Melissa has taken up swimming, since it is gentler on her joints, although she sometimes still feels uncomfortable wearing a swimsuit. She stressed, “I don’t want the attention. I’m not just a walking pair of breasts, I have a personality, and I am a real human.” The emotional impact of her condition is clear, as she stated, “It’s not a joke to me, it’s really serious and really upsetting just like any form of chronic pain.” Melissa first sought medical advice about breast reduction surgery when she was 20 years old but was warned about the potential risk of reduced ability to breastfeed. Since then, she has had two children, with her breasts growing further during pregnancy. Despite trying treatments like physiotherapy, she feels that surgery is essential for her to regain a normal quality of life.
The NHS criteria for breast reduction surgery varies depending on the region but commonly includes strict BMI requirements. Many women, including Melissa, are refused surgery because their BMI is considered too high. Higher BMI levels carry increased risks related to anesthesia, wound healing, blood clots, and infections. Patients usually must maintain a BMI range between 20 and 27 for at least one year to be eligible. Melissa has managed to lower her weight somewhat since her initial referral, as her hormones have rebalanced post-pregnancy, but she remains uncertain about how she can achieve the necessary reduction given the physical challenges posed by her breast size.
There has been ongoing debate for over a decade about whether BMI is an accurate measure of overall health, especially for individuals with body proportions like Melissa’s. Gill Baird, who owns Cosmedicare and founded St Ellens’ Hospitals, commented that even meeting the criteria does not guarantee NHS surgery. She explained to BBC Scotland, “There are thousands of people waiting for surgery from before Covid and the NHS are only seeing the most extreme cases just now. The NHS is not an infinite resource and they have to prioritise what they have.” Baird added, “BMI is a limiting factor because when you look at the most extreme cases, you’re not going to see women with size G, H or M cups and a BMI of below 30.”
Responding to the situation, a spokesperson for the Scottish government said, “We recognise the importance of ensuring clinically appropriate access to procedures such as breast reduction surgery. Access must be fair, transparent and evidence based.” They highlighted that the National Referral Protocol (NRP), which was developed by an expert clinical group, outlines the criteria patients must meet for various procedures. According to the spokesperson, “These criteria are informed by clinical evidence and do not aim to restrict access but instead aim to ensure that people who will benefit from those procedures can do so.
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