SHOULD BREAST REDUCTION SURGERY BE RATIONED - A COMPARISON OF THE HEALTH-STATUS OF PATIENTS BEFORE AND AFTER TREATMENT - POSTAL QUESTIONNAIRE SURVEY

Objectives-To assess the health status of patients before and after br east reduction surgery and to make comparisons with the health status of women in the general population. Design-Postal questionnaire survey sent to patients before and six months after surgery. Setting-The thr ee plastic surgery departments in the Oxford Regional Health Authority , during April to August 1993. Subjects-166 women (over the age of 16 years) referred for breast reduction; scores from the ''short form 36' ' (SF-36) health questionnaire completed by women in the 1991-2 Oxford healthy life survey. Main outcome measures-Health status of breast re duction patients before and after surgery as assessed by the SF-36, th e 28 item general health questionnaire, and Rosenberg's self esteem sc ale; comparisons between the health status of breast reduction patient s and that of women in the general population; outcome of surgery as a ssessed retrospectively by patients. Results-Differences between the h ealth status of breast reduction patients and that of women in the gen eral population were detected by the SF-36 both before and after surge ry. Breast reduction surgery produced substantial change in patients' physical, social, and psychological function. The proportion of cases of possible psychiatric morbidity according to the general health ques tionnaire fell from 41% (22/54) before surgery to 11% (6/54) six month s after treatment. Eighty six per cent (50/58) of patients expressed g reat satisfaction with the surgical result postoperatively. Conclusion -The study provides empirical evidence that supports the inclusion of breast reduction surgery in NHS purchasing contracts.