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Interventions requested for psychological reasons should be studied

BMJ 1996; 313 doi: (Published 07 December 1996) Cite this as: BMJ 1996;313:1479
  1. Margaret Somerville,
  2. Gina Radford,
  3. Nicola Hews
  1. Consultant, public health department Team leader, incident room Information officer South and West Devon Health Authority, Dartington TQ9 6JE

    EDITOR,—We were interested to note that Anne Klassen and colleagues chose to look at breast reduction as an example of a cosmetic surgery procedure that is not being provided by the NHS.1 They comment that common reasons for referral were physical problems (for example, pain, discomfort, and skin irritation); psychological and social reasons were less common. They conclude that breast reduction is an effective treatment for these women. We question the relevance of this study to the debate on rationing, and particularly whether the findings can be taken to indicate the benefits likely to come from other cosmetic surgery procedures.

    South and West Devon Health Authority has operated a policy of restricted access to certain cosmetic surgery procedures, including breast reduction, for over a year. Under this policy requests for breast reduction because of physical symptoms have invariably been approved; such requests constitute a small proportion of the requests for cosmetic surgery (table 1).

    Table I

    Proportion of requests for breast surgery accepted by South and West Devon Health Authority, 1 January to 30 June 1996

    View this table:

    Of greater relevance to the rationing debate is the effectiveness of other procedures, such as breast augmentation, when the reasons for referral are psychological. We hope that future studies will address the issue of effective interventions, including non-surgical management, for such psychological need.


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