NHS accused of favouring men changing gender over women with medical needs for breast surgery

[NotSoLittle]

Telegraph article " NHS accused of favouring men changing gender over women with medical needs for breast surgery Report says NHS has 'facilitated greater access' to surgery for gender dysphoria patients whilst services are cut for women in pain"
archive.today/bRJd3

You may have to post this without the archive link.

Thanks for sharing that. It is rather interesting to see this written: It is a necessary and vital part of gender reassignment” for those who have not responded to hormones.

So…. What about females who have very small breasts? Are we allowed to get breast augmentation for our ‘gender confirmation’ then? Because we are also being told constantly it is not about ‘looks’?

Do these NHS experts see it yet? The inconsistency. The dissonance must be clanging!!!

I shall look forward to my offer of a NHS breast augmentation for the same reasons that these males get them- to help me feel more like a ‘woman’ then shall I?

(I am being sarcastic, and I am supportive of breast surgery for females who have the need for surgery. I also support breast reduction seeing as how my mother had the exact opposite issue as me and I know the pain she suffered.)

I could do with seeing the entire report and analysis to understand any nuance because the Telegraph version is moving me to wrath and I need to know if it's a reasonable interpretation.

Me too.

Full report if anyone wants to look (I think so, there's a quotation that matches).

www.gettingitrightfirsttime.co.uk/wp-content/uploads/2021/02/BreastSurgeryReport-Mar21o-EMBARGOED.pdf

Interesting.

My friend found a clinic that offers laser surgery to remove transwomens facial hair "on the nhs" because of how distressing they find having facial hair.

I'm a woman (by which I mean born female.) I also have a lot of facial hair thanks to a hormone imbalance. I asked my GP if I could have laser surgery on the NHS. Apparently not. Even though I find it distressing.

Hmm, so it sounds like your external appearance does not align with your true authentic self. If you can give that feeling a name, perhaps build an ideology around it, you might be able to convince the doc to send you to an endocrinologist.

@Crouton19 I was thinking of calling myself transwoman-woman. I was born female but identity as a man who wants to be female/feminine.

Thanks for link to report @EmbarrassingHadrosaurus
Exasperated after reading pages 75-82.

But, surely, if as they argue, they are women, they have to accept that real women don't get access to laser surgery or new breasts? We are even denied pain relief for actual.....pain.

Can the NHS do this? Prioritise the needs of "women" over those of women? Isn't that what the Equality Act is meant to guard against?

Re the title of the article - the report says the majority of aesthetic breast surgical procedures for gender dysphoria are being done on natal females ie transmen. Article may have assumed 'men' were being 'favoured' as the male gender marker is used on the medical records for these patients.

On p75 of the report: 'The main procedures were mastectomy or breast excisions. Nearly 90% were in persons whose gender was recorded as
male (trans males). The range of masculinising breast surgery procedures approved under Specialised Commissioning is
comprehensive and includes all breast surgery procedures commonly used to change the breast appearance.
The high percentage of male, compared to female admissions, is due to the fact that Specialised Commissioning funds
masculinising breast surgery (usually mastectomy and any related chest reconstruction) for males who were female at birth.
However, augmentation mammoplasty for women who were male at birth (trans women) is not funded. This may be because
trans women are often treated with female hormones, which also allow natural breast development, so feminising breast
surgery may be less commonly required.'

I despair.

I have recently had a therauputic mammoplasty as part of a lumpectomy for breast cancer removal. The NHS is operating normally for breast cancer however many women are having to wait for mastectomy with immediate reconstruction, so are opting for mastectomy then reconstruction up to two years later. I’m sure many of the women I know through support groups would not be happy if their local CCGs were funding cosmetic mastectomy/reductions on healthy individuals while they have to wait.
I do hope all cosmetic surgery has been suspended indefinitely while the current backlog of cancer cases are being dealt with.

See also pages 69-71 about limiting unnecessary bilateral mastectomy in women with breast cancer, who might request this if their cancer in one breast was missed on screening so don't trust the screening process to detect possible cancer in the other breast, as well as more cosmetic reasons like not wanting an asymmetric appearance.
Arguing the case for limiting these procedures, the report says:
'Bilateral
surgery also requires longer stays in hospital and, from the patient perspective, there are other factors related to decisional
regret and irreversible changes in body image and sexuality.'

Yet...'Over the last decade, the volume and percentage of all breast surgery admissions for gender reassignment has increased
from 0.06% (53 admissions) in 2008/09 to 0.40% (355 admissions) in 2017/18.'...'In the time period April 2015 – March 2018, there were just over 600 admissions for gender reassignment breast surgery.
Gender reassignment usually requires simultaneous surgery on both breasts, so the number of operations undertaken is
likely to be over 1,200.
The main procedures were mastectomy or breast excisions.'

I’ve read the full report and it appears to me the males being prioritised are FtM transmen. Thank you for posting it.

P74 states
“Over the last decade, the volume and percentage of all breast surgery admissions for gender reassignment has increased from 0.06% (53 admissions) in 2008/09 to 0.40% (355 admissions) in 2017/18.”

It says in the report on page 75
“The main procedures were mastectomy or breast excisions. Nearly 90% were in persons whose gender was recorded as male (trans males).80 The range of masculinising breast surgery procedures approved under Specialised Commissioning is comprehensive and includes all breast surgery procedures commonly used to change the breast appearance. The high percentage of male, compared to female admissions, is due to the fact that Specialised Commissioning funds masculinising breast surgery (usually mastectomy and any related chest reconstruction) for males who were female at birth. However, augmentation mammoplasty for women who were male at birth (trans women) is not funded.”

So the report is saying that 90% of those 355 gender reassignment procedures were done on trans men, not trans women and furthermore that augmentation mammoplasty for trans women is not funded.

Yes the later pages has heartbreaking stories of thousands of also women refused aesthetic breast surgery due to different funding standards being applied in different CCGs.

But what I see is that perhaps FtM or “trans men” breast surgery is being prioritised. With MtF breast augmentation being not funded at all NHS wide, you can’t make an argument that MtF or “birth men” are being prioritised.

Ah, I see @YesSheCan saw the same bits of the report I did.

p82 Where the report outlines the disconnect:
”Procedures of limited clinical value: our evidence and our concerns
Taken as a whole, the data related to breast surgery procedures deemed to be of limited clinical value raises significant concerns:

1. that across the country as a whole, it is becoming harder for individuals to access aesthetic breast surgery despite having a recognised medical condition; and

1. that there is considerable national variation in access to aesthetic breast surgery for a medical condition.

We disagree with the assertion that these operations are of limited clinical value. Surgery for a congenital condition can make an immense difference to a young woman’s, or young man’s, confidence and quality of life. Clearly, there need to be gateways and caveats to such surgery, but at present, it appears that the barriers to receiving surgery are greater in some areas than in others.
In this context, it is striking to note how NHS Specialised Commissioning has facilitated greater access to gender reassignment surgery for gender dysphoria – even though some of the surgical procedures involved are the same as those used to treat e.g. congenital breast developmental issues.

We see it as both inconsistent and illogical that a procedure can be deemed of limited clinical value for one group of patients or medical condition, but acceptable for another, where there is no substantial difference in the surgical outcomes.

Clear criteria exist for commissioning breast reduction surgery – as set out in the 2018 Evidence-Based Interventions: Guidance for Clinical Commissioning Groups (CCGs).85 However, it is apparent from our visits that these guidelines are not uniformly being adhered to.

Clear, evidence-based guidelines should be applied consistently and fairly to all individuals seeking surgery for congenital, developmental and acquired anomalies across the country.”

If you’re wondering about the difference between cosmetic breast surgery and aesthetic breast surgery, as well as what is meant by “low clinical value” here is the definition from p74
”The difference between cosmetic and aesthetic breast surgery
Cosmetic breast surgery can be defined as when surgical procedures are used to alter the breast appearance for personal preference. However, if these same procedures are required to support recovery from or reduce the risk of breast cancer, or indicated for a recognised medical problem such as gender dysphoria, failure of breast development, or overgrowth of the male breast because of cancer treatments, they are better termed aesthetic breast surgery procedures.

This is a subtle but important distinction: cosmetic breast procedures cannot and should not be routinely funded by the NHS, but breast surgery procedures for aesthetic purposes can and should be. At an individual patient level, the value of aesthetic breast surgery to correct a medical condition is often considerable, particularly in terms of the patient’s overall psychological wellbeing and quality of life. This is demonstrated by the fact that corrective aesthetic breast surgery has been clearly acknowledged as essential to facilitate high-quality recovery and survivorship after breast cancer surgery.

However, for other equally well-recognised medical conditions, the use of the same or similar breast surgery techniques for corrective aesthetic purposes are commonly banded under the umbrella term ‘procedures of low clinical value’ (PoLCV).77 This means access to corrective aesthetic surgery for these other medical conditions is dependent on local CCG policies and guidelines. With budgets stretched, such procedures can then appear as easy targets to be cut or severely restricted.”

This all goes back to underfunding of the NHS imho. With not enough money for all aesthetic breast surgery which should be funded, patients are being denied surgery when they shouldn’t be. And of course, any priority system you apply to fix the problem of too many patients and not enough money will rightly or wrongly prioritise one condition over another. The NHS CCGs may be getting their priorities wrong, but they wouldn’t have to prioritise anyone and turn away anyone if the NHS were adequately funded for the aesthetic breast surgery need.

It is so messed up that the taxpayer is forced to fund elective gender reassignment surgery when (a) it’s unnecessary (b) the NHS is broke and (c) the vast majority of taxpayers are against funding it.

It is unnecessary cosmetic surgery and they should pay for it themselves. Just like women usually have to pay for urgent surgery because of NHS waiting lists.

I don’t view it as cosmetic and think the tax payer should fund it for both FtM and MtF. It’s aesthetic breast surgery.

And with only 335 admissions for gender reassignment aesthetic surgery out of the 887,500 total admissions for aesthetic surgery, it’s a drop in the bucket. It’s not breaking the NHS to do it for gender dysphoria.

And just so we’re clear 90% of those 355 were admissions of natal women FtM transmen getting breast masculisation surgery. So 10% were procedures done on natal men but they were not breast augmentation because that specific procedure is not funded NHS wide according to the report.

I am going to read this when I am not on my phone.

There are a couple of things I want to check. One is what that 90% statistic refers to. Who are the other 10% and what procedures are they getting done.

The second is the quote from the article that seems to be mentioned above.

‘However, if these same procedures are required to support recovery from or reduce the risk of breast cancer, or indicated for a recognised medical problem such as gender dysphoria, failure of breast development, or overgrowth of the male breast because of cancer treatments, they are better termed aesthetic breast surgery procedures.’

It seems this is partly what the article was referring to.

Are these mentioned surgeries happening or not? And are they funded by any NHS trust, or not? To me, if it is funded by a different NHS trust, it doesn’t matter because it is still funded by public health. That is a way of splitting funding hairs and a distraction as to whether the procedures are being done.

Surely the NHS also can now see just how ridiculous it is that they cannot write accurate reports when they have allowed patients to change sex markers on their files. This should never have been allowed. Have sex and gender.

And with only 335 admissions for gender reassignment aesthetic surgery out of the 887,500 total admissions for aesthetic surgery, it’s a drop in the bucket

That should be 88,750 not 887,500, shouldn't it?

There are a couple of things I want to check. One is what that 90% statistic refers to. Who are the other 10% and what procedures are they getting done.

That doesn't seem at all clear. These are the relevant paragraphs and footnote.

The main procedures were mastectomy or breast excisions. Nearly 90% were in persons whose gender was recorded as male (trans males).80 The range of masculinising breast surgery procedures approved under Specialised Commissioning is comprehensive and includes all breast surgery procedures commonly used to change the breast appearance.

The high percentage of male, compared to female admissions, is due to the fact that Specialised Commissioning funds masculinising breast surgery (usually mastectomy and any related chest reconstruction) for males who were female at birth. However, augmentation mammoplasty for women who were male at birth (trans women) is not funded. This may be because
trans women are often treated with female hormones, which also allow natural breast development, so feminising breast surgery may be less commonly required.

80 When admitted to a hospital, a person who is gender incongruent is normally registered under the gender they identify with, rather than the sex they were born with. A trans man is a biological female, who identifies with the male gender; a trans woman is a biological male, who identifies with the female gender.

It's possible that the other 10% are also female, and have had their sex correctly recorded by the NHS, rather than their 'gender'. It does say that "augmentation mammoplasty for women who were male at birth (trans women) is not funded" so presumably no such NHS procedures are carried out on actual males.

So there does seem to be confusion then if this paragraph is also in the document:

‘However, if these same procedures are required to support recovery from or reduce the risk of breast cancer, or indicated for a recognised medical problem such as gender dysphoria, failure of breast development, or overgrowth of the male breast because of cancer treatments, they are better termed aesthetic breast surgery procedures.’

And ‘funded’ by whom? Is there some confusion between funded by gender clinics under the NHS and local trusts.

Thanks oldcrone. I am not actually asking anyone to read it for me though, as I will get it up on my PC and have a read soon as I am intrigued. Did the article in the OP miss something, did they speak to someone, or are they pointing out an ambiguity they found.

I'm on my phone too, so haven't read the report itself yet. But from the quotes there is only one conclusion.

The complete bastardisation of the language makes it nigh on impossible to be sure you know what SEX anyone is. All that male, trans male, summink summink (brackety bollocks). Even when you think you have it sussed you read another line that obscures, confuses.

Whether it is the journalist, NHS or both, it is absolutely infuriating and totally unnecessary.

I question who actually believes this obfuscation in NHS reporting is benefitting anyone? It is just bizzarre to think that it does.