BAPRAS’ response to the decision to restrict access for some plastic surgery in Wales

Media statement- 28 April 2008

The commissioners of Plastic Surgery in Wales (Health Commission Wales) announced this week further restrictions to some plastic surgery procedures which require patients to have a body mass index within the normal range (18-25). 

The procedures in question such as breast reduction were already subject to tight restrictions and are not generally available on the NHS and are given a low priority.

There is considerable evidence that breast reduction is a useful intervention for women who, as a result of disproportionately large breasts, are suffering from physical symptoms such as back and neck ache and skin infections (“intertrigo”). There is also evidence that patients who are obese (BMI greater than 30) are at greater risk of complications during surgery. The British Association of Plastic, Reconstructive and Aesthetic Surgeons supports the use of such clinical criteria in deciding which women should have the operation.

There is no clinical evidence to support the decision in Wales to restrict the surgery to women who are exactly within their ideal weight range and we are aware that the decision has been reached on financial/resource grounds rather than clinical ones. 

Such “low priority” surgery is only a small part of the work of plastic surgeons in the NHS which is mostly devoted to the treatment of cancer, accidents and birth anomalies. Nonetheless it is of great benefit to patients and we would wish to see it remaining available on the NHS on the basis of clinical need and clinical evidence.


About BMI
•Body Mass Index (BMI) is a ratio of weight and height (Kg/m2) 
•The normal BMI for most people is between 18 and 25
•A BMI of 26 for a typical woman seeking breast reduction would mean being only 4 lbs overweight
•The Department of Health Modernisation Agency produced guidance for Commissioners for low priority procedures like this in 2005.
•It recommended a BMI level of 30 for these procedures.


BAPRAS, the British Association of Plastic, Reconstructive and Aesthetic Surgery, is the voice of plastic surgery in the UK. It aims to increase the understanding of the professional specialty and scope of plastic surgery, promoting innovation in teaching, learning and research.

Founded in 1946 (originally as the British Association of Plastic Surgeons), today BAPRAS has over 800 members and is the professional representative body for reconstructive and aesthetic plastic surgeons providing services to patients on the NHS and privately in the UK.

Members of the public can find a member plastic surgeon in their area by logging on to Anyone can check the GMC to find out if a surgeon is on the plastic surgery specialist register.