Letters

Should breast reduction surgery be rationed?

EDITOR,--Anne Klassen and colleagues conclude from their study that breast reduction surgery improves the health status of women and should be included in NHS purchasing contracts.¹ We are concerned, however, about the high number of patients excluded from the crucial analysis.

Of 166 patients deemed to be studied, only 128 (77%) responded to the preoperative questionnaire. Why 10 of the 166 patients were excluded is not clear. The response rate to the postoperative questionnaire was even worse: of the 128 patients who responded to the preoperative questionnaire, only 85 were operated on and only 58 (68%) completed the postoperative questionnaire. Finally, only 54 women (that is, 33% of the initial 166) completed both the preoperative and the postoperative questionnaires; this is the most important group of patients. Although there was no significant difference in most variables between non-responders and responders, the statistical power of this analysis was low, and the authors' main conclusion is based on the responses of only 54 patients. We wonder how many of the 31 non-responders would have had to be unsatisfied with the operation to reverse the results of the statistical analysis. We suspect that it would not be many.

Research fellow Consultant surgeon Academic Department of Surgery, Royal Marsden Hospital, London SW3 6JJ

Jayant S Vaidya, Nigel Sacks 

1. Klassen A, Fitzpatrick R, Jenkinson C, Goodacre T. Should breast reduction surgery be rationed? A comparison of the health status of patients before and after treatment; postal questionnaire survey. BMJ 1996;313:454-7. (24 August.) [Abstract/Full Text]