A woman suffering from chronic back pain caused by naturally large breasts says she has been left unable to work and reliant on state benefits after the NHS rejected her application for breast-reduction surgery following a change in eligibility criteria.
Mary Rich, 36, said her breasts began growing rapidly during puberty and reached a double-F cup by the time she was 16. Growing up in Basingstoke, Hampshire, she was bullied at school because of her chest and given the nickname “Saggers,” experiences she says had a lasting impact on her confidence and mental health.
By her early 20s, when her breasts had reached a double-G cup, Rich began experiencing severe and persistent back pain. In 2013, aged 24, she approached the NHS to request breast-reduction surgery and was told she could be eligible if she lost weight and stopped smoking. She later met both requirements but says years of carrying the additional weight have caused lasting damage to her spine.
Rich reapplied for surgery in December 2024 with a lower body mass index and no longer smoking, but her application was rejected again under updated NHS criteria. The revised policy requires patients to demonstrate a clinically significant history of intertrigo or ulceration—skin conditions she says she has never suffered from—despite ongoing pain and functional impairment.
As her condition worsened, Rich said she became unable to continue working. After two decades employed in healthcare as a community carer and healthcare assistant, she stopped working for the NHS and is now reliant on Universal Credit and Employment and Support Allowance. She also requires daily assistance from her partner, Guy Firbank, 45, for basic activities such as dressing and showering.
Unable to afford private surgery, which she says would cost between £8,000 and £12,000, Rich fears her condition will continue to deteriorate. She said physiotherapy has confirmed spinal damage caused by prolonged strain, leaving her able to stand for only a few hours a day before needing to lie down. She has also described struggling with poor mental health, addiction to prescribed opioid painkillers, and later cannabis use, before eventually weaning herself off both.
Rich said her family history adds to her anxiety, explaining that both her mother and grandmother had large breasts and later developed serious back and spine problems that resulted in wheelchair use. “I’m only in my 30s, but my body can’t keep up anymore,” she said, adding that she fears facing a similar future without surgical intervention.
The NHS rejection letter stated that applications for breast-reduction surgery are considered only in exceptional circumstances and require all policy criteria to be met. In Rich’s case, the absence of documented skin conditions meant her application was declined. She says she has instead been offered pain medication and physiotherapy, and has begun fundraising to pay for surgery privately.
A spokesperson for NHS Hampshire and Isle of Wight said that while it could not comment on individual cases, it would welcome the opportunity to hear from Rich to better understand her experience and the advice she has received from local NHS services over the years.
