Charlotte Howard, 52, has back pain, rashes, a bad smell, and strangers shouting lewd comments at her in the street. The cause, she says, is her own breasts - which have grown from a 32B to a 40GG as she gained weight during the menopause. "I find them intolerable. I'm basically carrying half a stone off my neck and shoulders. I can't look at myself without clothes on," she says.

The horticulturist from West Lavington in Wiltshire says she has to use medicated talc under her breasts to prevent rashes and washes them "two or three times a day" because they smell. Exercise is painful and uncomfortable, making it hard to stay active. And when she goes out in public, she says she is regularly harassed. "I get fat-shamed in the street, people shout stupid jokes, lewd comments about them," she describes.

Howard visited her GP to ask about breast reduction surgery but was told there was "no chance" she would qualify. She is now considering private surgery, though the estimated £6,000 to £9,000 cost is daunting. The NHS says eligibility criteria vary by location, but surgery may be possible if other options - including professionally fitted bras - have not worked. Health problems caused by very large breasts are considered, along with breast size, weight, general health, and whether you smoke. Those seeking surgery purely to change their appearance must pay privately.

Simon Hawkins, a consultant breast surgeon in Wiltshire who treats both NHS and private patients, says he has seen an increase in women requesting the surgery privately over the last 15 years. "It's always been very difficult to get approved for breast reduction surgery on the NHS," he says. "It's generally regarded as a cosmetic treatment." According to the British Association of Aesthetic Plastic Surgeons, there were 4,673 private breast reduction procedures carried out in the UK in 2025, a 2% rise on the year before.

"It's not just a cosmetic operation where you have body confidence benefits, you might also be able to do activities and exercise more. There's also the potential impact on back and neck issues," says Hawkins.

Integrated care boards (ICBs) manage local NHS budgets and commission care and services, including surgeries such as breast reduction. A spokesperson for the NHS Bath and North East Somerset, Swindon and Wiltshire, NHS Dorset and NHS Somerset ICB says while "breast reduction surgery is not routinely commissioned for all patients" in the area, decisions "about treatment are made on an individual clinical basis". They say the person's circumstances are taken into account, including "the evidence of likely benefit". "The policy is designed to ensure that NHS resources are used fairly," they add.

Howard says she was not given a clear reason why she would not receive further support from the NHS. The NHS declined to comment on Howard's individual case when approached by the BBC. "I'm just exhausted really, it's a fight to get heard, to be listened to," she says. "The lack of support feels isolating. If you're a woman of a certain age and you have anything wrong with you they say 'lose some weight dear', or it's the menopause," she adds.

Meanwhile Hawkins says more women are also looking to get cheaper surgery abroad, with travel packages available in Lithuania, Turkey and Prague among other places. The NHS warns "safety standards may not be as high" in those countries as in the UK. "It's certainly is a lot cheaper but we're seeing quite a few patients who present to NHS services with problems and complications after surgery performed abroad," Hawkins adds.