Mary Rich, a 36-year-old woman suffering from chronic back pain caused by her natural double-G cup breasts, has been left unable to work and reliant on benefits after the NHS rejected her application for reduction surgery. Mary, who was bullied at school and nicknamed 'Saggers' due to her growing chest in Basingstoke, Hampshire, experienced rapid breast growth from puberty, reaching a double-F cup by age 16 and a double-G cup in her early 20s.

The severe back pain began in her early twenties, becoming so debilitating that she first approached the NHS for breast-reduction surgery in 2013, at age 24. At the time, she was told eligibility would require her to lose weight and stop smoking. Mary diligently met these conditions over the years; however, she states that the damage from carrying the significant weight of her breasts for over two decades has now rendered her unable to work. Despite reapplying for surgery in December 2024 with a lower BMI and improved health, her application was rejected again.

The rejection was based on new NHS criteria introduced last year, which mandates patients show a 'clinically significant history of intertrigo or ulceration' – skin damage Mary says she has never experienced. The NHS policy states: 'Applications are only considered in exceptional circumstances where ALL current policy criteria are fully met. As you do not have documented evidence of intertrigo or ulceration unresponsive to treatment, your application is declined.' Instead of surgery, Mary has been offered opioid medication and physiotherapy.

Currently, Mary relies on Universal Credit, receiving £995 a month, and Employment and Support Allowance, at £281 a fortnight, while awaiting a decision on her Personal Independence Payment application. Her partner, Guy Firbank, 45, provides daily assistance with basic tasks like dressing and showering. Unable to afford private surgery, which costs between £8,000 and £12,000, she fears her condition will continue to worsen.

Mary, who dedicated 20 years to working in healthcare as a community carer and healthcare assistant, stopped working for the NHS in late 2024, pausing her plans to start a business as a menstrual cycle coach. She expressed the profound impact of her condition: 'I'm only in my 30s but after carrying this weight for over 20 years, my spine has deteriorated so much and my body can't keep up. I have to spend days at home resting because my spine feels like it's burning, and I feel like I'm missing out on life.'

Physiotherapy has confirmed lasting spinal damage from years of pressure, limiting her to standing for only a few hours a day. Mary also noted the genetic predisposition, stating her mother and grandmother both had large breasts and ultimately ended up in wheelchairs due to back and spine issues, a fate she is terrified of sharing. Throughout her teenage years, she tried to conceal her chest with baggy clothes and avoided PE changing rooms. Despite maintaining a slim size eight to twelve frame in her early twenties, the pain intensified, leading to a binge-eating disorder linked to childhood trauma.

When she first applied for surgery, she was a size 18, which led to the advice about BMI reduction and quitting smoking. In the intervening years, she struggled with an addiction to opioid painkillers prescribed for her symptoms. By 2017, she had successfully lost weight and stopped smoking, but poor mental health led her to turn to cannabis rather than immediately re-pursuing surgery, stating her self-esteem was too low. She later weaned herself off drugs and cannabis, but the pain became unbearable.

Mary is now actively fundraising to pay for the surgery privately. She argues that the long-term financial impact on the NHS, should she become further disabled, would far exceed the cost of the surgery. She believes she would likely have been approved if not for the 2024 policy change. A spokesman for NHS Hampshire and Isle of Wight stated that while the policy position did not fundamentally change in 2024, they could not comment on individual cases but would be keen to hear from Mary Rich to understand her experience and the advice she received over the past 12 years.