PLASTIC surgeons have been accused of discrimination amid claims transgender women are routinely being denied breast augmentation surgery which would normally be provided to other patients.

Equality campaigners said transgender women are being left in a "distressing" limbo as they are turned down for breast surgery on the NHS in Scotland, sometimes despite having already completed more gruelling and expensive genital procedures.

James Morton, manager of the Scottish Trans Alliance, said: "The reality is that the plastic surgeons in Scotland are blanket banning trans-women getting access to breast augmentation, even in situations where a non-trans woman would be provided with it.

"It's really discriminatory at the moment and trans-phobically motivated as far as we can see. It's the classic thing where it's not seen as medically necessary but as a lifestyle choice."

While transgender patients transitioning from female to male are funded for chest reconstruction centrally, via National Services Division, and referred to England to have their breasts removed, patients transitioning in the opposite direction rely on their local health board to provide breast augmentation where hormone therapy has left them with lopsided or undeveloped breasts.

They are referred for the treatment by psychiatrists on the same grounds as other female patients with breast problems - that is, that the situation is causing the patient "severe psychological distress".

Becky Kaufmann, 55, from Edinburgh, completed genital surgery in April 2016 but said she has hit a dead end trying to access breast augmentation from NHS Lothian.

Ms Kaufmann said: "It's incredibly frustrating. The feminist in me wants to say 'bodies don't matter', but for me, the bar is that much higher. For a trans-person, acceptance in their identified gender - even today - still very much hinges on whether or not we meet classical standards of appearance.

"Yet as a middle-aged late transitioning trans-woman, after four years on hormones, without enhancements in my chest, I basically look like an overweight middle-aged man."

Ms Kaufmann, a former prison officer, said she also only learned by chance that she had been rejected for the procedure during a visit to her GP about separate ailment. After enquiring, she discovered that a letter sent months earlier to her GP - but never to her - confirmed that she had been rejected for breast augmentation because her BMI was above 27, a stricter threshold than that applied to genital surgery.

Although some NHS guidance does recommend that any patients seeking breast augmentation should have a BMI below 27, Ms Kaufmann said she was angry at the lack of communication.

She said: "Even if I was rejected because of my weight, in any other circumstance the doctor would say 'you're overweight, lose some weight, and then you can get the procedure'. I was told nothing. If you don't tell people the rules of the game, and then they tell you 'you lose' before you even found out you're playing, that's not fair."

She is now considering paying for implants privately.

Eleanor Matthews, 61, has also been rejected for nose reshaping and breast augmentation by NHS Lothian despite a psychiatrist referral. Weight was again given as the reason, but the former firefighter, who began hormone therapy six years ago, said staff at her local gender identity clinic told her NHS Lothian "would not entertain" trans-women for breast surgery.

She added: "I don't understand the logic to it at all. If you're a trans woman with asymmetrical breast growth, you don't get any surgical support, you don't get any funding. But for a non-trans woman, if a surgical intervention was necessary they would consider funding that. But because I'm a trans woman - no. It's horrible."

A Scottish Government spokeswoman said it expected all health boards to provide "fair and equitable access" to gender re-assignment procedures, including breast augmentation.

Tracey Gillies, medical director for NHS Lothian, said: "We are absolutely committed to providing services to all patients. In cases where we have not had the capacity to offer patients gender reassignment surgery, we have provided funding for surgery to be carried out in other NHS areas.

"NHS boards need to carry out a multi-disciplinary assessment of each patient before gender reassignment surgery - to reflect this recent change we are reviewing our services to ensure patients receive treatment safely and in line with guidelines."