Reviewed on : 18 Jun 2020

Reviewed by : Gateway Editor

Expires : 18 Jun 2022

 Female Breast Reduction (Reduction Mammoplasty)

Note: this policy does not apply to gender reassignment cases or to therapeutic mammoplasty for breast cancer treatment or contralateral (other side) surgery following breast cancer surgery.

The Association of Breast Surgery support contralateral surgery to improve cosmesis as part of the reconstruction process following breast cancer treatment.

Resection weights, for bilateral or unilateral (both breasts or one breast) breast reduction should be recorded for audit purposes.

Breast reduction surgery for cosmetic reasons is not funded. Breast reduction surgery is considered to be cosmetic unless breast hypertrophy is causing significant symptoms as indicated below.

Breast reduction surgery will be funded for non-cosmetic indications for women aged 18 or older for whom growth is complete when ALL the following criteria (1-4) are met:

(1) SIGNIFICANT SYMPTOMS ARE PRESENT

• The woman has received a full package of supportive care from their GP such as advice on weight loss and managing pain.
• In cases of thoracic/ shoulder girdle discomfort, a physiotherapy assessment has been provided
• Breast size results in functional symptoms that require other treatments/interventions (e.g. intractable candidal intertrigo; thoracic backache/kyphosis where a professionally fitted bra has not helped with backache, soft tissue indentations at site of bra straps).
• Woman must be provided with written information to allow her to balance the risks and benefits of breast Page 10 of 16 Procedure Guidance surgery.
• Women should be informed that smoking increases complications following breast reduction surgery and should be advised to stop smoking.
• Women should be informed that breast surgery for hypermastia can cause permanent loss of lactation.

(2) THE BREAST HYPERTROPHY IS SEVERE

Breast reduction planned to be 500gms or more per breast or at least 4 cup sizes.

(3) THE PATIENT IS NOT OBESE

Body mass index (BMI) is <27 and stable for at least twelve months.

(4) The patient is not less than one year post delivery of a child

Breast Reduction – Asymmetry

Note: As stated above in the general introduction to the policy, this does not apply to cases where breast reconstruction is following treatment for cancer, or cases following trauma.

Funding for breast asymmetry surgery will be funded in cases of gross asymmetry where all of the following criteria are met:

• Surgery can be approved for a difference of >150 gms size as measured by a specialist or a difference of cup sizes >2
• The plastic surgery team, in conjunction with the patient, will make the final clinical decision as to whether the patient should have reduction or augmentation to resolve the asymmetry. (Funding will be either for augmentation to one breast, or reduction of one breast in order to achieve a reasonable degree of symmetry.)
• The plastic surgery team must confirm that they have discussed possible future complications with the patient, and have not given any assurances that NHS funding for further surgery or replacement implants will be available in the event of weight or breast changes in the future (including those following pregnancy), or in the event of complications such as capsular contracture (except for removal of implant in line with current policy)
• The patient is aged 18 or over
• The BMI needs to be in the range >18 to <27 and stable for at least twelve months

Gynaecomastia – Male Breast Reduction

Surgery for gynaecomastia is NOT routinely funded by the NHS.

This recommendation does not cover surgery for gynaecomastia caused by medical treatments such as treatment for prostate cancer.

Breast Augmentation

Notes:

• This does not apply to cases where breast reconstruction is following treatment for cancer, or cases following trauma.
• This policy does not apply to gender reassignment cases Breast augmentation is not funded.

Revision of breast augmentation / Removal of breast implants

Removal of breast implants:

Where there are significant complications from breast implants (such as severe pain or clinical risk from leaking or otherwise damaged implants), removal of implants will be funded, irrespective of the reasons for their original insertion.

This includes removal for any of the following indications:

• Extrusion of implant through skin
• Implants complicated by recurrent infection.
• Implants with Baker Class IV contracture associated with severe pain (or implants with severe contracture that interferes with mammography)
• Intra or extra-capsular rupture of silicone gel-filled implants If any of the above criteria for removal of a breast implant is met unilaterally, patients will be offered the choice of removing both prostheses at the same time, with the intention of ensuring symmetry.

Note that following will NOT be funded:

• Insertion of a new implant (unless the criteria specified below are met)
• Correction of any asymmetry (other than removal of a contralateral implant, as specified above)
• Mastopexy and other similar surgical procedures.

Replacement of breast implants

Replacement of breast implants will be funded if removal is required for one of the reasons specified above AND the original procedure was funded by the NHS (either as part of treatment for breast cancer, or for other reasons, provided the original indication was broadly in line with the PCT’s current policy for breast augmentation or correction of asymmetry).

The replacement of privately funded breast implants, either unilaterally or bilaterally, is not funded.

Replacement with privately purchased prostheses is not allowed alongside NHS removal of implants.

Breast surgery following cancer treatment relating to an unaffected breast

Breast surgery following cancer treatment relating to an unaffected breast commissioned in accordance with guidelines

Mastopexy

Breast uplift not funded