Reviewed on : 30 Sep 2025

Reviewed by : Lucy Dyde, IFR Team Manager

Expires : 30 Sep 2027

 Female Breast Reduction (Reduction Mammoplasty)

Prior approval – To ensure the best outcomes, patients must have stopped smoking at least 4 weeks prior to referral

Note: this policy does not apply to therapeutic mammoplasty for breast cancer treatment or contralateral (other side) surgery following breast cancer surgery, and local policies should be adhered to

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

Breast reduction surgery for cosmetic reasons is not funded

Breast reduction surgery is a procedure used to treat female born patients with breast hyperplasia (enlargement), where breasts are large enough to cause problems like shoulder girdle dysfunction, intertrigo and adverse effects to quality of life

Breast reduction surgery for hypermastia can cause permanent loss of lactation function of breasts, as well as decreased areolar sensation, bleeding, bruising, and scarring and often alternative approaches (e.g. weight loss or a professionally fitted bra) work just as well as surgery to reduce symptoms

For women who are severely affected by complications of hypermastia and for whom alternative approaches have not helped, surgery can be offered

The aim of surgery is not cosmetic, it is to reduce symptoms (eg. back ache).

The NHS will only provide breast reduction for female born patients if all the following criteria are met:

• The patient is aged 18 years or over
• The patient 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)
• Breast reduction planned to be 500g or more per breast or at least 4 cup sizes
• Body mass index (BMI) is <27kg/m2 and stable for at least twelve months
• The patient must be provided with written information to allow her to balance the risks and benefits of breast surgery
• The patient should be informed that smoking increases complications following breast reduction surgery and must have stopped smoking 4 weeks prior to referral for surgery
• The patient should be informed that breast surgery for hypermastia can cause permanent loss of lactation

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

Correction of Female Breast Asymmetry

Prior approval – To ensure the best outcomes, patients must have stopped smoking at least 4 weeks prior to referral

Unilateral breast reduction is considered for asymmetric breasts as opposed to breast augmentation if there is an impact on health

Correction of Breast Asymmetry for cosmetic reasons is not funded

The NHS will only provide correction of breast asymmetry for female born patients if all the following criteria are met:

• The patient is aged 18 years or over
• 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)
• •Breast reduction planned to be 500g or more per breast or at least 4 cup sizes
• Where there is a difference of >150g as measured by a specialist or a difference of cup sizes >2
• Body mass index (BMI) is <27kg/m2 and stable for at least twelve months
• The patient must be provided with written information to allow her to balance the risks and benefits of breast surgery
• The patient should be informed that smoking increases complications following breast reduction surgery and must have stopped smoking for at least 4 weeks prior to referralnfor surgery
• The patient should be informed that breast surgery for hypermastia can cause permanent loss of lactation

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

References

As per Breast reduction (reduction mammoplasty) above

Gynaecomastia – Male Breast Reduction Surgery

Not funded

Surgery for gynaecomastia is not routinely funded by the NHS. This is because surgery for reduction of male breast tissue is deemed to be cosmetic and does not meet the principles laid out in this policy

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

Female Breast Enlargement (Augmentation Mammoplasty)

Not funded

Breast Augmentation/enlargement involves inserting artificial implants behind the normal breast tissue to improve its size and shape

Breast Augmentation is not routinely commissioned. This is because breast augmentation for non-cancer reasons is deemed to be cosmetic and does not meet the principles laid out in this policy

References

https://www.nhs.uk/conditions/cosmetic-procedures/cosmetic-surgery/breast-enlargement/

Revision of breast augmentation / Removal of breast implants

Prior approval – To ensure the best outcomes, patients must have stopped smoking at least 4 weeks prior to referral

Removal of breast implants

Surgery to remove breast implants is only carried out by the NHS in specific situations. when criteria are met.

All patients should be aware when having implant surgery that due to capsular contracture and less frequently rupture they will need to be replaced at some point

We recommend using the BRAN principles (Benefits, Risks, Alternatives and do Nothing) when speaking with patients about this

Breast implants may be inserted during reconstructive surgery for treatment or prevention of breast cancer or for cosmetic purposes

Surgery to remove a breast implant may be used to treat the complications of breast implants inserted for reconstructive or cosmetic purposes

This proposal does not cover implants inserted following surgery for breast cancer or breast cancer prevention performed under the NHS

In these cases, please refer to the Association of Breast Surgery (ABS) Guidance for the Commissioning of Oncoplastic Breast Surgery

Surgery to remove breast implants should only be considered for patients aged 18 years and over with the following clinical indications:

After implant leakage or rupture OR

There is severe capsular contracture (grade III/IV on the Baker classification). This will need to be confirmed by a specialist opinion OR

•Implants are complicated by recurrent implant infection or seroma OR

The patient develops Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

Pre and postoperative photographs MUST be recorded for audit purposes. All eligible patients MUST be entered into the Breast and Cosmetic Implant Registry (BCIR) for audit purposes

Patients whose initial procedure was privately funded should seek assurance from their private provider in the first instance

If, however, the patient meets one of the above clinical indications, and the private provider is unable to offer the patient surgery, the patient can be offered an NHS referral for breast implant removal but not for replacement

Where a patient is eligible for implant removal due to a problem associated with a single implant, bilateral implant removal should be offered

Only implant removal should be performed, and no other subsequent cosmetic procedure e.g. mastopexy

The removal of breast implants due to symptoms termed as Breast Implant Illness (BII) or Autoimmune Syndrome Induced by Adjuvants (ASIA) on social media, or due to the risk of developing Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is not currently recommended

Only patients whose initial procedure was funded by the NHS should be considered for both implant removal and replacement

In line with current guidance, patients eligible to have their implant replaced must be informed of the potential risk of BIA-ALCL

As per guidance NG180 from the National Institute for Health and Care Excellence (NICE), discuss lifestyle modifications with people having surgery — for example stopping smoking and reducing alcohol consumption — in order to reduce the risk of post-operative complications

See NICE guidance NG180 on Perioperative care in adults for more information

Rationale for recommendation

Patients should be informed at the time of initial surgery that implants are likely to need replacement and further surgery may be required

In the case of implant rupture, severe capsular contracture, recurrent infection, breast disease and BIA-ALCL the benefit of removing an implant outweighs the risk of keeping the implant in place

It is accepted that the NHS has a duty of care to patients who require their implant to be removed for a listed clinical indication, but only if their private provider is unable to offer this care

As the NHS does not routinely commission breast implants for cosmetic reasons, removal but not replacement is considered appropriate in these cases

Concerns have been expressed about the potential side effects of breast implants including the development of BIA-ALCL and BII or Autoimmune Syndrome Induced by Adjuvants (ASIA)

The BIA-ALCL is uncommon and in the UK is currently estimated to be 1 per 15,000 implants sold

The most recent guidance from the Medicines and Healthcare products Regulatory Agency (MHRA) states that based on the current available evidence people with breast implants do not need to have them removed in the absence of symptoms of ALCL

The MHRA states this position is consistent with international regulators and they will continue to collect data on ALCL in patients with breast implants and review the guidance in light of any new evidence

BII/ASIA is used by some to describe a constellation of symptoms felt to be associated with their breast implants. However, BII/ASIA is not a World Health Organization recognised disease

The MHRA states there is no single disease which could explain the reported symptoms and it is currently unknown whether there is a link between breast implants and the reported health problems

Replacement of breast implants

Replacement of breast implants is not funded. The ICB does not support Female breast enlargement (augmentation mammoplasty)

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

Breast Lift (Mastopexy)

Not funded

The surgical correction of breasts that sag or droop. This can occur as part of the natural aging process, or pregnancy, lactation and substantial weight loss

This is because the procedure is deemed to be cosmetic and does not meet the principles laid out in this policy.

References

https://baaps.org.uk/patients/procedures/5/breast_uplift_mastopexy

Inverted Nipple Correction

Not funded

This is because surgery to correct inverted nipples is deemed to be cosmetic and does not meet the principles laid out in this policy

Nipple inversion may be indicative of breast cancer which should always be excluded

• Most cases can be managed by use of a suction device for 3 months
• Otherwise, surgical correction of nipple inversion is not routinely commissioned