Female Breast Reduction (Reduction Mammoplasty)
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.
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 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
Unilateral breast reduction is considered for asymmetric breasts as opposed to breast augmentation if there is an impact on health.
Surgery will NOT be funded for cosmetic reasons.
Resection weights, for bilateral or unilateral (both breasts or one breast) breast reduction should be recorded for audit purposes.
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 – 200 gms size as measured by a specialist
- 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 <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 is NOT funded.
Revision of breast augmentation / 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
Patients will be offered the choice of removing both prostheses at the same time, with the intention of ensuring symmetry.
(see policy for further details)