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Breast

Please see below for the policies relating to breasts. To view the policy, patient leaflet and additional information, please click on the relevant heading.


 

  • Breast augmentation

    What is breast augmentation?

    Breast augmentation involves inserting breast implants to increase the size of the breasts and change their shape.

    Breast cancer patients - restricted criteria

    The patient’s local NHS commissioning organisation will fund this treatment if the patient meets the following criteria:

    • Treatment of the unaffected breast following breast cancer surgery will be commissioned if undertaken as part of the original treatment plan of reconstruction surgery on the cancer affected breast (later applications for such surgery would not be not routinely funded).

    The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation.

    Non-breast cancer patients - not normally funded treatment or procedure

    Breast augmentation for non-breast cancer patients is not usually funded by the patient’s local NHS commissioning organisation. This is because for non-cancer patients the surgery is considered to be a cosmetic procedure.

    The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation.

    See separate leaflet for more information on Individual Funding Requests (IFRs).

    Advice and further guidance:

  • Breast correction surgery (mastopexy)

    What is breast correction surgery?

    Breast correction surgery (mastopexy) refers to 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.

    Breast cancer patients – restricted criteria

    For breast cancer patients, this procedure is restricted. The patient’s local NHS commissioning organisation will fund this treatment if the patient meets the following criteria:

    • As part of the original treatment plan of reconstruction surgery on the cancer affected breast, correction/ lift surgery of the unaffected breast will be funded. Separate later applications for correction/ lift surgery would, however, not be routinely funded.

    The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation. See separate leaflet for more information on Individual Funding Requests (IFRs).

    Non-breast cancer patients – not normally funded treatment or procedure

    For non-breast cancer patients breast correction/ lift surgery is not routinely funded by the patient’s local NHS commissioning organisation. This is because correction of breasts for non-cancer patients is deemed to be a cosmetic procedure.

    Advice and further guidance:

  • Breast implant revision surgery

    What is breast implant revision surgery?

    Breast implant revision surgery covers two types of surgery. The first type of surgery is the removal of the implant when there is a medical fault. The second type of surgery is replacement of the breast implant in certain medical circumstances.

    Patients who might need breast implants removed include:

    • Patients with existing faulty breast implants funded through the NHS
    • Patients who have had NHS funded breast augmentation as part of gender reassignment surgery and the breast implant is faulty
    • Patients who have existing faulty breast implants (privately funded).

    Patients who might need removal and replacement surgery:

    • Patients with faulty breast implants which were originally funded by the NHS.

    Treatment

    Patients may need breast implant removal surgery, if:

    • Severe capsular contracture (Grade 3 or Grade 4) occurs. When a person has breast surgery, the body will naturally create scar tissue around the implant as part of the healing process. Over time, the scar tissue will begin to shrink (called capsular contracture). In some people, the scarring will tighten and squeeze the implant making the breast feel hard and sometimes causing pain and discomfort
    • The implant ruptures. A rupture is a split that occurs in the implants
    • The patient gets Anaplastic Large Cell Lymphoma (ALCL) as a result of breast implant surgery. ALCL is a rare type of non-Hodgkin's lymphoma and most cases occur in the capsule surrounding the implant.

    Patient eligibility criteria

    Removal of breast implants are commissioned where there is a clinical need for removal (such as rupture or some types of capsular contracture), whether the implant was initially inserted by the NHS or privately funded.

    Removal AND replacement of breast implants is commissioned where there is a clinical need for removal (such as rupture or some types of capsular contracture), AND the implant was initially inserted by the NHS under the following previously commissioned criteria:

    • Previous mastectomy or other breast removal surgery
    • Trauma to the breast during or after development
    • Total failure of breast development (congenital amastia)
    • Gland (endocrine) abnormalities
    • The breast have developed unevenly (developmental asymmetry) or are underdeveloped (severe hypoplasias)
    • Gender reassignment surgery.

    This means (for patients who DO NOT meet the above criteria) the CCG will only fund the treatment if an Individual Funding Request (IFR) application proves exceptional clinical need and that is supported by the CCG.

    Advice and further guidance

    • For more information, search for ‘breast revision surgery’ at www.nhs.uk
    • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.

    Or visit the following websites:

  • Breast reduction surgery

    What is breast reduction surgery?

    Female breast reduction surgery is a procedure to remove excess breast fat, breast tissue and skin. This is done to achieve a breast size that is in proportion with the body and to help lessen the discomfort associated with overly large breasts.

    The patient may be considered for this procedure, if:

    • The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability related to excessive breast weight; and
    • Symptoms are not relieved by physiotherapy and a professionally fitted bra; and
    • The patient’s body mass index (BMI) is less than 27kg/m²; and
    • The patient’s cup size is F+; and
    • The patient is over the age of 21.

    Breast cancer patients - restricted criteria

    This is part of the original treatment plan of reconstruction surgery on the breast that has been affected. This means that the patient’s unaffected breast will receive the reduction procedure whilst the patient is having reconstructive surgery on the breast that had cancer.

    The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation.

    Non-breast cancer patients - not normally funded treatment or procedure

    Cosmetic surgery breast reduction is not routinely funded by the patient’s local NHS commissioning organisation. This is because breast reduction is considered to be a cosmetic procedure.

    There is also published evidence showing that many patients seeking breast reduction surgery are not wearing a bra of the correct size and that a well fitted bra can sometimes reduce the symptoms that are troubling the patient. See separate leaflet for more information on Individual Funding Requests (IFRs).

    Advice and further guidance:

  • Enlarged male breasts

    What are enlarged male breasts?

    Enlarged male breasts, sometimes referred to as ‘man boobs’ (gynaecomastia) is a common condition that causes the breasts of boys and men to swell and become larger than normal.

    It is most common in teenage boys and older men, although it may occur at any time and there are a number of causes. It may occur due to hormonal imbalance linked to factors including obesity.

    Not normally funded treatment or procedure:

    Surgery for enlarged male breasts to improve appearance alone is not usually funded by the patient’s local NHS commissioning organisation. This is because surgery for reduction of male breast tissue is deemed to be a cosmetic procedure.

    If a physical examination raises suspicion of cancer, then an urgent referral for further investigation would be made. Specialist referral to determine the underlying cause of enlarged male breasts (gynaecomastia) should be made in the usual way.

    The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded.

    The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation. See separate leaflet for more information on Individual Funding Requests (IFRs).

    Advice and further guidance:

    In some cases, other treatment options will be available, such as medication to adjust a hormone imbalance.

    For more information search for ‘male breast reduction’ at www.nhs.uk

    • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.
  • Inverted nipples

    What is surgery for inverted nipples?

    An inverted nipple means a nipple that is turned in on itself. This can be caused by trauma, breastfeeding, breast infections, breast cancer or in some cases patients may be born with the condition.

    Inverted nipple correction surgery is a minor procedure, usually performed under a local anaesthetic. Patients should be aware that a potential side effect may be the inability to breastfeed following the procedure. Patients may be considered for this procedure if the patient has had breast cancer and this is part of the original treatment plan of reconstruction surgery on the breast that has been affected.

    Not normally funded treatment or procedure:

    Cosmetic surgery for inverted nipples is not normally funded by the NHS for non-breast cancer patients. This is because the treatment performed by doctors to reverse inverted nipples is classed as being a low clinical priority.

    The clinician in charge of the care of the patient’s specific condition, usually a hospital doctor, can assist the application, if there is exceptional clinical need for the treatment to be funded. The patient’s clinician must evidence clinical exceptionality and must be supported by the patient’s local NHS commissioning organisation. See separate leaflet for more information on Individual Funding Requests (IFRs).

    Advice and further guidance:

    • For more information search ‘inverted nipple’ at www.nhs.uk
    • Choosing Wisely UK is part of a global initiative aimed at improving conversations between patients and their doctors and nurses.

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