Policy number: MSEICB 083
Policy name: Breast Reduction
Status: Individual Prior Approval
Effective date: 1 April 2023
Next review date: 1 April 2024
Mid and South Essex ICB commissions surgery for breast reduction on a restricted basis.
Procedures for cosmetic purposes only will not be funded.
Women and people capable of pregnancy should be informed that breast surgery for hypermastia can cause permanent loss of lactation. They must be provided with written information to allow them to balance the risks and benefits of breast surgery.
Breast reduction will be funded if ALL the following criteria are met
a) Woman/ person assigned female at birth are aged at least 18 years.
AND
b) The patient has received a full package of supportive care from their GP such as advice on weight loss and managing pain
AND
c) In cases of thoracic/ shoulder girdle discomfort, a physiotherapy assessment has been provided
AND
d) Breast size results in functional symptoms over at least 12 months 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). Clinical evidence will need to be produced to rule out any other medical/physical problems to cause these symptoms.
AND
e) Body mass index (BMI) is <27kg/m2 and stable for at least twelve months
AND
f) Breast reduction planned to be 1kg or more per breast
AND
g) The patient is a non-smoker at the time of referral (confirmed by CO reading).
Initial assessment must be done by the GP prior to referral to ensure criteria a) to g) are met.
Contour irregularities and moderate asymmetry (including dog-ears, nipple direction or position, breast size and shape disparity) are predictable following surgery. Any post-surgical cosmetic irregularities will not be funded by the ICB in revision surgery.
Patients not meeting the above criteria will not be funded unless there are clinically exceptional circumstances.
Individual funding requests should only be made where the patient demonstrates clinical exceptionality.
Further information on applying for funding in exceptional clinical circumstances can be found on the ICS’ website.
A downloadable version of this document is available below:
083 – MSE ICB Breast Reduction – Effective from 1.04.23 (docx, 202kb)
Breast Reduction – Consent Form – Effective from 01.04.23 (docx, 219kb)