Policy Number: SRP 027
Policy Name: Breast Reconstruction
Status: Not Funded
Effective Date: 1 April 2024
Next Review Date: 1 April 2026
Mid and South Essex ICB commissions breast reconstruction surgery on a restricted basis in the following circumstances:
Group Prior Approval
- After a mastectomy or lumpectomy causing significant deformity when undertaken as part of treatment or prophylaxis of cancer
OR
- As part of post-trauma reconstruction surgery
Individual Prior Approval
- Congenital Amastia (an absence of the entire breast – Including breast tissue, nipple and areola)
Breast surgery to rebuild the normal contour of the affected and the contralateral unaffected breast to produce a more normal appearance, is considered reconstructive, following a mastectomy, lumpectomy, or other breast surgery carried out in circumstances detailed above.
In all cases MSE ICB only routinely fund two elective operations for an individual patient as part of the episode of care for the purpose of breast reconstruction – the first during or soon after the initial surgery e.g. mastectomy (although this may be delayed for medical reasons) followed by one further operation which is usually carried out as a day case. The second operation may include for example contra-lateral reduction, nipple reconstruction, lipofilling and removal of dog-ears.
All patients must be advised that further requests for surgery to address concerns about appearance, size, position, angle or balance – breast asymmetry- will be considered to be cosmetic and as such will not be routinely funded.
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.
Find out more information on applying for funding in exceptional clinical circumstances