This page was last reviewed 02-08-19
Developmental size, shape and symmetry abnormalities of the breast are common and affected women frequently seek surgical correction. In the NHS, such procedures are considered aesthetic although they may also have functional effects. As such, they are subject to the Exceptional Aesthetic Referral Pathway (EARP, see relevant section of RefHelp) and any indicated surgical procedures is only approved where the patient meets rigorous physical and psychological criteria and are not contraindicated on any of these measures. The availability of certain procedures on the NHS are subject to change, especially in relation to body contouring surgery.
The various surgical procedures that can be offered include:
Breast Reduction for hypermastia where patients are anticipated to need in excess of a 500g reduction on each side to achieve normal breast volume and meet EARP criteria. Unilateral breast reduction may be carried out to achieve breast symmetry. The procedure is carried out under general anaesthetic, with an overnight stay post-operatively. Patients are likely to require 2-4 weeks off work.
Breast uplift (mastopexy) is not available on the NHS unless to correct significant developmental or post reconstructive breast asymmetry.
Breast Augmentation with implants, expanders or by means of fat transfer techniques, may be performed for significant hypomastia where the inframammary fold is not apparent and in cases of significant breast asymmetry. Most often this surgery is carried out under general anaesthetic with an overnight stay. Post-operative recovery depends upon the nature of the procedure but is often more rapid than with other types of breast surgery.
Who to refer:
- Any patient with symptomatic hypermastia, significant breast asymmetry or underdeveloped breast.
- Tuberous breast deformity
Who not to refer:
- Patients with suspected breast disease should be referred to the breast department at the Western General Hospital.
- Patients who have had related breast surgery in the private sector should be referred back to their provider in the first instance.
- Patients who are not likely to fulfil the EARP requirements.
How to refer:
Via SCI gateway to the Plastic Surgery service at St John’s hospital with appropriate details and background information.
In an emergency, the NHS will deal with complications arising from breast surgery in the private sector, where the private provider has not or cannot take care of the patients themselves. This typically amounts to dealing with infections and may involve the explantation (but not the replacement) of breast implants. Any private patient should be advised to contact their private healthcare provider in the first instance if possible.
