Summary of intervention
Breast reduction surgery is a procedure used to treat women with breast hyperplasia (enlargement), where breasts are large enough to cause problems like shoulder girdle dysfunction, intertrigo and adverse effects to quality of life.
Number of CCG intervention 2017/18
The NHS will only provide breast reduction for women if all the following criteria are met:
- 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).
- Breast reduction planned to be 500gms or more per breast or at least 4 cup sizes
- Body mass index (BMI) is <27 and stable for at least twelve months
- 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
Unilateral breast reduction is considered for asymmetric breasts as opposed to breast augmentation if there is an impact on health as per the criteria above.
Surgery will not be funded for cosmetic reasons. Surgery can be approved for a difference of 150 – 200gms size as measured by a specialist. The BMI needs to be <27 and stable for at least twelve months.
Resection weights, for bilateral or unilateral (both breasts or one breast) breast reduction should be recorded for audit purposes.
This recommendation does not apply to therapeutic mammoplasty for breast cancer treatment or contralateral (other side) surgery following breast cancer surgery, and local policies should be adhered to. The Association of Breast Surgery support contralateral surgery to improve cosmesis as part of the reconstruction process following breast cancer treatment.
Gynaecomastia: 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.
Rationale for recommendation
One systematic review and three non-randomized studies regarding breast reduction surgery for hypermastia were identified and showed that surgery is beneficial in patients with specific symptoms. Physical and psychological improvements, such as reduced pain, increased quality of life and less anxiety and depression were found for women with hypermastia following breast reduction surgery.
Breast reduction surgery for hypermastia can cause permanent loss of lactation function of breasts, as well as decreased areolar sensation, bleeding, bruising, and scarring and often alternative approaches (e.g. weight loss or a professionally fitted bra) work just as well as surgery to reduce symptoms. For women who are severely affected by complications of hypermastia and for whom alternative approaches have not helped, surgery can be offered. The aim of surgery is not cosmetic, it is to reduce symptoms (e.g. back ache).