|General||Patients desiring uplift and change in appearance rather than symptomatic relief.
Body mass index (BMI) is greater than 30.
BMI should be recorded in all referral letters.
|Appropriate for relief of functional and psychological symptoms (neck, upper back and interscapular pain, bra straps cutting in, sleeps in bra, inframammary intertrigo, unable to undress in front of partner or go swimming due to breast size, social isolation and adverse comments from others etc).
Symptoms with bra cup size at least E or EE.
Obvious asymmetry ( = greater than a cup size difference with difficulty finding bras to fit).
Asymmetry following breast cancer surgery.
|Augmentation||Post partum related loss of volume and changes of appearance.
Small, but natural breasts (see ‘Male Chest’ below).
|Unilateral procedure to balance a contralateral breast cancer reconstruction.
Congenital anomalies such as Polands syndrome and constricted or ‘tubular’ breast, pectus deformity or chest wall asymmetry associated with scoliosis.
Asymmetry of more than one cup size.
‘Male chest’ appearance.
Bilateral augmentation only in patients with very little or no breast development, who have never had children.
|Inverted nipples||Treatment is aesthetic and surgical correction usually results in an inability to breast feed|
|Change in breast shape||Mastopexy (tightening of skin and ‘uplift’ without volume change).
Inverted nipples where there is no suspicion of underlying tumour.
|Any surgery related to breast cancer or its sequelae.
Surgery to contralateral breast during breast reconstruction or correction of asymmetry.
|Gynaecomastia (Male breast reduction)||The overweight and obese.
Body builders and sportsmen desiring reduction of perceived excess pre-pectoral tissue to enhance appearance at the gymnasium.
The abuse of anabolic medication should be excluded.
|Where there is true breast glandular development or obvious asymmetry.
Breast development secondary to hormonal disturbance or drug complication.
Suspicion of male breast cancer.