General
Excluded
- 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
Allowable
- 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
Excluded
- Post partum related loss of volume and changes of appearance
- Gender reassignment
- Small, but natural breasts (see ‘Male Chest’ below)
Allowable
- 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
Excluded
- Treatment is aesthetic and surgical correction usually results in an inability to breast feed
Change in breast shape
Excluded
- Mastopexy (tightening of skin and ‘uplift’ without volume change)
- Inverted nipples where there is no suspicion of underlying tumour
Allowable
- Any surgery related to breast cancer or its sequelae
- Surgery to contralateral breast during breast reconstruction or correction of asymmetry
Gynaecomastia (Male breast reduction)
Excluded
- 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.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
Allowable
- Where there is true breast glandular development or obvious asymmetry
- Breast development secondary to hormonal disturbance or drug complication
- Suspicion of male breast cancer