Breast implants - removal and replacement

Referral Criteria

Patients who have had previous augmentation surgery privately should be directed back to the private provider in the first instance.

Where there is a clinical indication for removal of breast implants this will be commissioned in the following circumstances:

• Intra/extracapsular rupture; or
• Significant breast pain; or
• Baker Grade IV capsular contracture; or
• Implant is a Poly Implant Prostheses (PIP implant).

This commissioning decision applies regardless of funding source of the original surgery (i.e. whether funded by the NHS or on a private basis). Patients will be offered the choice of removing both prostheses in the event that only one has been ruptured with the intention of ensuring symmetry.

Treatment for patients wishing to have their implants replaced will only be commissioned when they meet the criteria for removal and both of the following indications are met:

• The original procedure was provided by the NHS;

and

• The patient meets the policy for augmentation at the time of revision (consideration will be made of the original reason for NHS funding and the cosmetic appearance following removal of implants, but replacement of implants is not automatic).

The replacement of breast implants for patients whose original surgery was paid for on a privately funded basis is not commissioned.

This policy does not cover breast reconstruction following surgery for breast cancer.

Co-payment

Patients are not able to self-fund the additional cost of the replacement implant at the same time as surgery to remove the implant as this is inconsistent with DH guidance on 'top up' payment

Patients who are not eligible for treatment under this policy may be considered for exceptionality on an individual basis. Individual cases will be reviewed at the Restricted Treatments Funding Panel upon receipt of a completed application from the patient's GP, consultant or clinician.

Applications cannot be considered directly from patients.

Breast implants removal and replacement commissioning policy

Exceptional /Individual Funding Requests (IFR)

Referral Instructions

Applications for consideration for funding approval should be sent to:

Email: d-icb.ifr-newsdt@nhs.net

Patient Information

Individual Funding Request (IFR)