Referral Criteria

Breast implant removal

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:

• After implant leakage or rupture; or
• Baker Grade II capsular contracture associated with significant pain; or
• Baker Grade IV capsular contracture; or
• Implants are complicated by recurrent implant infection or seroma; or
• The patient develops Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL).

This commissioning decision applies regardless of funding source of the original surgery (i.e. whether funded by the NHS or on a private basis). In the event that only one implant is affected, removal of both implants will be offered to ensure symmetry.

The removal of breast implants due to symptoms termed as Breast Implant Illness (BII) or Autoimmune Syndrome Induced by Adjuvants (ASIA), or due to the risk of developing Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is not routinely commissioned.

Breast implant replacement

Treatment for patients wishing to have their implants replaced will only be commissioned for patients who meet the above criteria for removal AND whose original breast augmentation was performed by the NHS as part of a treatment plan to repair or reconstruct missing or damaged tissue that occurred through accident or illness.

Breast implant replacement or any other cosmetic procedures (e.g., mastopexy), is not routinely commissioned for patients where their original augmentation procedure was privately funded. Patients are not able to self-fund the additional cost of replacement implant(s) (or any other cosmetic procedures) at the same time as surgery to remove implant(s).

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

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

Guidance notes on exceptionality

Where the circumstances of treatment for an individual patient do not meet the criteria described above exceptional funding can be sought. Individual cases will be
reviewed by the appropriate panel of the ICB 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)

Date of decision: 7 March 2012

This commissioning decision was adopted by Northern, Eastern and Western

Devon CCG and South Devon and Torbay CCG on 1 April 2013, having been

originally agreed by the previous commissioning organisations (NHS Devon,

NHS Plymouth and Torbay Care Trust).

This policy has been adopted from Northern, Eastern and Western Devon CCG

and South Devon and Torbay CCG by NHS Devon from 1 April 2019

This policy has been adopted by NHS Devon ICB on 1st July 22.

Updated: 29th February 2024