HNY Policy and Pathway Repository - York

Any change in appearance of implants or increased associated pain.
Common problems include age related sagging, calcification of breast tissue, capsular contraction, leak from implant, implant wrinkling or rippling, infection, inflammation or irritation.

Urgent suspected cancer (USC) referral required if has below associated symptoms:

• Breast lump

• Nipple changes

• Nipple discharge

The ICB does NOT routinely commission the removal of breast implants (See Image A)

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

• Breast cancer
• Breast Implant associated – Anaplastic Large Cell Lymphoma (BIA-ALCL) is suspected
• Implants complicated by recurrent infections • Implants with capsule formation that is associated with severe pain
• Implant is proven to be ruptured (intra or extra capsular) • Baker Grade IV capsular contracture
• Implants with a capsule formation that interferes with breast imaging
• Implant is a 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).

(In the first instance the patient should be directed back to the original private provider for the procedure. If the private provider is unable to support the patient, the NHS will undertake removal only. The ICB reserves the right to seek reimbursement from the provider.)

Patients will be offered the choice of removing both prostheses if only one has been ruptured to preserve symmetry.

This policy does not include replacement of removed implants (see next)
 

The ICB does NOT routinely commission the replacement of breast implants. (See Image B)

Where revision surgery is being carried out for implant failure, the ICB will support the removal of failed implants in certain circumstances (as above) but will not approve their replacement, other than where clinical exceptionality may apply and where approval for funding is granted by the IFR panel.

Replacement of implants will only be considered when patients meet the criteria for removal (as above) and BOTH of the following indications are met:

• The original procedure was provided by the NHS

AND

• The original implant insertion was following cancer surgery, trauma or developmental asymmetry

Replacement of implants will only be considered when patients meet the criteria for of breast implants for patients whose original surgery was paid for on a privately funded basis is not commissioned unless undertaken following cancer surgery.  

Referral should include details of original surgery, why performed and who by. Referral back to the original surgeon is always preferable.

Patient information leaflets / PDAs

Cosmetic surgery - Breast enlargement (implants) - NHS (www.nhs.uk)

Breast implant removal: What to expect, pros, cons, cost (healthline.com)