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Breast Implants – Removal

Definition

The presence of breast implants may cause patients a range of symptoms over time. These include a change in appearance of implants or increased associated pain. Common problems include age related sagging; calcification of breast tissue; capsular correction; leak from implant; implant wrinkling or rippling; infection; inflammation or irritation.

Concerns about cosmetic appearance should not be referred to secondary care. These procedures will not be funded.

Red Flag Symptoms

In all cases, exclude Red Flag Symptoms and if present, refer 2WW or to symptomatic breast clinic.

Exclusions to policy

This policy does not apply to breast reconstruction as part of the treatment for breast cancer.

Commissioning Position

NHS Scarborough & Ryedale and Vale of York CCG’s do not routinely commission the removal of breast implants.

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**). 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.

This policy does not include replacement of removed implants – please see separate policy.

** 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 CCG reserves the right to seek reimbursement from the provider.

OPCS Codes

B30.

References

Poly implant Prothese (PiP) breast implants; Final report of the Expert Group June 2012 Sir Bruce Keogh NHS Medical Director http://www.nhs.uk/conditions/breastimplants/Documents/PIP%20expert%20group%20final%20report.pdf

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