Cosmetic Breast Procedures including Gynaecomastia
Cosmetic surgery is any surgery carried out to enhance outward appearance. It may be carried out on people who perceive their appearance is abnormal from a range of clinical or congenital conditions or syndromes or as a result of surgery or injury. It can also be carried out to enhance appearance changes due to ageing or obesity.
This guideline covers a group of surgical procedures with cosmetic indications.
Red flag symptoms
In all cases exclude Red Flag Symptoms and if present, refer 2WW or to symptomatic breast clinic.
Breast asymmetry is a degree of difference in the size of an individual’s breasts and is entirely normal. The difference can be corrected surgically and may involve breast reduction surgery or breast augmentation surgery
Breast augmentation/enlargement involves inserting artificial implants behind the normal breast tissue to improve its size and shape.
Breasts begin to sag and droop with age as a natural process. Pregnancy, lactation and substantial weight loss may escalate this process. This is sometimes complicated by the presence of a prosthesis which becomes separated from the main breast tissue leading to ‘double bubble’ appearance.
Breast nipple correction
The term inverted nipple refers to a nipple that is tucked into the breast instead of sticking out or being flat. It can be unilateral or bilateral. It may cause functional and psychological disturbance. Nipple inversion may occur as a result of an underlying breast malignancy and it is essential that this be excluded.
Excessively large breasts can cause physical and psychological problems. Breast reduction procedures involve removing excess breast tissue to reduce size and improve shape.
Gynaecomastia is a benign enlargement of the male breast. Most cases are idiopathic. For other cases, endocrinological disorders and certain drugs such as oestrogens, gonadotrophins, digoxin, spironolactone, cimetidine; proton pump inhibitors or drugs for treatment of prostate cancer could be the primary cause. Obesity can also give the appearance of breast development as part of the wide distribution of excess adipose tissue. Early onset gynaecomastia is often tender but this usually resolves in 3 to 4 months.
Full assessment of men with gynaecomastia should be undertaken, including screening for endocrinological and drug related causes and necessary treatment is given prior to request for NHS funding. It is important to exclude inappropriate use of anabolic steroids or cannabis.
NHS Scarborough and Ryedale and Vale of York CCGs do not routinely commission the above procedures for cosmetic reasons. Patients should not be referred unless clinical exceptionality is demonstrated and approved prior to initial referral by the Individual Funding Request panel.
Z151 Upper inner quadrant of breast
Z152 Upper outer quadrant of breast
Z153 Lower inner quadrant of breast
Z154 Lower outer quadrant of breast
Z155 Axillary tail of breast
Z158 Specified breast NEC
Z159 Breast NEC
Breast Asymmetry/Breast augmentation – B30.1/.8/.9; B31.2; B37.5
Breast –Inverted nipple correction – B35.4/.6
Breast – Mastopexy – B31.3
Breast – Prosthesis Removal and/or replacement – B30.-
Breast – reduction – B31.1
Gynaecomastia – B31.1
NHSE Evidence Based Interventions Policy – published November 2018 - https://www.england.nhs.uk/wp-content/uploads/2018/11/ebi_statutory-guidance-v2.pdf