COSMETIC BREAST SURGERY POLICY

Transcription

1 COSMETIC BREAST SURGERY POLICY Please note that all Central Lancashire Clinical Commissioning policies are currently under review and elements within the individual policies may have been replaced by the pan Lancashire Clinical Commissioning Policies listed on the webpage. Please ensure that relevant pan Lancashire Clinical Commissioning Policies are read in conjunction with this Central Lancashire Clinical Commissioning Policy. REFERENCE NUMBER DCCE 12 APPROVING COMMITTEE(S) AND DATE Governance Committee AUTHOR(S) / FURTHER INFORMATION Associate Director Commissioning for Health & Well Being LEAD DIRECTOR Director of Commissioning and Community Engagement THIS DOCUMENT REPLACES Previous Policies for the predecessor organisations Chorley & South Ribble, Preston and West Lancashire PCT s REVIEW DUE DATE November 2010 RATIFICATION DATE/DRAFT No November 2008 VALIDATION SIGNATURE

2 The NHS Central Lancashire is committed to ensuring that, as far as it is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on the basis of their ethnic origin, physical or mental abilities, gender, age, religious beliefs or sexual orientation. Should a member of staff or any other person require access to this policy in another language or format (such as Braille or large print) they can do so by contacting the communications department or the relevant policy holder. NHS Central Lancashire will do its utmost to support and develop equitable access to all policies. Managers are responsible for ensuring staff within their area of responsibility are aware of NHS Central Lancashire policies and that staff adhere to them. Managers are responsible for ensuring that a system is in place for their area of responsibility that keeps staff up to date with new policy changes. Staff are responsible for ensuring they are familiar with policies, know where to locate the documents on the PCT s website, and seek out every opportunity to keep up to date with NHS Central Lancashire policies. Independent contractors are expected to identify a lead person to be responsible for ensuring staff employed within their practice are aware of NHS Central Lancashire policies. This policy is individual to NHS Central Lancashire. NHS Central Lancashire does not accept any liability to any third party that adopts or amends this policy. NHS Central Lancashire Page 2 of 6

3 CONTENTS PAGE 1. INTRODUCTION Scope Principles Exceptionality 4 2. COSMETIC BREAST SURGERY POLICY Context Inclusion criteria Exclusion criteria IMPLEMENTATION 6 4. REFERENCE DOCUMENTS 6 5. GLOSSARY 6 Page 3 of 6

4 1. INTRODUCTION This is the policy of NHS Central Lancashire to commission cosmetic breast procedures. This includes cosmetic surgery and non-surgical cosmetic treatments. The term 'cosmetic surgery' means operations that revise or change the appearance, colour, texture, structure or position of the bodily features to achieve what patients perceive to be more desirable. 'Non-surgical cosmetic treatments' means other procedures that revise or change the appearance, colour, texture, structure or position of the bodily features to achieve what patients perceive to be more desirable 1. This policy is written in recognition of service agreements that exist for the provision of cosmetic breast procedures and describes eligibility criteria for these procedures. Patients may satisfy the criteria, or may be confirmed as exceptions by NHS Central Lancashire on an individual patient basis. 1.1 Scope This policy applies to the commissioning of services for those individuals who request a cosmetic breast procedure. Exceptional circumstances are considered when funding requests are received. This policy applies to patients who are registered with a Central Lancashire General Practitioner. 1.2 Principles The principles that underpin this policy include the need for NHS Central Lancashire to commission interventions that are evidencebased, based on need and equitably accessible. The principles are outlined in more detail in a separate policy entitled: The Ethical Framework Policy for commissioning individual patient funding requests. 1.3 Exceptionality The Panel will consider the exceptionality of the case when considering funding requests. For the purposes of the policy, exceptionality is taken to mean that the patient is different in their needs compared to other patients with a similar condition requiring an intervention. Page 4 of 6

5 2. COSMETIC BREAST SURGERY POLICY 2.1 Context The NHS will not pay for surgery for cosmetic reasons alone. However, reconstructive surgery and cosmetic surgery to correct or improve congenital abnormalities and injuries may be undertaken free of charge. The policy covers a range of procedures relating to breasts in men and women broadly headed as follows: Reduction mammoplasty (Breast reduction) Breast augmentation surgery (Breast enlargement) Revision of breast augmentation Breast reduction for gynaecomastia (Enlarged breasts in men) Nipple inversion Mastopexy (Breast lift) Inclusion Criteria Reduction mammaplasty This will only be considered in the following circumstances: Body Mass Index less than 26 Cup size of F or above Physical symptoms such as significant shoulder pain not alleviated by physiotherapy or intertrigo that are resistant to conventional treatment, such as antifungal creams Where physical symptoms persist even after obtaining a professionally fitted bra More than 500g breast tissue removal Breast augmentation This will only be considered in the following circumstances: Breast asymmetry where the degree of asymmetry is felt to be beyond that expected in normal variation Physical development has been judged to be complete Congenital absence of breast tissue Revision of breast augmentation Revisional surgery will only be considered if the NHS commissioned the original surgery. If revisional surgery is being carried out for implant failure, the decision to replace the implant(s) rather than simply remove them should be based upon the clinical need for replacement and whether the patient meets the policy for augmentation at the time of revision. Page 5 of 6

6 Breast Reduction for Gynaecomastia Surgery will only be considered in exceptional circumstances where there is confirmation of being post pubertal, a normal BMI and evidence of significant gross asymmetry. Nipple inversion This procedure is not routinely available on the NHS. Where nipple inversion occurs as a result of an underlying breast malignancy, surgery would be considered Exclusion Criteria Breast Reduction for Gynaecomastia The policy excludes surgery for gynaecomastia resulting from use of anabolic steroids. Mastopexy (Breast Lift) This procedure is not routinely available on the NHS for cosmetic reasons only. 3. IMPLEMENTATION Line Managers will ensure that all staff involved in processing commissioning requests in Public Health, Health Standards and Commissioning Directorates will follow the policy. This policy will be available to all General Practitioners and service providers. The policy will be available to the public from the NHS Central Lancashire website. Any breaches to this policy will be monitored through the Commissioning Appeals Process and reported to the Governance Committee. 4. REFERENCE DOCUMENTS 1 Department of Health: Cosmetic Procedures Frequently Asked Questions. dcservice=get_file&did=139989&rendition=web 5. GLOSSARY Not Required. Page 6 of 6