Norfolk Public Health improving health and wellbeing, protecting the population and preventing ill health

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1 Norfolk Public improving health and wellbeing, protecting the population and preventing ill health Name of document: Breast surgery policy File location / Filename: \\norfolk.gov.uk\nccdfs1\public \Clinical Effectiveness\Clinical Policy Development Group\Breast surgery final Version: 10.0 Date of this version: Status: Final draft for consultation Synopsis and outcomes of Equality and Diversity Impact Assessment Owner: Jon Cox Approved by: n/a Clinical Policy Development Group of the Individual Funding Requests Panel for Norfolk & Waveney Produced by: Jon Cox Shamsher Diu Date ratified: Public Programme: Children and Young People Working Age Older People Protection Screening care commissioning Public Development care commissioning Copyholders: Next review due: Enquiries to: Dr. Shamsher Diu Consultant in Public July 2017 Shamsher.diu@nofolk.gov.uk

2 Acknowledgements The authors are grateful for the invaluable support of the North East London Commissioning Support Unit in ensuring liaison with individual service and business managers at the James Paget University Hospital, Great Yarmouth, the Norfolk and Norwich University Hospital, Norwich and the Queen Elizabeth Hospital, Kings Lynn and their efforts to consult with clinicians in the appropriate specialities at every stage of the development of this policy. Individuals who contributed to this process are acknowledged in Appendix 1. Breast Surgery Policy 1. Surgical treatment of Inverted Nipples 2. Hypoplasia or Aplasia of Breast(s) 3. Mastopexy / Mastoplexy CCGs will commission breast mastopexy where it is required as a part of breast reconstruction after prophylactic or treatment mastectomy or breast surgery relating to cancer treatment, or breast disease or breast trauma. 4. Breast Reduction CCGs will commission breast reduction surgery only where ALL of the following criteria are met: Contra-lateral breast reduction surgery is required to help achieve breast symmetry AND Mastectomy or reduction in breast size has been performed for treatment of breast cancer treatment, other breast disease or breast trauma. 5. Other Breast Asymmetry treatment 6. Gynaecomastia 7. Breast augmentation CCGs will commission the unilateral/bilateral insertion of breast implants following prophylactic or treatment mastectomy for breast cancer, breast disease or breast trauma. 8. Breast Implant Removal CCGs will commission the bilateral removal (but not replacement - see below) of breast implants for ANY of the following indications in patients who have previously undergone augmentation mammoplasty that was performed either in the NHS or privately: Diagnosed significant breast disease Implant complicated by recurrent infection Implant with documented capsular contracture that is associated with severe pain that cannot be sufficiently managed by analgesics Implant with capsular contracture that interferes with mammography in opinion of a Consultant Radiologist Implant is proven to be ruptured Implant is a PiP implant 9. Replacement of breast implants CCGs will commission the bilateral replacement of breast implants only where ALL of the following criteria are met:

3 Implants were inserted following prophylactic or treatment mastectomy for breast cancer, breast disease, breast trauma or due to lack of usual development of the breast resulting from congenital disorder and Implant with documented capsular contracture with or without pain, or the implant is proven to be ruptured by ultrasound. 10. All patients who are considered for treatment under this policy and are smokers must be referred to smoking cessation services at the time of the referral and their status assessed at the initial appointment with a consultant. 11. Prior approval will not be required for procedures carried out under this policy. 12. Medical photographs may be required for cases referred to the Individual Funding Requests Panel. Clinical effectiveness The Provider will participate constructively and in a timely manner in an audit of all patients treated under this policy as agreed with the Commissioner. Please discuss this with your directorate/ healthcare governance lead. If you require any advice in conducting an audit then contact joanne.creaser@norfolk.gov.uk in Public, Norfolk County Council, who can advise you in preparing the audit, measuring performance, making or sustaining improvements in the care of patients in line with this policy. NB Transgender Patients NHS England is the lead commissioner for Transgender patients. Therefore, the treatment for this group of patients is not included in this policy. Please refer to policy guidance at: Page 24 of this guidance lists the seven gender specialist clinics for adults where referrals can be made to explore with the patient the options available to them.

4 APPENDIX 1 This draft policy has been developed through consultation with the following people: Name Designation CCG/Acute provider CCG clinicians Dr Hitesh Kumar GP representative NHS Great Yarmouth and Waveney CCG Prof David Scott Clinical Advisor NHS Great Yarmouth and Waveney CCG Dr James Gair GP representative NHS Great Yarmouth and Waveney CCG Dr Alasdair Lennox GP representative NHS North Norfolk CCG Dr Brian Cole GP representative NHS Norwich CCG Dr Chris Dent GP representative NHS Norwich CCG Dr Les Cooper GP representative NHS South Norfolk CCG Louise Stevens CCG representative NHS West Norfolk CCG Dr Paul Williams GP NHS West Norfolk CCG Dr Imran Ahmed GP NHS West Norfolk CCG Dr Julian Brown GP NHS West Norfolk CCG Dr Anthony Burgess GP and CCG NHS West Norfolk CCG Dr Pallavi Devulapalli GP NHS West Norfolk CCG Dr Mark Funnell GP NHS West Norfolk CCG Dr Ian Mack GP NHS West Norfolk CCG Maggie Carter Clinical Governance Lead NHS West Norfolk CCG CCG Colleagues Kathryn Griffiths Project Management Specialist (representing) NHS Great Yarmouth and Waveney CCG Rachel Leeds Commissioning Manager NHS Great Yarmouth and Waveney CCG Ellis Layward Commissioning Manager NHS North Norfolk CCG Lindsay Springall Commissioning Manager NHS Norwich CCG Jon Bryson Chair NHS South Norfolk CCG Ann Donkin Chief Officer NHS South Norfolk CCG Katy Blakely Commissioning Manager NHS South Norfolk CCG Louise Browning Independent Consultant (representing) NHS South Norfolk CCG Jan Sanders Commissioning Manager NHS West Norfolk CCG Andrew Hassan Medical Director NHS West Suffolk CCG Acute provider colleagues Mr Andrea Figus Consultant Plastic and James Paget University Hospital NHSFT Rebecca Hulme Operational Manager Head Norfolk and Norwich University Hospital NHSFT and Neck Services Tim Shayes Business Manager Norfolk and Norwich University Hospital NHSFT Stephen Day Head of Commissioning Norfolk and Norwich University Hospital NHSFT Miss Elaine Sassoon Consultant Breast and Norfolk and Norwich University Hospital NHSFT

5 Mr Jonothan Clibbon Consultant Plastic and Norfolk and Norwich University Hospital NHSFT Janice Reid Performance and Business Norfolk and Norwich University Hospital NHSFT Development Manager Jonathon Wade Commissioning Manager Queen Elizabeth Hospital NHS Trust, King s Lynn Miss Amy Burger Consultant Breast and Queen Elizabeth Hospital NHS Trust, King s Lynn Public Team Dr Shamsher Diu Consultant in Public Norfolk County Council Dr Jon Cox Speciality Registrar Public Norfolk County Council Dr Tha Han Consultant in Public Norfolk County Council Dr Stuart Keeble Speciality Registrar Public Norfolk County Council Dr Lisa Rodolico GP Registrar Norfolk County Council Dr Lal Gurung FY2 Doctor Norfolk County Council Dr Suzy Duckworth GP Registrar Norfolk County Council Dr Arabella Stuart FY2 Doctor Norfolk County Council Dr John Ford Speciality Registrar Public Norfolk County Council Dr Victoria Wilson GP Registrar Norfolk County Council

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