Document type
Clinical pathways
Hertfordshire and West Essex ICB
Output type
Clinical Pathways
Female Breast ReductionMale Breast Reduction

Breast Reduction

Pathway published: September 2023.
Next review date: September 2025. 



  • Cosmetic surgery is not routinely funded by the NHS.  HWE ICB do, however, have policy criteria for some procedures.  If these criteria are not met, advise patient that they do not meet criteria and discharge.  If exceptional circumstances, submit an individual funding request (IFR). Please see policy/policies for full information.

  • If patient meets policy criteria for surgery, HWE ICB will approve funding requested at primary care level (NB - it is the responsibility of the GP - not the surgeon - to apply for funding). It should be made clear to the patient that the final decision to proceed with surgery will lie with the surgeon at secondary care, once the surgeon has seen the patient AND agreed that the patient meets the policy criteria.

This guidance applies to those over 18 years; cosmetic breast surgery will not normally be considered for those under 18.

Breast reconstruction after treatment for breast cancer - see separate page

Cosmetic breast augmentation

Breast augmentation for small breasts and augmentation or corrective surgery for asymmetry are considered low priority and therefore not generally funded unless there is congenital absence.

In the case of very significant asymmetry e.g. as a result of Poland’s syndrome, patients will be considered on an individual basis via the individual funding requests process.

Breast reduction - for females

Covered below are indications for referral for breast reduction surgery for females

Applications for funding will normally only be considered in patients in whom the following apply:

  • The individual patient’s breast development is considered to be complete AND
  • Where the BMI is stable below 27kg/m2 for at least 12 months prior to referral AND
  • Bra cup size of greater than GG AND
  • One of:
    • The patient has clinically significant history of back, neck or shoulder pain, which has not resolved despite treatment(s) - medically documented evidence needs to be provided OR
    • Clinically significant history of intertrigo or ulceration which has not responded to treatment(s) - medically documented evidence needs to be provided

For outpatients use Choose and Book / e-referral.

Removal and/or replacement of prosthetic breast implants - relating to cosmetic enlargement

HWE ICB will generally only fund removal of the implant for significant clinical reasons; replacements are usually not funded.  Specifically:

  • PIP implants will be removed after assessment of clinical need risk or impact of unresolved concerns OR
  • PIP implants will be removed and replaced where initial surgery was performed by the NHS OR
  • Non-PIP implants will be removed in the case of rupture with associated symptoms e.g. pain OR
  • Non-PIP implants will be removed and replaced in the case of leakage and associated pain where initial surgery was performed by the NHS

Male Breast Reduction

Referral for male gynaecomastia surgery requires prior approval and will usually only be approved under the following circumstances:

  • Patient is at least 20 years of age (or demonstrated to be 2+ years post pubertal) AND
  • Grade 3 or 4 gynaecomastia on Rohrich classification (or other appropriate gynaecomastia classification system), where an estimated 100g or more of breast tissue could be surgically removed on each affected side AND
  • Associated breast ptosis AND
  • BMI is 25 or less AND
  • Underlying aetiology has been investigated and managed (or ruled out - see pathway for considerations of underlying pathology)