RAG rating
Document type
Clinical policy
Hertfordshire and West Essex ICB
Output type
Clinical Policies & Evidence-based Interventions

Breast Asymmetry Surgery


Breasts are considered asymmetrical when there is a noticeable difference in one breast’s shape, size or where the nipple is positioned compared to the other breast. Surgery for this is not usually carried out by the NHS.

It can be done if the difference is due to something the person was born with, such as certain genetic conditions, and specific criteria are met. Studies looking at individuals who have and have not had surgery showed a variation in the criteria applied, impacting on the ability to access this surgery. The EBI programme proposes clear, evidence-based criteria for use across England. The expected outcome from the use of these criteria is consistent and fair access to corrective surgery for congenital breast asymmetry across England where individual funding requests are being considered.


Surgery for breast asymmetry for cosmetic reasons is not routinely funded by the NHS. However, where asymmetry is a result of a congenital condition, corrective surgery can be considered, through an Individual Funding Request (IFR) if the following criteria are met:

• A difference of at least 250gms size as estimated by a specialist AND

• BMI <27 and stable for at least twelve months AND

• Congenital conditions may include (but are not limited to): macromastia, Poland Syndrome, tuberous breast, unilateral or asymmetric hypoplasia, amazia (unilateral/bilateral), congenital symmastia.

Congenital symmastia is very rare and should be considered for treatment on that basis.

Corrective procedures for inverted nipples are not recommended.

This recommendation does not cover the following, where separate guidance is available:

  • Gender reassignment surgery
  • Surgery for breast cancer.

Expected outcome

The implementation of this proposed guidance would result in a reduction in unwarranted variation to access across England for corrective surgery for congenital breast asymmetry by standardising the criteria for the consideration of funding.

Rationale for recommendation

The GIRFT Breast Surgery report identified significant variability in the ICB’s approach to funding surgery for congenital abnormalities. Findings from the GIRFT report emphasise the need for a standard set of criteria that ICB’S must consider when reviewing IFRs for corrective surgery for congenital asymmetry.

Surgery is not funded on the NHS for cosmetic purposes (personal preferences) alone. However, a recent cohort study considering the outcomes after treatment for congenital breast asymmetry found significant postoperative psychological improvements. The study included those with congenital breast asymmetry secondary to: macromastia, Poland Syndrome, tuberous breast, unilateral or asymmetric hypoplasia and amazia. When compared to age matched controls, patients undergoing corrective surgery for breast asymmetry experienced significant postoperative improvements on the Rosenberg Self-Esteem Scale, and in three Short-Form 36v2 domains: Role - Physical, Social Functioning and Mental Health.

These improvements were sustained for a minimum of 5 years. Postoperatively, asymmetry participants’ quality of life was comparable to controls and did not vary by age at the time of surgery, asymmetry severity, or diagnosis.


  1. NHS. Cosmetic procedures - When it's on the NHS. 2019 Available at: https://www.nhs.uk/conditions/cosmetic-procedures/cosmeticprocedures-on-the-nhs/
  2. REILLEY A. Breast asymmetry: Classification and management. Aesthetic Surgery Journal. 2006;26(5):596-600
  3. NHS. Gender Identity Services for Adults (Surgical Interventions). 2019 Available from: https://www.england.nhs.uk/wp-content/uploads/2019/12/nhsengland-service- specification-gender-                identity-surgical-services.pdf
  4. Association of Breast Surgery, British Association of Plastic, Reconstructive & Aesthetic Surgeons. Oncoplastic Breast Reconstruction Guidelines for Best Practice. Breast Cancer Now. 2018
  5. Getting it right the first time. Draft GIRFT national report for breast surgery. 2021 Available at: https://www.gettingitrightfirsttime.co.uk/bpl/
  6. Nuzzi L, Firriolo J, Pike C, Cerrato F, DiVasta A, Labow B. The Effect of Surgical Treatment on the Quality of Life of Young Women with Breast Asymmetry: A Longitudinal, Cohort Study. Plastic & Reconstructive Surgery. 2020;146(4):400e- 408e

Prior Approval Form

Please refer to GP Plastic Surgery Referral Form on Ardens or https://www.hweclinicalguidance.nhs.uk/assets/PA-Forms/Plastic-Surgery-procedures-(GP-)-V1.1-Nov-23.docx