01 June 2018

A new report published by Breast Cancer Now has revealed that hundreds of breast cancer patients are potentially being denied access to reconstructive surgeries. Evidence collected from a series of Freedom of Information (FOI) requests showed huge variation across the Clinical Commissioning Groups (CCGs) and a worrying emergence of arbitrary restriction policies.

Based on the findings detailed in the ‘Rebuilding My Body: Breast Reconstruction Surgery in England’ report, the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), Association of Breast Surgery (ABS) and Breast Cancer Now, have developed new guidance for CCGs on the commissioning of oncoplastic breast surgery to ensure patients have appropriate access to reconstructive surgery, regardless of where they live.

Around 42,000 women are diagnosed with breast cancer in England each year, and roughly 11,500 will undergo a mastectomy.[i] Breast Cancer Now’s research found that 22.6% of CCGs in the England have introduced policies to restrict breast reconstruction surgery, for non-medical reasons, with a further 14.4% having draft, informal, or unclear policies in place.[ii] The restrictive policies include limiting the number of procedures allowed, enforcing time-frames, and denying balancing surgery for unaffected breasts. Not only do these policies affect patients’ self-confidence and quality of life, but the variation between CCGs leads to a ‘postcode lottery’ in access to treatment.

The new guidelines include the following recommendations:

  • That all patients should be able to choose to return for breast reconstruction surgery at any point following their diagnosis and initial treatment
  • That a full range of symmetry and adjustment procedures should be available, including surgery on the unaffected breast
  • That clear communication is needed between surgeons and their patients in treatment planning to ensure patients have realistic expectations of what reconstruction can achieve

Joe O’Donoghue, a BAPRAS surgeon involved in drafting the guidelines, commented: “It is unacceptable for some women to not be given access to essential reconstructive or balancing surgery purely because of where they live. We know that this surgery is a vital part of breast cancer treatment, recognised by the National Institute for Health and Care Excellence and internationally as beneficial to women’s psychological recovery and wellbeing.

BAPRAS calls on all Clinical Commissioning Groups to implement the new guidelines and ensure that all women access the appropriate care they need, when they need it.”

[i]  These are estimates based on data from: The NHS Information Centre, 2011: National Mastectomy and Breast Reconstruction Audit 2011, Available at:

[ii] Breast Cancer Now. ‘Rebuilding My Body: Breast Reconstruction Surgery in England’. 2018.