Breast cancer patients ‘denied reconstructive surgery due to NHS restrictions’

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Breast cancer patients are being denied “life-changing” reconstructive surgery due to rationing in the NHS, a report has said.

Figures revealed nearly a quarter of local NHS commissioning groups had introduced policies to restrict reconstruction services for non-clinical reasons, the Breast Cancer Now investigation found.

The charity said the policies included limiting the number of surgeries women were allowed, putting a time-frame on when they could have the surgery, and also led to some women being denied operations to ensure both breasts were symmetrical.

Baroness Delyth Morgan, chief executive of the charity, said it was “totally unacceptable” that any patient was being denied reconstructive surgery – or being rushed into potentially life-changing decisions.

“Reconstructive surgery has profound benefits for those that choose it, helping give many their confidence and their lives back after breast cancer,” she said.

“These arbitrary restrictions in some areas of the country therefore represent a backward step in treatment and are absolutely not in the best interests of patients.

“The reasons for these restrictions remain unclear, but with the NHS facing unprecedented pressures, their introduction despite clear clinical advice begs the question whether they are being driven by a desire to reduce costs.”

Freedom of information requests to all 208 Clinical Commissioning Groups (CCGs) in England showed 47 (22.6%) had established restrictive policies, while a further nine (4.3%) had draft policies or informal restrictions in place.

Such policies can contravene clinical advice issued by NHS England’s Breast Cancer Clinical Expert Group in 2017, which states: “Patients make decisions at very different speeds so delayed reconstruction or further operative procedures to optimise symmetry should be available without time restrictions.”

Twenty of the 47 CCGs with restrictive policies were found to be in the West Midlands, while 12 were in London and six in the East of England.

Around a quarter of the 42,000 women diagnosed with breast cancer each year in England undergo a mastectomy – with about 2,400 of these opting to have immediate breast reconstruction. Another 1,100 have delayed reconstruction.

For many, the reconstruction can require multiple surgeries.

The charity is now launching new guidelines, alongside the Association of Breast Surgery (ABS) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), urging CCGs to ensure all patients have access to the services they need, regardless of where they live.

Mark Sibbering, president of the ABS, said reconstructive surgery should not be considered cosmetic, and was part of a patient’s treatment.

“It should be available to all patients equitably”, he said.

Joe O’Donoghue, member of the BAPRAS, added that the surgery was “a vital part of breast cancer treatment, recognised… as beneficial to women’s psychological recovery and wellbeing.”

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