Breast cancer patients are being denied 'life-changing' reconstructive surgery, research shows

Breast cancer patients are being denied “life-changing” reconstructive surgery across swathes of the country, amid deepening NHS rationing, research shows.

Freedom of Information disclosures reveal that almost one in four NHS authorities have introduced restrictive policies, which mean women can be denied the operations to restore their bodies.

Experts said the rationing measures mean some women who  have just been treated for cancer are being told they can only have the surgery within a limited time frame.

Around one quarter of the 42,000 women diagnosed with breast cancer each year in England undergo a mastectomy.

Of those, around one third opt to have breast reconstruction, with a significant proportion choosing delayed reconstruction, after they are better recovered from their surgery and treatment.

The new figures, from clinical commissioning groups across the country, show many are only allowing women t have surgery if they do soon after their mastectomy, with others refusing to carry out more than one operation, if efforts are not successful.

In other cases, the NHS is refusing to carry out “balancing” surgery to the breast unaffected by cancer, when cancer sufferers wanted to achieve symmetry with their reconstructed breast.

Baroness Delyth Morgan, chief executive at Breast Cancer Now, which led the report, said:

“Whether to have reconstructive surgery is a very personal decision – one which is never taken lightly and which many women need time to think about. Following their diagnosis and as they undergo long-term treatment, many women are going through some of the most gruelling months and years of their lives.”

“It is totally unacceptable that any patient is being denied the reconstructive surgery they need or rushed into potentially life-changing decisions, at such a difficult time.”

She said the  restrictions were a “backward step” for thousands of women.

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

The  research by the charity found 47 out of 208 (22.6 per cent) CCGs in England have introduced policies to restrict NHS breast reconstruction services for non-clinical reasons, with a further 30 CCGs (14.4 per cent) having draft, informal or unclear guidelines in place.

Such policies directly contravene recent 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.”

The charity is today launching new guidelines, with the Association of Breast Surgery (ABS) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) to ensure all patients have access to the reconstructive services they need.

Experts said cancer sufferers who wanted such surgery often felt it was an essential part of their treatment and plays an instrumental role in their recovery and ongoing quality of life – helping restore their body confidence, self-esteem and sexuality.

Mark Sibbering, ABS president said: “The Breast Cancer Now report confirms concerns raised by both ABS and BAPRAS members that in some areas restrictions are being placed on access to this important part of breast cancer management.”

The charity raised concerns that financial pressures on the NHS are fuelling the rise of rationing.

Restrictions were most common in the West Midlands, with 17 CCGs having such measures, with 12 in London, eight in the East of England, five in the South West and 4 in Yorkshire and Humber.

Baroness Morgan said: “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. For those that want it, reconstruction must not be dismissed as a cosmetic or dispensable part of breast cancer treatment.

“If we are to achieve the Government’s ambition of world-class NHS cancer care, all patients must be fully involved and supported in making decisions about their treatment – with their doctors, at their own pace. We hope these new guidelines will be practice-changing, ensuring all patients have access to the services they need and enabling more to live well beyond breast cancer.”

Joe O'Donoghue, Member of the British Association of Plastic, Reconstructive and Aesthetic Surgeons, said: “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.”

It is estimated that around 11,500 of the 42,000 women diagnosed with breast cancer each year in England undergo a mastectomy  – with around 2,400 (21 per cent) of these patients opting to have immediate breast reconstruction, and around 1,100 (10 per cent) having delayed reconstruction.

For most, reconstruction is a process requiring multiple procedures, depending on the patient and method chosen.  There are two main types of reconstruction: patients can have an implant inserted, or they can have a breast shape recreated using tissue from another part of their body, usually the back or abdomen.

Where the reconstructed breast may not match a patient’s unaffected breast, clinical guidelines recommend that they are also offered ‘balancing surgery’ to increase, decrease or change the shape of their remaining breast to help them achieve symmetry.

Samia al Qadhi, Chief Executive of Breast Cancer Care, said: "These appalling, short-sighted decisions are denying women with breast cancer a crucial step to help them move on and heal after what can be a life-changing experience.

“Women tell us every day that the long-term impact of surgery to remove the cancer is more than physical; their self-esteem can be left in tatters. Breast reconstruction is, for many, an essential part of living life with confidence after breast cancer – so we cannot and must not allow it to be pushed out of their reach."