Jo is one of hundreds of women who have had their options restricted after breast cancer
One in five NHS bodies in England is limiting the number of reconstruction surgeries breast cancer patients are allowed, potentially affecting hundreds of women, a charity report suggests.
Breast Cancer Now says the restrictions are "arbitrary" and put patients' quality of life at risk. But it found evidence that some procedures were being denied. Breast surgeons have also raised concerns and are calling for equal access to services.
Jo Waterman, from Somerset, says she feels "frustrated and disappointed" at having to apply for funding to have her healthy breast reduced in size after being diagnosed with breast cancer in May 2017. She had a lumpectomy which allowed her to keep some breast tissue and the nipple, but left her breasts unbalanced. "I don't want breast cancer to be the first thing I see when I look at myself in the mirror," she says.
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"People said to me 'the most important thing is that you're still here and you're back to normal' but I'm not back to normal. "It will not ruin my life not having the surgery, but if you don't encourage women to apply for it then they will be put off - and the fewer applications the NHS get for this kind of surgery means they will say there is no demand for it."
She adds: "I just want to get on with life."Women with breast cancer have been through enough without having to go over another hurdle afterwards."
Balancing surgery changes the shape of the remaining breast so that they are symmetrical
Clinical guidelines say that patients should be able to return for breast reconstruction surgery at any point after their initial treatment.This can include having an implant inserted or having the breast shape recreated using tissue from another part of the body.
If necessary, balancing surgery, which changes the shape of the remaining breast so that the breasts are symmetrical, is also recommended. But data obtained by the charity found that 47 out of 208 clinical commissioning groups (CCGs) in England had policies in place which restricted these services - either by putting a time limit on them, limiting the number of surgeries allowed or denying access to balancing surgery. Another nine CCGs indicated they could introduce similar policies.
'Give their lives back'
Breast Cancer Now said around a third of women who have a mastectomy every year in England choose to have breast reconstruction - about 3,500 - either straight away or after a delay.
It estimates that hundreds of these women may have been rushed into deciding on surgery or denied the corrective surgeries they need. The report calls for all patients to be allowed to return for breast reconstruction surgery at any point following their diagnosis and treatment. Baroness Delyth Morgan, chief executive of Breast Cancer Now, said:
"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 represent a backward step and are absolutely not in the best interests of patients."
Mark Sibbering, president of the Association of Breast Surgery, said the report showed that "in some areas restrictions are being placed on access to this important part of breast cancer management".
Samia al Qadhi, from Breast Cancer Care, said the decisions to restrict surgery were "appalling" and "short-sighted". "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."
An NHS England spokesperson said: "These are very personal decisions for women with breast cancer and guidance from NHS England's Clinical Expert Group for Breast Cancer is clear - reconstruction should be available without time restrictions. As shown by this data, guidance is followed in the vast majority of areas, and we are working closely with local services to ensure consistent care is available to all women wherever they live."