Reconstruction following breast cancer: The postcode lottery continues - A cross-sectional analysis of English Integrated Care Boards.

[INTRODUCTION] For certain patients, breast reconstruction is an integral part of cancer recovery. The Association of Breast Surgery (ABS) and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) published guidance which advocates for unrestricted access to these procedures in 2018. Despite this, in 2022, the charity Breast Cancer Now, published a report demonstrating widespread inequalities in the provision of breast reconstruction with many CCGs restricting access to reconstructive procedures. The 2022 transition from Clinical Commissioning Groups (CCGs) to Integrated Care Boards (ICBs) aimed to reduce regional variation. This study evaluates whether ICB policies have improved compliance with national ABS/BAPRAS guidance.

[METHODS] A cross-sectional policy review of all 42 English ICBs was conducted between July and December 2025. Data was obtained via a Freedom of Information (FOI) request to all 42 ICBs alongside a review of any publicly available commissioning policies for breast reconstruction.

[RESULTS] Responses were received from 100% (42/42) of ICBs. While 71% (30/42) demonstrated alignment with national guidance, 29% (12/42) retained restrictions on access to breast reconstruction. These included caps on procedure counts (ranging from one to four surgeries) and rigid timelines for completion (2-5 years). Restrictive policies directly contradict commissioning guidance that permits multiple procedures to achieve satisfactory reconstructive outcomes.

[CONCLUSION] Structural reorganisation into ICBs has not eliminated the postcode lottery. Compared to prior audits, the proportion of restricted health systems has increased, suggesting regression rather than progress. Almost a third of health systems continue to enforce restrictions on procedure numbers and timelines, directly contravening ABS/BAPRAS guidance.