A new follow-up report from the Getting It Right First Time (GIRFT) team offers an updated national picture of breast surgery services across England, highlighting where progress has been made and where variation still exists.
The breast surgery follow-up report builds on the themes and recommendations of the original GIRFT national specialty report for breast surgery, which was published in 2021. Drawing from national data and information gathered at gateway reviews with all 20 Cancer Alliances, it aims to assess progress on the report’s recommendations, identify ongoing variation and signpost to practical tools to support local implementation.
The follow-up report is supported by the Association of Breast Surgery, the British Association of Plastic Reconstructive and Aesthetic Surgeons and Breast Cancer Now.
It shows that NHS breast surgery teams continue to manage high activity: nationally, referral volumes remained at around 2,500 patients per working day between 2021 and 2025. Breast surgery admissions have increased by 21.4% over five years.
The report highlights significant progress across several areas, such as:
- An increase in day case surgery rates for most procedures.
- A reduction in median length of stay for mastectomy with immediate autologous reconstruction (5 to 3.8 days).
- Stable or improving rates of complication, readmission and implant loss.
- A notable increase in activity coded as oncoplastic (11.7% to 16.2%).
- The impact of well-designed pathways: between September and November 2025, the top 20 providers achieved an average Faster Diagnosis Standard (FDS) performance of 97.6%.
However, the findings also underline that variation in practice remains a significant challenge. For example:
- Patient-initiated follow-up (PIFU) is widely implemented, although around one in four patients do not have access.
- Day case rates have improved but remain below benchmarks in many providers, particularly for mastectomy.
- Length of stay for autologous reconstruction continues to vary, between 2.3 and 5.5 days.
Workforce and diagnostic constraints remain central to performance, and long-term vacancies are reported across key roles. The report highlights radiology and pathology bottlenecks, including delays in access to imaging and variation in pathology turnaround times.
It also emphasises the importance of data quality: new OPCS-4 codes and national GIRFT coding guidance will support better capture of oncoplastic and reconstructive activity, while improved engagement with registries such as the Breast and Cosmetic Implant Registry (BCIR) and UK National Flap Registry (UKNFR) is needed to strengthen outcomes monitoring and benchmarking.
Tracey Irvine, GIRFT’s clinical lead for breast surgery, said:
“It is clear that many high-impact changes are already being delivered, and that NHS breast teams continue to deliver high-quality, patient-centred care, despite financial and workforce pressures. But we can also see that, while many providers are managing challenges on the service, others face barriers to improving or developing services to keep pace with medical advances and rising demand. The key recovery recommendations from our original national report - limiting unnecessary hospital attendances, minimising unnecessary interventions and improving clinical coding and data capture - remain as relevant now as they were in 2021. This report highlights where there are significant opportunities to improve breast cancer pathways, also signposting to implementation resources to support teams to deliver high-quality, effective care.”
