A complete guide by Prof. Alfredo Borriello, Head of Plastic Surgery at Ospedale del Mare Naples, on when and how plastic surgery is covered by the Italian National Health Service
Every year, at Ospedale del Mare and in my private clinic in Naples, many patients ask the same question: "Can I have surgery through the NHS?" It is a legitimate question — one that often comes from patients who have faced breast cancer, a serious trauma, or have a child with a congenital malformation, and do not know whether the public health system can cover the cost of plastic surgery. The short answer is: it depends on the clinical indication. This guide explains when, how and for whom it is possible to access plastic surgery through Italy's National Health Service (SSN).
In Italy, the distinction between reconstructive and aesthetic surgery is not merely semantic — it is the line that separates what the National Health Service (SSN) covers from what remains at the patient's expense. Reconstructive surgery aims to restore a function or anatomy altered by disease, trauma, congenital malformation or previous medical treatments. Aesthetic surgery, on the other hand, operates on a normal anatomical structure to modify its appearance according to the patient's wishes. This distinction is established by law and governs access to services under the Essential Levels of Care (LEA).
In clinical practice, the boundary is not always clear. Rhinoseptoplasty — correcting a deviated nasal septum with both a functional and an aesthetic component — is a case that requires precise clarification. If the problem is purely aesthetic, the procedure falls under private plastic surgery and is performed in my private clinic. If a functional component is also present (documented breathing difficulty), the procedure may fall within NHS coverage, but it is performed by the ENT specialist or by the plastic surgeon, without the possibility of making any aesthetic correction. A patient with a mixed concern — both aesthetic and functional — who seeks NHS coverage must be aware that the intervention will be aimed only at functional correction, and not aesthetic. Clinical evaluation is fundamental in defining the most appropriate pathway for each patient.
Similarly, post-bariatric surgery, after significant weight loss following surgical intervention, may fall within NHS coverage if skin excess causes documentable conditions (dermatitis, maceration ulcers, functional difficulties). Each case must be assessed individually by a specialist, who prepares the clinical documentation required for potential access to LEA services.
The Essential Levels of Care (LEA), updated with the DPCM of 12 January 2017, include numerous reconstructive plastic surgery procedures. These are not exceptions or privileges — they are rights recognised for all Italian citizens enrolled with the NHS. The main covered procedures are:
To access these services, a referral from the general practitioner (NHS prescription) or from a contracted specialist is always required. Without a referral, even procedures technically included in the LEA are treated as private or accessed under self-pay arrangements.
The pathway for reconstructive plastic surgery under the NHS follows well-defined steps. The first step is a visit to the general practitioner, who assesses the clinical situation and — if the indication is reconstructive — issues a referral for a "first plastic surgery visit". With this referral, the appointment is booked through the CUP (Unified Booking Centre) of your local ASL or directly at the plastic surgery outpatient clinic of Ospedale del Mare (ASL Napoli 1).
The visit has a reduced co-payment (approximately €23 in Campania) or is free for exempt categories (income, age, chronic condition). During the first visit, the plastic surgeon assesses the case, makes a diagnosis and decides whether the indication for surgery is present. If confirmed and the procedure falls within the LEA, the patient is placed on the waiting list for admission, with priority according to clinical complexity.
For oncological urgencies — such as immediate breast reconstruction concurrent with mastectomy — timing is coordinated directly with the breast surgery team and takes place within the same operative admission. For elective reconstructive procedures, average waiting times range from a few weeks to a few months. No advance payment is required: the surgery and hospital stay are covered by the NHS, except for the daily co-payment for non-exempt patients.
Since 2020 I have directed the Complex Operative Unit of Reconstructive Plastic Surgery at Ospedale del Mare (ASL Napoli 1 Centro), the main plastic surgery facility in the Naples metropolitan area. The unit operates on two fronts: reconstructive surgery under the NHS — breast reconstruction, skin tumours, trauma, malformations — and surgical emergencies from the A&E department and trauma centre.
Alongside my hospital role, I practise privately at my private clinic in Naples (Viale Antonio Gramsci), where I see patients requiring aesthetic surgery procedures or those who choose the private pathway for greater flexibility in timing. Both pathways are regulated and separate: every patient receives the same surgical quality, but the setting, timing and access arrangements differ.
Discover the surgical procedures available:
This dual presence allows me to be a complete reference point: patients with reconstructive clinical indication who wish to follow the NHS pathway are guided accordingly. Those who choose aesthetic surgery find a clinic equipped with the same expertise and standards. My priority is that every patient knows clearly which path to take.
For procedures classified as purely aesthetic — cosmetic rhinoplasty, breast augmentation, abdominoplasty without documented skin pathology, cosmetic blepharoplasty — the NHS provides no coverage. The patient accesses the private system at their own expense.
The private consultation is an information-gathering appointment with no pressure to proceed. Many patients return after weeks or months, once the decision has matured at their own pace. The consultation covers the indication, expectations, technique, risks and a complete written estimate that remains valid for the stated period.
Choosing a procedure in the private sector does not mean sacrificing safety and quality guarantees. Procedures performed in my private clinic use the same techniques, the same safety standards and the same level of post-operative follow-up as hospital procedures. The difference is the organisational setting and the cost — not the quality of the outcome or the surgeon's experience.
Yes, this is entirely possible. A private consultation is a fundamental moment for gathering information, desires and possibilities, allowing me to assess your case in detail without waiting times. If the indication turns out to be reconstructive, I can direct you to the NHS pathway at Ospedale del Mare, with a GP referral and CUP booking. The two pathways are not mutually exclusive, and the clinical assessment remains valid for both.
Waiting times depend on clinical urgency. For post-oncological breast reconstruction, times are short — in many cases surgery is immediate or deferred by a few weeks, coordinated with oncology. For elective reconstructive procedures (malformations, post-bariatric), average waiting times vary depending on waiting lists. Each case is assessed and classified by priority at the first outpatient visit.
The first NHS plastic surgery visit is subject to the standard co-payment, unless exempt. The standard co-payment for a specialist visit in Campania is approximately €23, varying by procedure type and current regional regulations. Patients who are exempt (chronic conditions, income-based exemption, age) pay nothing.
Asking whether the NHS covers a procedure is an intelligent question — not a sign of financial need. It means knowing your rights and making an informed choice. Over 35 years of plastic surgery, I have met patients who were entitled to fully NHS-funded reconstructive procedures and did not know it. This guide was written precisely because of that.
Whether you are looking for the public or private pathway, the first step is always a correct assessment of your individual case. If in doubt, write or book a consultation: at my outpatient clinic at Ospedale del Mare or at my private practice, I will give you a clear answer on the most appropriate pathway.
This content is intended for informational and educational purposes only. It does not in any way replace professional medical advice, diagnosis, or treatment. For any medical questions or concerns, it is essential to consult your physician or a qualified specialist.
Contatta per una consulenza personalizzata.