Renee Brooks

Dear Mr Bennett,

I write in response to your report, dated Friday 31 January 2020, regarding the death of Mrs Renee Simone Brooks.

We have considered the circumstances surrounding Mrs Brooks’s death, and your that there is an absence of UK guidance relating to indications for safe practice for lipoedema-related liposuction.

In August 2017 NICE published interventional procedures (IP) guidance on liposuction for chronic lymphoedema (IPG588), which currently recommends the following:

1.1 Current evidence on the safety and efficacy of liposuction for chronic lymphoedema is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.

1.2 Patient selection should only be done by a multidisciplinary team as part of a lymphoedema service.

However, we have not published guidance on the use of liposuction for the specific condition of chronic lipoedema.

NICE IP guidance makes recommendations on the conditions for the safe use of a procedure in the NHS, based on the available evidence relating to safety and efficacy. The recommendations specify the type of arrangements that should be made for consent, audit and clinical governance.

In view of the safety concerns raised by this case, the IP team will consider whether:

• the current recommendations in relation to the safety and efficacy of liposuction for chronic lymphoedema should be updated to allow the guidance to provide additional explicit detail on safety concerns. In the meantime, our website (www.nice.org.uk/ipg588) now explains that “We are considering whether we need to update this guidance in response to safety concerns” and the webpage will be updated with the outcome of these considerations, in due course.

• new IP guidance should be produced specifically relating to the use of liposuction in the treatment of chronic lipoedema.

As part of any future guidance development, the IP team would consult with specialist societies such as the British Association of Aesthetic Plastic Surgeons (BAAPS) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS).

Dear Mr Bennett,

Re: Renee Brooks – Report to Prevent Future Deaths

We write in response to your Regulation 28 Report to prevent further deaths in relation to liposuction and the treatment of lipoedema. As a result of this request, both associations (BAPRAS & BAAPS) have agreed to work in partnership to create guidelines for the use of liposuction in the UK.

We recognise the importance of making the distinction between liposuction for the treatment of lipoedema and liposuction for purely cosmetic reasons but feel that we should create combined guidelines for the safe use of liposuction in all surgical procedures. We consider this to be particularly important as some commercial organisations have drawn up their own guidelines which appear to aim to control the use of the technique in an ill-informed manner. A definitive and all-encompassing set of guidelines will ensure that the distinction between the two types of procedures is readily apparent.

In order to create the guidelines, we have set up a joint BAAPS & BAPRAS expert panel. This panel will include invited expert members of both surgical associations, a member of the Association of Anaesthetists and any other relevant stakeholders that the co-chairs believe to be appropriate. Their report is intended to cover not only the specifics of the procedure but also the level of hospital support required, any pre-assessment needs and the potential need for a multi-disciplinary team (MDT) meeting for lipoedema patients. It is hoped that we can produce this report within the next six months and that it will be adopted by the wider sector, including those practitioners who are not members of our associations. The majority of liposuction in the UK is likely to be carried out by such practitioners and so we intend to submit these guidelines to the CQC for their use in the inspection of premises involved in liposuction.

We will forward the guidelines for your inspection prior to publication.