The Skin: Disfigurement, Scars and Skin Grafts
Assessment of injury to breast/s resulting from damage to breast implant/s
This material is issued by the Motor Accidents Authority under s.65 (2) of the Motor Accidents Compensation Act 1999 (the Act) in the interests of promoting accurate and consistent medical assessments under the Act. The interpretation provided here is not legally binding but represents the clinically recommended interpretation in an area where more than one interpretation of existing provisions may be possible. This recommended interpretation is publically available. Any medical assessment which does not adopt this interpretation should be accompanied by clinical justification for the interpretation adopted, supported by full, robust reasons.
- The Motor Accidents Authority Permanent Impairment Guidelines – Guidelines for the assessment of permanent impairment of a person injured as a result of a motor vehicle accident 1 October 2007 (MAA Guidelines): Chapter 8 The Skin Clauses 8.27-36 pages 51- 53, Table 8.1 TEMSKI.
- The American Medical Association Guides to the Evaluation of Permanent Impairment, 4th Edition (AMA 4 Guides): Chapter 13 section 13.4 Disfigurement: 13.5 Scars and Skin Grafts pages 279 – 280.
Neither the MAA Guidelines nor the AMA 4 Guides make provision for the assessment of injury to a breast resulting from damage to a breast implant caused by a motor accident.
Issue requiring clarification
Occasionally, a seat belt injury can cause damage to a breast implant/s, resulting in alteration to the aesthetic appearance, shape and/or texture of the breast/s. There is no provision for alteration to breast/s resulting from damage to a breast implant/s. Although clause 8.26 of the MAA Guidelines directs that total loss of one or both mammary glands is deemed to be an impairment of greater than 10% WPI, this is not appropriate for assessing damage to breast implants because they are not mammary tissue. Damage to breast implant/s should therefore be assessed as less than 10% WPI, given the mammary tissue remains, albeit with altered contour, shape etc. However, clause 8.33 of the MAA Guidelines provides that fat necrosis in any part of the body is assessed with reference to the skin. It is suggested that, by analogy, damage to a breast implant/s be assessed with reference to the criteria for fat necrosis.
In accordance with the provisions relating to pre-existing impairment the Medical Assessor should clarify the aesthetic appearance and condition of the breast implant/s prior to the motor accident, ensure that any treatment/surgery/replacement of the implant/s is complete and, that therefore, any injury is permanent.
The Medical Assessor should then determine the extent to which one or both breast/s have been altered as a result of the motor accident, with respect to the aesthetic appearance, shape, texture and/or contour defect. The Assessor should provide an assessment of impairment with reference to Table 2 page 280 of the AMA 4 Guides and where appropriate with reference to clause 8.34 of the MAA Guidelines which states that a Class 1 impairment must be assessed in accordance with the TEMSKI criteria.
In accordance with clause 8.31 of the MAA Guidelines, when using Table 2 p 280 of the AMA 4 Guides the Medical Assessor should consider the skin as an organ when assessing the effect of any scarring (whether associated with a breast implant or otherwise).
Justification for preferred interpretation
In the absence of specific provisions in respect of breast implants, Medical Assessors are guided to the relevant sections of the MAA Guidelines and AMA 4 Guides when conducting the permanent impairment assessment.
The preferred interpretation and methodology as outlined above is suggested to promote consistency of assessment.
Injury Strategy Branch