Reconstructive breast surgery

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Airway compromise
    • Uncontrolled bleeding
    • Acute burns
    • Uncontrolled sepsis including hand infections
    • Complex facial fractures
    • Compound fractures
    • Threat to limb viability
    • Hand fractures (open or closed)
    • Acute fingertip injuries
    • Tendon injuries
    • Acute development of peripheral nerve compression symptoms following trauma or acute event
    • Lacerations and wounds not suitable for primary health management e.g. lip lacerations, large facial lacerations, lacerations with altered sensation, large skin defects.

    Paediatric

    • Amniotic band compromising circulation

    • Refer to Healthpathways or local guidelines
    • It is strongly recommended that people who smoke stop 3 months prior to consultation. It is associated with delayed skin healing. Please consider directing your patient to a smoking cessation program.
    • Breast cancer patients must be 6 months post chemotherapy and 12 months post radiotherapy
    • Breasts will usually be considered for reduction when their size is not attributable to excess weight and when a substantial health benefit can be expected.
    • If BMI is greater than 30, manage weight loss
    • A frailty assessment should be undertaken, where relevant, to ensure appropriate surgical management
    • Ruptured or painful breast implants can be removed but not replaced unless the primary reason for augmentation was reconstructive.
    • Consider referring patient to support groups e.g.
      • breast cancer network Australia
      • community support groups
      • cancer council connect
    • Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)

Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)

  • Pre-operative mastectomy patients
  • Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) positive patients
Category 2
(appointment within 90 calendar days)
  • Extracapsular implant rupture with severely incapacitating pain
  • Those that have symptoms of BIA-ALCL or suspicion on imaging despite a negative aspirate
Category 3
(appointment within 365 calendar days)
  • Extracapsular implant rupture and/or severely painful implants
  • Post mastectomy reconstruction 6 months post chemotherapy and 12 months post radiotherapy
  • Macromastia: where breast size causes substantial disability and the patient's BMI is <35
  • Post burn reconstruction
  • Congenital abnormalities e.g. Poland syndrome, tuberous breast deformity and gross asymmetry
  • Gynaecomastia where there is a substantial breast enlargement or significant breast tenderness and where breast size is disproportionate to body habitus
  • Breast implant for removal
  • Asymptomatic with recalled, suspended or undetermined implants. For consideration of replacement where the existing implant was placed in the context of breast cancer or Congenital abnormality.

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Height, weight and BMI (ideally BMI should be <35 for reconstruction and reduction surgery). Patients with a BMI 35-40 may be reviewed by a multidisciplinary team regarding the appropriateness of surgery.
  • Confirmation of type of implant product and when it was inserted if at all possible
  • Smoking status
  • Mammography results for women >40 years (unless contraindicated)

3. Additional referral information Useful for processing the referral

  • History of surgery/chemotherapy/radiotherapy in breast cancer patients
  • Ultrasound +/- aspirate of seroma surrounding breast implant is insitu (if available)

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and available, the referral may be streamed to an associated public allied health and/or nursing service. This may include initial assessment and management by associated public allied health and/or nursing, which may either expedite or negate the need to see the public medical specialist.
    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 25 March 2021

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