Reconstructive Breast Surgery

Emergency department referrals

All urgent cases must be discussed with the on call Plastic and Reconstructive Surgery Registrar. Contact through Royal Brisbane and Women's Hospital (07) 3646 8111 to obtain appropriate prioritisation and treatment.

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • Pre-operative mastectomy patients
  • Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) positive patients

Category 2

Appointment within 90 days is desirable

  • Extracapsular implant rupture with severe incapacitating pain
  • Those that have symptoms of BIA-ALCL or suspicion on imaging despite a negative aspirate

Category 3

Appointment within 365 days is desirable

  • 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 implants was placed in the context of breast cancer or Congenital abnormality

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

  • Refer to HealthPathways for assessment and management information if available
  • It is strongly recommended that people who smoke stop 3 months prior to consultation (smoking is a contraindication for both autologous and prosthetic breast reconstruction).  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)

Referral requirements

A referral may be rejected without the following information.

  • Height, weight and BMI (ideally BMI should be <32 for reconstruction and reduction surgery). Patients with a BMI 32-40 may be delayed and reviewed by a multidisciplinary team (MDT) regarding the appropriateness of surgery.
  • Confirmation of type of implant product and when it was inserted if at all possible.
  • Smoking status (Confirmed non-smoker status for previous 3 months).
  • Mammography results for women >40 years (unless contraindicated).

Additional referral information (useful for processing the referral)

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

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

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

Send referral

Hotline: 1300 364 938

Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs

Mail:
Metro North Central Patient Intake
Aspley Community Centre
776  Zillmere Road
ASPLEY QLD 4034

Health pathways

Access to Health Pathways is free for clinicians in Metro North Brisbane.

For login details email:
healthpathways@brisbanenorthphn.org.au

Login to Brisbane North Health Pathways:
brisbanenorth.healthpathwayscommunity.org

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