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.

Essential referral 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.

Clinical Modifiers (where relevant)

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

Reason for Referral (essential)

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 Information (essential)

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