Breast reconstruction Referral Access Criteria

• Post-reconstruction breast abscesses with sepsis or septic shock (based on 2 or more of the following: fever, tachypnoea, tachycardia, hypotension, lactate >2)
• Any suspicion of post-surgical nipple necrosis/ischaemic nipple, expanding haematoma, infection/sepsis, or wound necrosis/breakdown
• Post-surgical breast haematoma

• Post-reconstruction breast abscess, without sepsis or septic shock
• Patients with breast implants with a large seroma confirmed by ultrasound plus:
  • enlargement of the breast
  • swelling
  • pain
  • overlying skin changes, e.g. redness, induration, and tenderness
  • palpable lump
  • lymphadenopathy

NB: Where appropriate, contact the surgeon/service that completed the initial surgery

• Significant breast asymmetry with an estimate of >20-25% difference
• Delayed reconstruction post-surgical management of breast cancer
• Congenital breast deformity e.g. Poland’s syndrome, tubular breast or amazia requiring augmentation
• Suspected breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and symptoms (this includes patients who currently have implants and those who have had their implants removed) of:
  • enlargement of the breast
  • swelling
  • pain
  • overlying skin changes
  • palpable lump
  • lymphadenopathy
• Extracapsular implant rupture and/or severely painful implants

NB: Where appropriate, refer to the surgeon/service that completed the initial surgery. If unable, provide an explanation in the body of the referral (e.g. patient unable to access surgeon/service in regional or remote areas or due to financial reason).

• Relevant history, onset, duration and severity of symptoms (including reason for implant)
• Degree of functional impairment (e.g. impact on mobility/exercise tolerance/ADLs/ability to work/quality of life)
• Current medication list
• Any known allergies
• Details of smoking and/or vaping (containing nicotine) status (not mandatory for malignancies)
• Details of current and previous treatment and outcome, including surgery
• For breast cancer patients: history of any oncological treatments

• BMI

• Mammography for women aged ≥40 years
• Breast ultrasound (US) for women aged <40 years
• For BIA-ALCL patients: bilateral diagnostic breast ultrasound (US)

• Advise whether or not your patient is taking any anti-platelets or anti-coagulants
  
  • if so, state the indication

• Breast examination

• Nil

Category 1

Appointment within 30 days

• Breast implant associated anaplastic large cell lymphoma (BIA-ALCL)
• Extracapsular implant rupture
  
  

Category 2

Appointment within 90 days

• Severely painful implants 

Category 3

Appointment within 365 days

• Delayed reconstruction post-surgical management of breast cancer
• Post-burn reconstruction
• Congenital abnormalities, e.g. Poland’s syndrome, tuberous breast deformity and significant asymmetry (estimate >20-25% difference)

• Breast implant patients who are asymptomatic and there is no clinical or radiological concern for BIA-ALCL
  • specialist review is not warranted. It is recommended follow-up is arranged with the patient at a later date within a time frame agreed with the patient, or as initiated by the patient if new symptoms develop, the patient continues to be concerned or their symptoms recur, persist, or worsen. Ultrasound (US) is not recommended for asymptomatic patients unless there are clinical concerns.
• Breast reconstruction is an excluded condition when BMI ≥32
  
  • except when part of cancer treatment

• Breast cancer patients should be 6 months post-chemotherapy and post-radiotherapy for delayed reconstruction
• Gene mutation or strong family history should be referred to Breast Clinic
  
  • see Clinician Assist WA: Breast Requests
• Ruptured or painful breast implants can be removed but not replaced unless the primary reason for augmentation was reconstructive.
  • see Referral Guidelines: Review of patients with breast implants related to concerns of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)