Gynaecomastia Referral Access Criteria

Referrers should use this page when referring patients to public adult plastics and reconstructive surgery outpatient services for gynaecomastia.

Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
Nil

Immediate referral
Immediately contact the on-call registrar or service to arrange an immediate plastics and reconstructive surgery assessment (seen within 7 days):
Nil

Clinical indications for outpatient referral
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
Persistent gynaecomastia (≥6 months with normal blood tests) Significant asymmetry Breast size is disproportionate to body habitus Has not responded to medical treatment where clinically indicated (e.g. androgens, anti-oestrogens, and aromatase inhibitors)

Mandatory information
Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reasons). This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
History	Relevant history, onset, duration and severity of symptoms 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 current and previous treatment and outcome, including bariatric surgery Details of smoking and/or vaping (containing nicotine) status
Examination	BMI Breast examination findings (and any suspicion of malignancy)
Investigations	hCG Prolactin Testosterone with LH and FSH Oestradiol LFT TSH U&E Ultrasound (US) breast

Highly desirable
History	Cancer history including family history Advise whether or not your patient is taking any anti-platelets or anti-coagulants if so, state the indication
Examination	Nil
Investigations	Nil

Indicative clinical urgency category
Category 1 Appointment within 30 days	No defined category 1 criteria
Category 2 Appointment within 90 days	No defined category 2 criteria
Category 3 Appointment within 365 days	Gynaecomastia where there is a substantial breast enlargement/asymmetry or significant breast tenderness and where breast size is disproportionate to body habitus

Indicative clinical urgency category

Category 1

Appointment within 30 days

Category 2

Appointment within 90 days

Category 3

Appointment within 365 days

Gynaecomastia where there is a substantial breast enlargement/asymmetry or significant breast tenderness and where breast size is disproportionate to body habitus

Exclusions
Gynaecomastia is an excluded condition when BMI ≥32 Any suspicion of malignancy or indeterminate mass refer to Breast Clinic. See Clinician Assist WA: Breast Requests

Useful information
Male breast cancer may present similar to gynaecomastia and should be considered as part of initial assessment. Any suspicion of malignancy should be sent to Breast Clinic see Clinician Assist WA: Breast Cancer Risk Assessment and Screening See MBS item: 66695 for information on the Medicare Benefits Schedule on the mandatory investigations

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Last reviewed: 15-08-2025

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