Breast and endocrine (BES) surgery referral

Eligibility

At least one must be met for the patient to be eligible for referral.

Patients who are being treated for the same condition at another Victorian public hospital

Children under 18 years of age are not seen at The Alfred

Cosmetic breast surgery is not offered at The Alfred - see: “Guidelines for Aesthetic Surgery on the Public Hospital Waiting List”

Suspected hernia with symptoms suggestive of strangulation or incarceration, including acute abdominal pain, pain on palpation, nausea, vomiting

Symptoms suggestive of bowel obstruction including acute abdominal pain, abdominal distension, nausea, vomiting

Abdominal wall or groin hernia felt on examination, or that is clinically evident, that is affecting the person’s activities of daily living

Femoral hernia

Recurrence of a repaired hernia or previous hernia repair with new symptoms

Person with high risk due to a family history of breast cancer or ovarian cancer occurring in two first-or second-degree relatives on the same side of the family, plus one or more of the following features:

additional relatives with breast cancer or ovarian cancer

a relative with both breast and ovarian cancer

breast cancer diagnosed before the age of 40

breast cancer affecting both breast

Ashkenazi Jewish ancestry

breast cancer in a male relative

a relative who has tested positive for a high-risk gene mutation e.g. mutation in genes such as BRCA1 or BRCA2

Findings from breast screening that includes advice that an assessment is recommended

Referral from a Familial Cancer Centre

Post mastectomy (immediate or delayed)

Significant deformity and surgery is indicated due to disease, trauma or congenital conditions (e.g. extensive burns, chemotherapy, radiotherapy, large cell lymphoma, contralateral breast Poland syndrome)

Metastatic breast disease with intractable pain

Fungating mass with haemorrhage

Post-surgical wound with dehiscence or sepsis

Core biopsy with suspicious or equivocal findings or proven breast cancer (e.g. detected through

Breast abscess failing drainage

Lactational mastitis with systemic symptoms

New palpable and persistent cyst(s) with complex features on imaging

Recurrent cyst(s) with complex features on imaging

Palpable, symptomatic, or growing fibroadenoma

Any one component of the triple test is positive (clinical examination, imaging or non-excisional biopsy)

Red flags

Indicate urgent (Category 1) referral or emergency assessment.

Routine referral criteria

Determine Category 2 or 3 urgency.

Initial primary-care work-up complete (history, examination, baseline investigations per Alfred guideline)

Symptoms persist or progress despite primary-care management

Usually managed in primary care

Patients who are being treated for the same condition at another Victorian public hospital
Children under 18 years of age are not seen at The Alfred
Cosmetic breast surgery is not offered at The Alfred - see: “Guidelines for Aesthetic Surgery on the Public Hospital Waiting List”
Referrals based on incidental findings found on imaging where the hernia is asymptomatic and not palpable
Rectus diastasis as the only reason for referral
At low or slightly above average risk where there is no family history of breast cancer
Moderate risk due to family history of breast cancer
Referrals for familial cancer services should be directed to publicly funded familial cancer centres
Referrals for genetic testing should be directed to publicly funded genetic testing clinics
No significant abnormality detected
Benign or indeterminate findings on imaging
Single or multiple simple cysts
Fibrocystic breasts
Breast pain with normal imaging and clinical examination
No significant abnormality or benign findings on biopsy or imaging or both
Refer to the full Alfred Health PDF guideline for complete inclusion / exclusion criteria, required investigations and triage categories.