Plastic Surgery Referrals
Find information about assessment and management of Plastic Surgery conditions at:
Clinician Assist WA » Plastic Surgery
Clinician Assist WA » Hand and Wrist (Plastics)
Plastics and reconstructive surgery (adult) Referral Access Criteria
If any of the following are present or suspected, phone 000 to arrange immediate transfer to the Emergency Department or seek emergent advice if in a remote area:
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Condition: |
Details (where applicable): |
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Breast reconstruction |
• 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 |
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Breast reduction |
• 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 |
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Craniofacial conditions |
• Complex facial fracture with bleeding and/or airway obstruction that is life threatening and/or visual disturbance/threat to eye • Acute nasal fracture with septal haematoma |
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Eyelid procedures |
• Acute eyelid injury e.g. burns, chemical exposure, foreign body, eyelid lacerations • Acute visual impairment (e.g. double vision, tunnel vision, esotropia) |
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Facial fractures |
• Complex facial fracture with bleeding and/or airway obstruction that is life threatening and/or visual disturbance/threat to eye • Acute nasal fracture with septal haematoma • Associated neurological symptoms |
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Non-healing wounds and ulcers |
• Sepsis or septic shock (based on 2 or more of the following: fever, tachypnoea, tachycardia, hypotension, lactate >2). • Suspected deep tissue infection (presence of bullae, necrosis, or subcutaneous emphysema) • Suspected necrotising fasciitis • Upper limb cellulitis with suspicion of sepsis or septic shock, or not responding to oral antibiotics • Infectious flexor tenosynovitis • Neurovascular compromise • Acutely exposed fixation plates (e.g. post-fall) • Fracture non-union requiring flap coverage |
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Peripheral nerve palsies and compressions/entrapments |
• Trauma with neurovascular compromise • Suspected acute compartment syndrome |
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Reconstructive hand surgery |
• Open fracture or fracture with obvious deformity • Amputations • Complex injuries (e.g. crush injuries, multi-fracture) • Dislocations unable or not appropriate to be managed in primary care • Tendon laceration or open rupture • High pressure injury (e.g. injection injury) • Neurovascular compromise • Suspected septic joint • Suspected compartment syndrome • Suspected necrotising fasciitis |
RPH is an adult service.
Referrals for child and adolescent health services should be directed to Perth Children’s Hospital.
For country patients, consider a local service and view the resources at AHCWA MAPPA.
See the Referral Access Criteria for plastic and reconstructive surgery (adult).
This table below provides advice on where to refer your adult patients:
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Condition: |
Details (where applicable): |
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Burns |
Refer to State Burns Service See Clinician Assist WA: Specialised Burns Management Requests
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Craniofacial and Facial fracture |
Some craniofacial conditions can be referred to any of the following specialities and will be triaged in line with local agreements. Refer to:
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Parotid masses |
Some parotid masses can be referred to any of the following specialities and will be triaged in line with local agreements. Refer to:
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Spinal Pressure injuries |
Contact the Spinal Outreach Service,
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Diabetic peripheral neuropathy
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This will require comprehensive diabetic management
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Carpal tunnel Syndrome |
Refer to:
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Hand & wrist referrals |
Refer to:
Consider conservative management options: |
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Ganglions |
Not on the wrist/hand AND causing compressive nerve symptoms, pain, or functional disability, refer to:
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Skin lesions |
Refer to:
For information on skin biopsies: |
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Lower limb tissue infections |
For infections without ulceration, including cellulitis of the lower limb, refer to:
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To arrange an urgent review or advice, please phone the RPH switchboard on 9224 2244 and ask to speak with the on-call registrar for Plastic Surgery.
After verbal clinical handover and agreement with the registrar that the patient requires an appointment with RPH within 7 days, please email the patient’s referral to:
RPH.OutpatientReferrals@health.wa.gov.au
Ensure the referral is:
- marked IMMEDIATE
- the name of the registrar or consultant spoken with is written on the referral.
- all essential referral information, investigations, clinical photos are included.
Find out more here about the Referral Access Criteria.
IMMEDIATE (Appointment within 7 days):
Condition Presenting issue All • Animal bites (including human) Breast reconstruction • 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 (redness, induration and tenderness) or palpable lump •lymphadenopathy Note: Where appropriate, contact the surgeon/service that completed the initial surgery Craniofacial conditions • Infection post-reconstructive surgery/cancer treatment • Difficulty eating/drinking after surgery/cancer treatment Note: Where appropriate, contact the surgeon/service that completed the initial surgery Facial fractures • All acute facial fractures (<6 weeks) with no threat to eye or visual disturbance • Acute nasal fracture requiring surgical intervention i.e. external bone displacement Note: Best results for acute nasal fracture are achieved within 2 weeks from time of injury Non-healing wounds and ulcers • Skin threatening injury e.g. large haematoma, large skin tear • Soft tissue loss greater than 5cm2 Peripheral nerve palsies and compressions/entrapments • Symptomatic malignant tumour Reconstructive hand surgery • Acute closed hand fractures where alignment or management is uncertain (patients should be seen within 2-3 days of injury for best outcomes) • Acute closed tendon rupture • Acute scapho-lunate or triangular-fibrocartilage (TFCC) injury • Failed internal fixation Subcutaneous tissue malignancies and masses • Infected cysts around critical areas (eyes, lips) • Clinically large fungating lesion or exophytic tumours with delayed presentation to healthcare
Plastic Surgery Trauma Clinic referrals Please follow the information sheet and flow chart. Then contact the RPH Plastic on-call Registrar via RPH switchboard on 9224 2244. Once your referral has been accepted by the Registrar, email your referral to RPH.OutpatientReferrals@health.wa.gov.au (and include the name of the registrar you spoke with.) The RPH Plastics trauma form can be completed. If imaging has been done, include the name of the Imaging Provider on your referral, so the Clinic staff can contact and ask them to load the images on to RPH radiology systems. Advice for patients Please provide this information to the patient: Trauma Clinic Patient Information For non-ED presentation "open” injuries (tendon injury, simple lacerations, minor infection) For non-ED presentation “closed” injuries (closed fractures, no neurovascular compromise) For referrals made on Friday and Saturday: Patient can present to RPH Emergency Department the next day (Saturday/Sunday) at 9am for review if accepted by the RPH Plastic Registrar.
Referrals are triaged based on clinical priority following the Plastics Referral Access Criteria In-scope Plastic Surgery conditions: Specialist clinics include
Essential Referral Information
Find the Plastic Surgery Referral guide at Plastics and reconstructive surgery (adult) Referral Access Criteria.
- Breast reconstruction
- Breast reduction
- Craniofacial conditions
- Eyelid procedures
- Facial fractures
- Gynaecomastia
- Non-healing wounds and ulcers
- Peripheral nerve palsies and compression entrapments
- Reconstructive hand surgery
- Skin lesions
- Subcutaneous tissue malignancies and masses
Please include all relevant investigations, including photographs with your referral.
If a specific test result cannot be obtained due to access, financial, religious, cultural or consent reasons, a Clinical Override may be requested. This reason must be clearly articulated in the referral.
Standard Referral Information
Read the Referral-form-templates and the Minimum-standards-for-outpatient-referrals-Central-Referral-Service
Please include patient email and mobile phone numbers.
Patients can be flagged for video or telephone consultations at referral, triage or follow-up.
Other options
Please Note: RPH Plastic Surgery has an extensive outpatient waitlist for routine referrals, so please consider contacting the specialists below:
- Refer to:
- BHS: Bentley Health Service - Contracted Medical Practitioners
- AHS: Armadale Health Service - Contracted Medical Practitioners
- Midland SJoG: Find A Specialist Doctor | St John of God (sjog.org.au)
- A private or community provider
At RPH, named referrals for Plastic Surgery will be allocated a suitably qualified specialist to see the patient, noting these referrals are booked based on first on, first off principle from the outpatient waitlist.
Where appropriate and available, referrals may be streamed to an associated public allied health and/or nursing service.
Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either allow or negate the need to see the RPH medical specialist.
Standard Referral Information
Read the Referral-form-templates and the Minimum-standards-for-outpatient-referrals-Central-Referral-Service
Please include patient email and mobile phone numbers.
Patients can be flagged for video or telephone consultations at referral, triage or follow-up.
Please Note: RPH Plastic Surgery has an extensive outpatient waitlist for routine referrals.
Consider alternate referral pathways such as:
Ensuring full condition clinical pathways have been explored via Clinician Assist WA » Plastic Surgery
Referral to Contracted Medical Practitioners including:
- BHS: Bentley Health Service - Contracted Medical Practitioners
- AHS: Armadale Health Service - Contracted Medical Practitioners
- Midland SJoG: Find A Specialist Doctor | St John of God (sjog.org.au)
Referral to a private or community provider
At RPH, named referrals for Plastic Surgery will be allocated a suitably qualified specialist to see the patient, noting these referrals are booked based on first on, first off principle from the outpatient waitlist.
Where appropriate and available, referrals may be streamed to an associated public allied health and/or nursing service.
Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either allow or negate the need to see the public medical specialist.
The following are not routinely provided in a public Plastic Surgery service.
Condition Presenting issue Breast Eyelid Facial fractures Gynaecomastia Burns Wounds Chest and abdomen soft tissue infections Lower limb soft tissue infections without ulceration, including cellulitis of the lower limb Chronic wounds and ulcers that are primarily of vascular nature Non-infected foot ulcer in a person with diabetes, not decreased in size by 50% after 2 to 4 weeks standard care, refer to Multidisciplinary Foot Ulcer Clinic Peripheral nerve palsies Subcutaneous tissue masses Mucosal lesions of female genitalia Chest and abdomen soft tissue infections Lower limb soft tissue infections without ulceration, including cellulitis of the lower limb Ganglion not on the wrist/hand and causing compressive nerve symptoms, pain, or functional disability refer to:
WA Health has a list of Excluded Procedures which precludes procedures being performed for cosmetic or other non-medical reasons. However, procedures which meet an identified clinical need to improve the health of the patient may be undertaken in public hospitals. To avoid patients unnecessarily waiting for and attending appointments in cases where surgery cannot be offered at RPH, referral criteria have been established for some conditions such as: For more information, visit here. The following are not routinely provided in a public service. Procedure Exceptional circumstance includes Abdominal lipectomy (Abdominoplasty) • Associated with functional problems e.g. prelude to hip replacement surgery or renal transplant • Significant skin breach due to pannus, either with or without association with massive ventral hernia repair • Persistent infections in skin folds following significant weight loss Breast reduction (not performed as part of cancer treatment) • Clinically significant and persistent mobility & functional issues • Clinically significant and persistent intertrigo • Non-gestational breast hypertrophy Breast augmentation (not performed following surgical management of breast cancer) • Congenital breast deformity e.g. Poland’s syndrome, tubular breast or amazia Removal or replacement of breast prosthesis • Replacement prostheses for post cancer patients only • While failed breast implants can be removed to reduce health risks, replacement of prostheses implanted for cosmetic reasons shall not occur within the public health system. This will apply even where the patient seeks to supply the implants. Breast lift (mastopexy) • Unless significantly asymmetrical Brachioplasty • Persistent infections in skin folds following significant weight loss Brow lift • Significant vision loss following facial trauma or post-surgery complications Blepharoplasty (reduction of upper or lower eyelid) • Clinically significant visual impairment Correction of bat ear(s) Excision of accessory nipple Face lift • Unilateral facelift for facial palsy Gender reassignment procedures Hair transplant • Major burns/trauma Liposuction • As part of reconstructive pathway • Debilitating lipoedema Lipectomy (other) • Significant functional problems or impairment of ADLs Neck lift Penile procedures for sex transformation Removal of benign moles • Requiring histology to exclude malignancy Rhinoplasty • Major facial trauma Excluded procedures
WA Health has a list of Excluded Procedures which precludes procedures being performed for cosmetic or other non-medical reasons. However, procedures which meet an identified clinical need to improve the health of the patient may be undertaken in public hospitals. To avoid patients unnecessarily waiting for and attending appointments in cases where surgery cannot be offered at RPH, referral criteria have been established for some conditions such as: For more information, visit here. The following are not routinely provided in a public service. Procedure Exceptional circumstance includes Abdominal lipectomy (Abdominoplasty) • Associated with functional problems e.g. prelude to hip replacement surgery or renal transplant • Significant skin breach due to pannus, either with or without association with massive ventral hernia repair • Persistent infections in skin folds following significant weight loss Breast reduction (not performed as part of cancer treatment) • Clinically significant and persistent mobility & functional issues • Clinically significant and persistent intertrigo • Non-gestational breast hypertrophy Breast augmentation (not performed following surgical management of breast cancer) • Congenital breast deformity e.g. Poland’s syndrome, tubular breast or amazia Removal or replacement of breast prosthesis • Replacement prostheses for post cancer patients only • While failed breast implants can be removed to reduce health risks, replacement of prostheses implanted for cosmetic reasons shall not occur within the public health system. This will apply even where the patient seeks to supply the implants. Breast lift (mastopexy) • Unless significantly asymmetrical Brachioplasty • Persistent infections in skin folds following significant weight loss Brow lift • Significant vision loss following facial trauma or post-surgery complications Blepharoplasty (reduction of upper or lower eyelid) • Clinically significant visual impairment Correction of bat ear(s) Excision of accessory nipple Face lift • Unilateral facelift for facial palsy Gender reassignment procedures Hair transplant • Major burns/trauma Liposuction • As part of reconstructive pathway • Debilitating lipoedema Lipectomy (other) • Significant functional problems or impairment of ADLs Neck lift Penile procedures for sex transformation Removal of benign moles • Requiring histology to exclude malignancy Rhinoplasty • Major facial trauma
EMHS is responsible for providing public health services to the people who reside within its boundaries.
The emhs-catchment-map.pdf (health.wa.gov.au) outlines the suburb catchment areas for East Metropolitan Health Service (EMHS). The country areas that flow to EMHS are Kimberley, Pilbara and Wheatbelt.
Referral to a hospital for assessment and/or treatment is based around multiple criteria. These include:
- Place of residence – most hospitals have catchments to help service people closer to home. For country patients, the residence of family with whom they will reside whilst attending appointments can be taken into consideration.
- Age – RPH is an Adult Hospital, children are only treated by some hospitals.
- Hospital location of specialty services – some conditions need designated specialist services that are not available at all hospitals.
Please use this information to guide referrals to the hospital servicing your patient's residence and inform your patients of these criteria when you are referring them for public hospital services via the Central Referral Service (CRS).