Plastics and reconstructive surgery (adult) Referral Access Criteria
Plastics and reconstructive surgery (adult) Referral Access Criteria
Patient requires immediate (within 7 days) attention
| Immediate referrals (patient to be seen within 7 days) should be sent directly to the relevant hospital. Do not send immediate referrals via Central Referral Service (CRS). |
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Contact the on-call registrar or service to arrange immediate plastics and reconstructive surgery assessment for:
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All
- Animal bites (including human)
- 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
- 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 (e.g. eyes, lips)
- Clinically large fungating lesion or exophytic tumours with delayed presentation to healthcare
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| Plastics and Reconstructive Surgery (adult) conditions with Referral Access Criteria |
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These conditions are routinely seen by Plastics and Reconstructive Surgery (adult) outpatient services. This is not an exhaustive list of all conditions seen by the outpatient service. Consideration for referral will not be excluded unless the condition is listed on the exclusion list. If the condition you are referring for is not listed, or is unknown, please include details in the body of the referral.
Referrals missing 'mandatory information' with no explanation provided may not be accepted.
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Excluded conditions and services
Exclusions
Referrals to public plastics and reconstructive surgery (adult) outpatient services are not routinely accepted for the following conditions:
| Excluded condition |
Details |
Nil other specific exclusions unrelated to listed conditions in RAC
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Excluded elective procedures
All elective procedures must meet an identified clinical need to improve the health of the patient. Procedures are not to be performed for cosmetic or other non-medical reasons. Excluded procedures will not be performed unless under exceptional circumstances and where a clear clinical need has been identified. For excluded procedures, the referral must clearly state:
- that the request is for an excluded procedure
- the clinical exception reason as to why it should be considered.
Access the WA Elective Surgery Access and Waiting List Management Policy at WA Health Policy Frameworks.
| Excluded procedure |
Clinical exception reason |
| 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
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| 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
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Breast augmentation (not performed following surgical management of reast cancer)
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- Congenital breast deformity e.g. Poland’s syndrome, tubular breast or amazia
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| 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.
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Breast lift (mastopexy)
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- Unless significantly asymmetrical
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Brachioplasty
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- Persistent infections in skin folds following significant weight loss
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Brow lift
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- Significant vision loss following facial trauma or post-surgery complications
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Blepharoplasty (reduction of upper or lower eyelid)
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- Clinically significant visual impairment
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| Correction of bat ear(s) |
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Excision of accessory nipple
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| Face lift |
- Unilateral facelift for facial palsy
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| Gender reassignment procedures |
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| Hair transplant |
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| Liposuction |
- As part of reconstructive pathway
- Debilitating lipoedema
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| Lipectomy (other) |
- Significant functional problems or impairment of ADLs
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| Neck lift |
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| Penile procedures for sex transformation |
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| Removal of benign moles |
- Requiring histology to exclude malignancy
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| Rhinoplasty |
- Major facial trauma
- Deemed necessary for functional improvement to the airway, regardless of cause
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| Tattoo removal |
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| Vaginoplasty |
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| Varicose veins |
- If CEAP Grade > C3, refer to Vascular Surgery
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| Vulvoplasty/labioplasty |
- Functional labial hypertrophy causing persistent infections
- Significant functional problems
- Correction of female genital mutilation or congenital abnormality
- Impairment of ADL where the labium extends >8cm from vaginal introitus on standing
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Last reviewed: 15-08-2025