Department of Health
A patient consults with their GP

Specialty: General surgery
Age group: Adult

Criteria for referral to public hospital service

  • Patients with body mass index (BMI) less than 30, not a current smoker and HbA1c less than 8 millimole per mol (if diabetic) with:
    • significant clinical symptoms present (e.g. intractable intertrigo, correction of asymmetry following previous breast conserving surgery for breast cancer, severe gynaecomastia)
    • macromastia with pain in the neck or shoulder region with functional or psychological impact or both.

Information to be included in the referral

Information that must be provided

  • Expectation, or outcome, anticipated by the patient, and the referring clinician from the referral to the health service
  • How symptoms are impacting on activities of daily living including impact on work, study, exercise or carer role
  • Details of previous medical or non-medical management of symptoms including conservative management such as professionally fitted supportive garments, counselling and weight loss
  • Relevant medical history and comorbidities
  • Current and complete medication history (including hormonal treatments, non-prescription medicines, herbs and supplements and recreational or injectable drugs)
  • Body Mass Index (BMI)
  • History of smoking
  • Patient’s age
  • Recent HbA1c (if applicable)
  • If older than 50 years, most recent mammography results including when and where imaging was performed.

Provide if available

  • If younger than 50 years, most recent mammography results including when and where imaging was performed
  • Statement that the patient has indicated interest in having surgical treatment
  • If the person identifies as an Aboriginal and/or Torres Strait Islander.

Additional comments

The Summary and referral information lists the information that should be included in a referral request.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Note the indications for breast reduction surgery in the Planned surgery access policy 2024.

Breast reduction (bilateral/unilateral) where significant clinical symptoms are present (for example intractable intertrigo and severe gynaecomastia) and BMI less than 30.

Some health services may accept referrals in limited circumstances for patients with a BMI less than 35 provided they are non-smokers and have a HbA1c less than 8 millimole per mol with severe symptoms impacting on activities of daily living.

Note patients can only be referred for elective surgery at a public hospital if they meet the clinical threshold for that surgery at the time of referral for surgery.

Referral to a public hospital is not appropriate for

Referrals that do not meet the criteria.

Reviewed 27 May 2025

Statewide Referral Criteria

Contact us

Address
50 Lonsdale Street
Melbourne, VIC 3000

Phone
1300 650 172
National Relay Service

Email
plannedcare@health.vic.gov.au