Information for Referring GPs
Referrals, and what
makes them useful.
MIKKO Plastic Surgery welcomes referrals for specialist assessment across plastic, reconstructive, aesthetic, hand and wrist surgery.
How We Work
Referral, advice or
a second opinion.
Referrals may be made for assessment, management advice, operative treatment, reconstruction or a second opinion. Where appropriate, care is coordinated with the patient's GP and other treating specialists.
If you are unsure whether a condition falls within Dr Larsen's scope of practice, please send a referral or contact the practice for advice.
Referral Streams
Nine streams.
One assessment pathway.
Divided by referral stream rather than by the patient-facing procedure menu, so a referral can be directed to the right assessment.
- Breast surgery Breast reduction, asymmetry, developmental breast conditions, implant complications, implant removal and revision, mastopexy and selected augmentation.
- Breast reconstruction Immediate or delayed reconstruction, implant-based reconstruction, DIEP and other autologous reconstruction, partial breast reconstruction, and revision or tertiary reconstruction.
- Hand & wrist surgery Carpal tunnel and other nerve compression, Dupuytren disease, trigger finger, ganglia, tendon and ligament injuries, fractures, arthritis, nerve injury and selected complex wrist pathology.
- Skin cancer BCC, SCC, melanoma and lesions requiring excision and reconstruction.
- Head & neck reconstruction Post-oncological reconstruction, facial soft-tissue defects, eyelid, nasal, lip and ear reconstruction, and facial nerve reconstruction or reanimation.
- Reconstructive microsurgery Complex defects following malignancy, trauma or previous surgery; free-tissue transfer; peripheral nerve reconstruction.
- Body contouring Abdominoplasty, post-weight-loss body contouring, arm and thigh contouring, and selected medically indicated procedures.
- Facial plastic surgery Eyelid, brow, facial ageing and nasal surgery.
- Scar & secondary reconstruction Problematic scars, contour deformity, and revision following trauma, cancer treatment or previous surgery.
What to Include
Enough to triage,
and to plan.
For most referrals: the reason for referral and the clinical question; diagnosis or suspected diagnosis; symptom duration and progression; relevant examination findings; and previous treatment and response.
Relevant medical and surgical history; current medications, particularly anticoagulants and antiplatelet therapy; allergies; smoking and nicotine status; diabetes and HbA1c where applicable.
Occupation and functional implications where relevant, together with any imaging, pathology or investigation results already to hand.
Please do not delay a referral solely to obtain investigations, unless those investigations are necessary for the patient's immediate management. They can be arranged after specialist assessment where appropriate.
Referral Guides
Five streams,
in detail.
Different conditions need different information. These set out when to refer, what to include and which investigations help if you already have them.
Breast & Breast Reconstruction
- When to refer
- Symptomatic macromastia, asymmetry, implant complications, and any patient considering reconstruction before or after mastectomy. Early referral is encouraged where immediate reconstruction is being considered, so reconstructive planning can happen alongside oncological planning.
- Information to include
- Diagnosis and laterality; proposed or previous oncological surgery; whether immediate or delayed reconstruction is sought; chemotherapy and radiotherapy history or planned treatment; previous breast and abdominal surgery; BMI; smoking status; diabetes and HbA1c where relevant; significant comorbidities; and the patient’s own reconstructive priorities.
- Investigations, if already available
- Histopathology, breast imaging, and previous operative reports where these already exist.
- When to contact us
- Where reconstruction has to be coordinated with another operation, particularly immediate reconstruction.
Hand & Wrist
- When to refer
- Nerve compression, Dupuytren disease, trigger finger, ganglia, tendon and ligament injury, fractures, arthritis and nerve injury. Acute injuries threatening function warrant prompt referral.
- Information to include
- Hand dominance; occupation and important recreational activities; duration and progression; functional impairment; sensory change; motor weakness or wasting; neurovascular findings; history of trauma; and previous splinting, injection, therapy or surgery.
- Investigations, if already available
- Radiographs, ultrasound, CT or MRI and nerve-conduction studies are helpful when already available, and may be requested where clinically indicated. Nerve-conduction studies are not required before referral for suspected carpal tunnel syndrome, and ultrasound is not required before referral for trigger finger.
- When to contact us
- Complex hand trauma, or nerve injury where timing affects the outcome.
Skin Cancer & Melanoma
- When to refer
- BCC, SCC and lesions requiring excision and reconstruction. A highly suspicious lesion or biopsy-proven melanoma should be referred promptly.
- Information to include
- Site and size of the lesion; duration; change in size, colour or morphology; ulceration or bleeding; previous skin cancers; anticoagulant or antiplatelet therapy; immunosuppression; and relevant nodal findings.
- Investigations, if already available
- Biopsy or excision histology and margin status following previous excision. For melanoma, the complete histopathology report including Breslow thickness and ulceration where reported. A clinical photograph is useful where one has been taken with consent and can be transferred securely.
- When to contact us
- Suspected or confirmed melanoma.
Complex Reconstruction & Microsurgery
- When to refer
- Complex defects following cancer resection, trauma, infection or previous reconstructive failure. Early discussion is welcome, and referral before the definitive resection where possible allows reconstructive options to be considered without compromising subsequent treatment.
- Information to include
- Cause and anticipated extent of the defect; timing of planned oncological or orthopaedic surgery; previous operations; radiotherapy; vascular history; functional deficit; and the anticipated timing of definitive reconstruction.
- Investigations, if already available
- CT, MRI or angiography; microbiology in infected wounds; and photographs where appropriate.
- When to contact us
- Free-flap and microsurgical reconstruction, and any reconstruction needing coordination with another surgeon.
Cosmetic Plastic Surgery
- When to refer
- Patients seeking cosmetic surgery require a referral, preferably from their usual GP. Where that is not possible, referral may be made by another GP or a specialist medical practitioner.
- Information to include
- The reason for referral and relevant patient history is the minimum required. Relevant medical and surgical history, medications, allergies, smoking or nicotine use, and any physical or psychological health issues relevant to the patient’s consideration of surgery are all helpful.
- Investigations, if already available
- None required before referral.
- When to contact us
- Any uncertainty about whether a patient is an appropriate candidate.
Cosmetic Surgery Referrals
A referral is not
an endorsement.
Under the Medical Board of Australia's cosmetic surgery guidelines, patients seeking cosmetic surgery require a referral. The referring practitioner must be independent of the practitioner performing the surgery, and must not themselves provide cosmetic surgery or non-surgical cosmetic procedures.
The purpose is to provide relevant health information and to give the patient an opportunity to discuss their motivation with an independent practitioner. You are not expected to have detailed knowledge of the proposed procedure, are not responsible for determining whether the operation is suitable, and are not responsible for obtaining surgical consent.
Assessment of surgical suitability, informed consent and the required screening for body dysmorphic disorder remain the responsibility of the practitioner providing the surgery.
Talking It Through
Some referrals are
worth a conversation.
You are welcome to contact the practice to discuss a time-sensitive or complex referral, particularly suspected melanoma, complex hand trauma or nerve injury, immediate breast reconstruction, or reconstruction that needs coordinating with another surgeon.