Recommendations

Encourage discussion of all relevant BR options with clinically eligible and interested patients prior to mastectomy as a minimum standard of care and routine practice (as per the 2016 Cancer Australia statement Influencing best practice in breast cancer). Appoint breast and plastic surgeons who are skilled in BR to new positions in public cancer services organisations, as members of their credentialled multidisciplinary team. Promote and disseminate widely BR information for GPs from existing resources to inform their referral practices. Promote and disseminate widely, prior to mastectomy, a generic package of BR information for patients based on information available from existing resources. Use a simple and comprehensive online or paper-based BR discussion prompt list, to aid discussion between patients and surgeons or patients and BCNs/specialist BR nurses. Recommend health professionals follow a BR referral pathway to ensure patients have access to informed discussion and referral to a specialist BR surgeon in line with patient preferences. Include BR discussion and referral as a performance indicator for membership of Breast Surgeons of Australia and New Zealand.† Develop a register of hospitals of where BR is available and what types (with some measure of quality assessment) by government department/surgical representative societies. Consider preoperative MDT discussion of potential immediate BR patients to aid BR decision-making with plastic/oncoplastic surgeons attending. Introduce a formal ‘mentor system’ between hospitals to provide inexperienced surgeons with advice on patient selection for specific BR procedures, access to MDT discussion and the establishment of regular referral patterns (supported by telemedicine).