Purpose Assess the autologous reconstruction demand on the Gold Coast Health Service breast reconstructive unit. Methodology As our institute has no specific database all mastectomies and breast reconstructions from April 2023-2024 were identified. Electronic medical records were used to assess outpatient discussion, operative information and demographic information such as wait time. Results A total of 143 mastectomies were performed, with 53 patients having pre-mastectomy discussions about autologous reconstruction by breast surgeons. 12 patients were referred to the plastic and reconstructive surgery (PRS) team, and 4 opted for autologous reconstruction. All 12 patients were offered autologous reconstruction by the PRS team. A total of 62 patients had reconstructions; 45 implant based (73.7%), 18 autologous (27.8%) with 53 immediate (86.9%) and 8 delayed (13.1%). Discussion Compared to the Breast Reconstruction Australia Audit 2021 there is a preference for implant reconstruction 73.7% vs 48.6% (QLD average) with lower autologous rates 27.8% vs 37.6%. These findings highlight the need for referral pathways and the role of PRS consultation in offering autologous reconstruction options both before and after mastectomy. Only approximately a third of patients had documented discussions of autologous reconstruction with only 12 (8.4%) formally referred and consulted in outpatient. A further review into referral processes between the teams is vital to ensure adequate pre-operative consultation for autologous breast reconstruction.