Breast Endocrine Surgery

The Royal Adelaide Hospital (RAH) Breast and Endocrine Unit is Australia’s most established oncoplastic breast centre.

We provide a tertiary referral service for complex benign and malignant breast and endocrine conditions for individuals both in South Australia and interstate, as well as patients referred from rural and remote areas. 

The RAH Breast Clinic provides comprehensive diagnostic services including a “one-stop” radiology (mammography/breast ultrasound) and biopsy service. Breast magnetic resonance imaging (MRI) is available at the RAH for selected patients.

Services include:

• breast cancer/malignancy management
• benign breast conditions
• specialised clinics, such as:
  • High Risk Breast Ovarian Clinic (combined with gynaecology) for women with diagnosed cancer susceptibility gene
  • Breast Reconstruction Clinic (combined with plastic surgery) for those women considering breast reconstruction after breast cancer treatment or for prophylaxis
  • one stop Breast clinic, providing multi-disciplinary assessment for patients with new breast symptoms
    • patients will be seen by a breast surgeon, attend the medical imaging department (co-located within the breast clinic) to have a mammogram, ultrasound and/or biopsies as appropriate within the appointment time (this will always apply to country patients)
    • patients then return to see the breast surgeon at the same clinic appointment, post diagnostic procedures, to receive imaging results and have a provisional treatment plan developed (pending pathology results and multidisciplinary review)
• multi-disciplinary care: weekly breast multi-disciplinary team (MDT) meetings with medical and radiation oncology, radiology, pathology, breast care nurses, genetics
• all surgeons provide opportunities for patients to enter relevant national and international clinical trials in breast cancer
• breast reduction
• adrenal lesions
• parathyroid disease
• thyroid disease: complex and/or high-risk endocrine surgery within CALHN is undertaken at the RAH, for example, parathyroid surgery for renal patients, thyroid surgery requiring thoracotomy
• monthly combined endocrine/endocrine surgery multi-disciplinary meetings with endocrinology, medical, oncology, radiation oncology, radiology, nuclear medicine, pathology, clinical genetics and ENT surgery
• weekly multi-disciplinary outpatient clinic consultations (combined with endocrinology and nuclear medicine physicians) for the diagnosis and management of benign and malignant endocrine surgical conditions, such as thyroid, parathyroid, adrenal and parotid/salivary gland.

All unit surgeons provide oncoplastic breast surgery including:

• skin and nipple-sparing mastectomy
• tissue expander reconstruction
• direct-to-implant (DTI) reconstruction
• latissimus dorsi reconstruction
• therapeutic mammaplasty
• perforator flap partial breast reconstruction.

In addition to the provision of specialist breast and endocrine surgical services, surgical staff participate in the emergency general surgery and trauma on-call roster.

The objective of patients attending the Breast and Endocrine surgical outpatient service is for the assessment, management and follow-up of both benign and malignant conditions. Patients will not be required to pay out-of-pocket costs for attendance.

Patient referrals will be prioritised according to the urgency of the condition, based on the referral information received. It is important that a detailed referral note is produced to enable effective triage of patients. If your patient resides outside the CALHN catchment area, but wishes to be seen at the RAH, please provide a named referral to one or multiple RAH surgeons.

Outpatient clinic, Level 3 (ground floor), Royal Adelaide Hospital.

Check appointment information and screens on arrival at the RAH, for the specific location.

Consultants

• Dr Melissa Bochner – Head of Unit

There are two breast care nurse consultants based at RAH, whose role is to:

• provide expert consultative and liaison service for patients with breast cancer, as well as their families, carers and health service providers
• provide counselling to patients and their families about breast cancer. This includes at the time of first diagnosis, prior to admission, during and after their surgery and during follow-up/surveillance
• act as first contact for all enquiries, provide literature as well as communicate treatment plans, coordinate investigations and communicate results.

The nurses are also involved in health promotion activities to the South Australian public and health professionals through displays, information forums, professional meetings and seminars.

The breast care nurse consultants at the RAH are:

• Trish Harris
• Sarah Siedlaczek.

You need a referral from a GP or medical practitioner to access this service.

Once your referral has been received it will be triaged according to clinical urgency.

If your referral is accepted, you will either:

• receive a letter, phone call or text message confirming your appointment time, date and location
• receive a letter confirming you have been waitlisted for an appointment.

If the referral is declined, your GP or referring medical practitioner will be notified.

Contact us to:

• change your appointment time
• cancel your appointment
• find out triage status
• general outpatient enquiries.

If you need to cancel or change your appointment time, let us know as soon as possible.

We accept GP and specialist referrals to this service.

HealthLink Portal eReferrals are preferred for urgent new referrals and all non-urgent referrals. A follow-up call is not required.

To ensure timely triage, include all demographic and clinical details, such as:

• patient demographics including name, address, date of birth, telephone numbers, Medicare number, language spoken and mobility issues (if relevant)
• presenting problem
• past history including medications and known allergies
• family history of breast and/or ovarian cancer
• previous test results (including name of radiology provider so that images can be accessed at the breast clinic).

The service triages referrals according to clinical urgency. The waiting time for an appointment may vary and will be dependent on the demand for this service and the urgency of the patient’s condition. As a guide, expected waiting times for:

• All newly diagnosed breast cancer patients will be offered an appointment within 5 working days of receipt of referral.
• All patients with a non-diagnosed breast lump will be offered an appointment within 10 working days of receipt of referral.

Note: Routine staging tests (e.g. CT, bone scan) are often not required for patients with early breast cancer and can be arranged, from the breast clinic, if necessary.

For investigations requiring blood tests, please be aware that only blood tests performed at SA Pathology are easily available for viewing by doctors in the clinic. If your patient has had blood taken by another provider, it is essential that hard copies of these results are included in the referral. Asking for copies of results to be sent to the RAH may not allow results to arrive in time for the patient’s appointment.

Find out about research and education opportunities within the Breast Endocrine Surgery Unit.

The Unit is accredited as a post for intern training (CEPTSA), pre-fellowship surgical training (RACS SET training) and by BreastSurgANZ for post-fellowship training in breast and endocrine surgery.

Trainees working on the unit will be responsible to the Head of Unit and can expect significant exposure and training in:

• The management of both benign and malignant breast disease
• Experience in level I and level II oncoplastic breast surgery (including skin-sparing mastectomy, tissue expander reconstruction, DTI reconstruction, Latissimus Dorsi and TRAM Flap reconstruction, therapeutic mammoplasty, perforator flap partial breast reconstruction etc.)
• Experience in endocrine surgery (including thyroid surgery, neck dissection, minimally invasive parathyroid surgery and adrenal surgery)
• Emergency general surgery
• Breast/thyroid ultrasound
• Teaching and training of junior staff
• Conduct research with the aims of publication in peer-reviewed journals and presenting papers at national/international meetings
• Outpatient clinics in both specialist breast (1-2 per week) and endocrine surgery (1 per week)
• Multidisciplinary meetings for both breast and endocrine cases
• Multidisciplinary clinics at BreastScreen SA

The Breast Endocrine Fellow position is funded by the Surgical Specialties Directorate as a senior registrar with terms and conditions in accordance with the South Australian Salaried Medical Officers Enterprise Bargaining Agreement. The Fellow provides remote call for the unit’s emergency commitments. At the end of their year the Fellow can expect to gain confidence in managing high volume elective and complex breast and endocrine cases, and to develop well rounded evidence-based decision-making skills.