Breast and Endocrine outpatient services in CALHN

The Central Adelaide Breast and Endocrine Surgical Units of the Royal Adelaide Hospital (RAH) and The Queen Elizabeth Hospital (TQEH) provide inpatient and outpatient services for patients living in the Central Adelaide Local Health Network area who suffer from breast and endocrine surgical disorders. It also provides a tertiary referral service for complex breast conditions from both South Australia and interstate, and for patients referred from rural and remote areas.

Contact details – outpatients

Royal Adelaide Hospital

We prefer that new referrals are directed through the eReferral system (available through the HealthLink Portal within the GP practice management software)

For those without access to the eReferral system, please use the Breast Clinic fax (08) 7074 6247

Appointment enquiries

Royal Adelaide Hospital

RAH: Urgent new case appointment enquiries (Monday to Friday 8:00 am to 4:00 pm):

RAH: Appointment enquiries (new, review or change of appointments)

  • RAH Outpatient Call Centre: 1300 153 853

Appointment location – outpatients

Royal Adelaide Hospital

Wing 1, Level 3E, Outpatient Department
Royal Adelaide Hospital
Port Road SA 5000

RAH: Breast and Endocrine Surgical Unit Staff

  • Dr Melissa Bochner (Head of Unit)
  • Dr Robert Whitfield
  • Dr Janne Bingham
  • Dr Leong Tiong
  • Dr Arnie Nathan
  • Dr Linda Madigan – Breast Physician
  • Breast Endocrine Fellow
  • Breast Endocrine Registrar (full-time)
  • Breast Endocrine Registrar (part-time)
  • Breast Endocrine Intern
  • Trish Harris – Breast Care Nurse Consultant
  • Sarah Siedlaczek– Breast Care Nurse Consultant
  • Christine Abbott – Nurse Unit Manager
  • Olivia Siow – Unit Secretary

The RAH Breast and Endocrine Unit is Australia’s most established oncoplastic breast centre.

The unit comprises five consultant surgeons (all of whom are full BreastSurgANZ and ANZES members and have gained experience in international centres of excellence in breast surgery), one breast physician, one post-Fellowship trainee, one full-time surgical trainee, one part-time surgical trainee and one intern.

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

All unit surgeons provide level I and level II oncoplastic breast surgery (including skin and nipple-sparing mastectomy, tissue expander reconstruction, direct-to-implant (DTI) reconstruction, Latissimus Dorsi reconstruction, therapeutic mammaplasty, and perforator flap partial breast reconstruction). The breast surgeons work closely with the RAH plastic surgeons, providing a breast reconstruction service for patients requiring advanced microvascular flap reconstruction.

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.

RAH: Services and clinics available

RAH Breast services provided are:

  • ‘One Stop’ triple assessment outpatient clinics for the diagnosis and management of benign and malignant breast conditions
  • 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
  • Multi-disciplinary care - weekly breast MDT meetings with medical and radiation oncology, radiology, pathology, breast care nurses, genetics
  • Inpatient consultations
  • All RAH surgeons are trained in, and can provide, the full range of oncoplastic breast surgery procedures for patients with breast cancer, including breast reconstruction
  • All surgeons provide opportunities for patients to enter relevant national and international clinical trials in breast cancer

RAH Endocrine surgical services provided are:

  • 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 – thyroid, parathyroid, adrenal and parotid / salivary gland
  • Monthly combined endocrine / endocrine surgery multi-disciplinary meetings with endocrinology, medical, oncology, radiation oncology, radiology, nuclear medicine, pathology, clinical genetics and ENT surgery
  • Inpatient consultations
  • Complex and/or high-risk endocrine surgery within CALHN is undertaken at the RAH e.g. parathyroid surgery for renal patients, thyroid surgery requiring thoracotomy
  • paediatric endocrine surgery assessment clinic

RAH 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.

RAH: Breast care nurse consultants:

  • Trish Harris: telephone: 0429 312 751
  • Sarah Siedlaczek: telephone: 0402 398 692

RAH: Breast and Endocrine Surgery outpatients

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.

GPs caring for patients with acute breast or endocrine surgical conditions can discuss their patient with the Breast Endocrine Fellow (contact via switchboard RAH (08) 7074 0000). Those patients requiring emergency attention should be referred to the appropriate accident and emergency department.

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.

RAH: Clinic Days

Monday 1:00 pm to 5:00 pm

Breast clinic (weekly) — conditions seen below:

  • Benign and Malignant breast conditions (new and review)

Tuesday 8:00 am to 12:30 pm

Multi-disciplinary Thyroid Surgical (weekly) — conditions seen below:

  • Benign and malignant thyroid conditions
  • Parathyroid pathology
  • Adrenal pathology
  • Salivary gland pathology
  • Splenomegaly

Tuesday 1:30 pm to 5:00 pm

Surgical D general (monthly) — conditions seen below:

  • LN biopsy
  • Infusaport referrals
  • Surgical oncology

Wednesday — No clinics

Thursday — 8:00 am to 12:30 pm

Breast (weekly) — conditions seen below:

  • Benign and Malignant breast conditions (new and review)

High Risk Breast Ovarian (2 monthly) — conditions seen below:

  • For women with diagnosed cancer susceptibility gene (new and review)

Breast Reconstruction (monthly) — conditions seen below:

  • Patients considering breast reconstruction (no direct GP referrals to this clinic)

Friday 8:00 am to 12:30 pm

Breast (weekly) — conditions seen below:

  • Routine annual review patients

Friday 1:30 pm to 5:00 pm

Breast (weekly) — conditions seen below:

  • Benign and Malignant breast conditions (new and review)

Patients will not be required to pay out-of-pocket costs for attendance at RAH Breast Endocrine clinics.

Breast Endocrine surgical referrals are triaged according to clinical urgency.

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.

RAH: Urgent referrals (patients with breast or endocrine cancer)

We prefer that urgent new referrals are directed through the eReferral system (available through the HealthLink Portal within the GP practice management software). A follow-up phone call is NOT required.

Clinic fax (08) 7074 6247

RAH: Non-urgent referrals

We prefer that all non-urgent referrals are directed through the eReferral system (available through the HealthLink Portal within the GP practice management software)

Clinic fax (08) 7074 6247

All new referrals at the RAH will be triaged on a daily basis by a consultant Breast & Endocrine surgeon using agreed unit protocols. All referrals are triaged according to the Clinical Urgency Category Timeframes:

Rapid Access Appointment – immediate appointment within 72 hours

Category 1 – urgent within 30 days

Category 2 – semi-urgent within 90 days

Category 3 – non-urgent, greater than 90 days

We aim to allocate all new referrals to the Breast and Endocrine Surgical clinics within the category 1 timeframe

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.

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.

RAH: One Stop Breast Clinic

This clinic provides 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).

Whilst breast imaging can be organised at the one stop breast clinic, GPs can access free breast imaging directly from SA Medical Imaging prior to the patient’s assessment at breast clinic so that treatment plans can be expedited.

Information required from GP

  • 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)

Note: Mammograms and ultrasounds can be organised at the one stop breast clinic if required, however GPs can access free breast imaging directly from SA Medical Imaging prior to the patient’s assessment at breast clinic.

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

Clinical resources

RAH: treatment of specific diseases

RAH: Breast reduction

We generally do not consider breast reduction surgery unless your patient’s Body Mass Index (BMI) is equal to or less than 30. Your patient must also be experiencing symptoms as a result of their mammary hypertrophy and be a non-smoker.

If your patient meets the BMI criteria, is symptomatic, is a non-smoker and you would like to refer them to the breast clinic, please include the information below.

Information required from GP

  • Patient demographics including name, address, date of birth, telephone numbers, Medicare number, language spoken and mobility issues (if relevant)
  • Past history including medications and known allergies
  • Symptoms caused by mammary hypertrophy
  • Patient’s weight, height and BMI
  • Patient’s smoking status

RAH: treatment of Thyroid Disease

Common thyroid disorders seen at the Thyroid Surgical clinic include multinodular goitre, solitary thyroid nodules and thyroid malignancy.

Information required

  • Patient demographics including name, address, date of birth, telephone numbers, Medicare number, language spoken and mobility issues (if relevant)
  • Patient history
  • Family history of thyroid disease or thyroid cancer
  • Personal history of radiation exposure
  • Results of blood tests

Note: 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)

Suggested investigations

  • TFTs/Antibodies

Clinical resources

RAH: treatment of Parathyroid Disease

Parathyroid disease may be primary, secondary or tertiary.

Information required

  • Patient demographics including name, address, date of birth, telephone numbers, Medicare number, language spoken and mobility issues (if relevant)
  • Patient history

Suggested investigations

  • PTH
  • Calcium / ionised calcium level
  • Vit D level
  • Renal function
  • Serum beta-crosslaps
  • 24 hour urinary calcium level
  • Bone mineral density scan

Note: Sestamibi and parathyroid ultrasound scans are not recommended prior to attendance at the thyroid surgical clinic. These investigations are only useful to localise a parathyroid adenoma once the decision to operate has been made.

Note: 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)

Clinical resources

RAH: treatment of Adrenal lesions

Most adrenal lesions are benign, do not cause any signs or symptoms and therefore do not require treatment. However, some may be active or functioning, or are large, and therefore require surgical excision.

Information required

  • Patient demographics including name, address, date of birth, telephone numbers, Medicare number, language spoken and mobility issues (if relevant)
  • Patient history
  • Blood pressure
  • Any relevant medical imaging
  • Results of blood and urinary tests (see below)

Note: 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)

Suggested Investigations for adrenal mass

  • Blood tests: Serum K+, serum cortisol, plasma metanephrines & normetanephrines, DHEAS, aldosterone / renin ratio, plasma biogenic amines (adrenaline, noradrenaline & dopamine)
  • Urine tests: 24 hour urine sample for cortisol, metanephrines and normetanephrines
  • CT scan

Suggested GP management

  • Please include all relevant information to enable accurate triage
  • Refer urgently all functioning lesions to the Thyroid Surgical clinic using the eReferral system or fax (08) 7074 6247
  • Refer all adrenal masses ≥ 2cm to the Thyroid Surgical clinic for workup
  • Refer non-functioning adrenal masses to the Thyroid Surgical clinic for ongoing surveillance

Clinical resources