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Breast and Endocrine outpatient services in CALHN - Single service multiple sites

The Central Adelaide Breast Endocrine Service provides outpatient services for patients living in the Central Adelaide Local Area Health Network (CALHN) at both the Royal Adelaide Hospital (RAH) and The Queen Elizabeth Hospital (TQEH).

The majority of inpatient care for breast / endocrine conditions occurs at TQEH. Some surgery is also undertaken at the RAH and Women’s and Children’s Hospital.

Introduction

The objective of patients attending the Breast and Endocrine surgical outpatient service is for assessment, management and follow-up of both benign and malignant conditions.

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

General practitioners (GPs) caring for patients with acute breast or endocrine surgical conditions can discuss their patient with:

  • Breast Endocrine Fellow at the RAH or
  • Breast surgical staff at TQEH.

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, and based on the referral information received. A detailed referral note must be provided to enable effective triage of patients (see referral checklists).

Breast Endocrine services provided at the RAH

RAH provides inpatient and outpatient services (OPD) for patients living in the CALHN 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, including rural and remote areas.

The RAH Breast Endocrine Unit is South Australia’s largest tertiary referral centre providing specialist care for patients with benign and malignant breast and endocrine diseases.

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

RAH Breast services

The RAH Breast and Endocrine Unit is Australia’s most established oncoplastic breast centre. All unit surgeons provide level I and level II oncoplastic breast surgery (including skin-sparing mastectomy, tissue expander reconstruction, direct-to-implant (DTI) reconstruction, Latissimus Dorsi and TRAM Flap reconstruction, therapeutic mammaplasty, 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.

Elective breast and endocrine surgery is performed at the TQEH.

RAH Breast clinic services available:

  • ‘one stop’ triple assessment outpatient clinics for the diagnosis and management of benign and malignant breast conditions
  • women with family history of breast or ovarian cancer, no genetic mutation found are assessed prior to appointment by nurse unit managers (NUMs).
  • High Risk Breast Ovarian Clinic (combined with gynaecological oncology unit) for BRCA 1 and 2 carriers (Women) 
  • Breast Reconstruction Clinic (combined with plastic surgery) for women considering breast reconstruction after breast cancer treatment or for prophylaxis
  • multi-disciplinary care weekly  breast meetings with medical and radiation oncology, radiology, pathology, breast care nurses, and 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 RAH surgeons provide opportunities for patients to enter relevant national and international clinical trials in breast cancer

Clinics are supported by highly dedicated nursing staff (including 2 Breast care nurse consultants) who provide information and nursing care in a sensitive and supportive manner to address the needs of women attending the clinics. The nurses are involved in health promotion activities to the South Australian public and health professionals through displays, forums, professional meetings and seminars. Staff have close links to professional bodies such as the Cancer Council, Multicultural Centre, Familial Cancer Unit, Ovarian cancer and Breast cancer Networks, Breast Care Nurses and Social work departments.

Breast care nurse consultants at RAH

There are two breast care nurse consultants based at the 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 in regards to the diagnosis of breast cancer. This includes first diagnosis, pre admission, surgery, post-operative period and follow-up / surveillance
  • act as first contact for all enquiries, providing literature as well as communicating treatment plans, investigations required and results
  • provide assistance with the weekly multi-disciplinary team meeting which includes preparation of list, presentation of cases and patient communication regarding treatment decisions.

RAH Breast care nurse consultants:

Endocrine surgery at RAH

Endocrine surgery provided by unit surgeons includes thyroid surgery, neck dissection, parathyroid surgery (including minimally invasive operations), adrenal surgery (open and laparoscopic) and salivary gland surgery.

In addition to the specialist breast and endocrine surgical services the unit provides, several of the unit surgeons also contribute to emergency general surgical cover after hours, supported by a dedicated Acute Surgical Unit.

RAH endocrine surgical services provided at the RAH: 

  • weekly multi-disciplinary outpatient clinics (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
  • multi-disciplinary care monthly combined multidisciplinary team (MDT) meetings with endocrinology, medical and radiation oncology, radiology, nuclear medicine, pathology, genetics, ear, nose and throat (ENT)
  • inpatient consultations
  • inpatient surgery at RAH for complex parathyroidectomy / renal patients


Breast and Endocrine services provided at TQEH

TQEH provides inpatient and outpatient services to patients from CALHN, South Australia, as well as interstate, who are diagnosed with breast and endocrine surgical disorders. The majority of inpatient care for all CALHN breast / endocrine conditions occurs at TQEH including elective surgery and emergency admissions.

The unit comprises four consultant surgeons (BreastSurgANZ and ANZES members) one breast and endocrine fellow, one resident medical officer (RMO) and one full time equivalent breast care nursing position. Services provided include:

  • a ‘one stop’ diagnostic services including radiology (mammography / breast ultrasound) and biopsy service co-located within the unit
  • multi-disciplinary outpatient clinics for the diagnosis and management of benign and malignant breast conditions
  • breast MRI and complex diagnostic services 
  • comprehensive surgical management of both benign and malignant conditions 
  • High Risk Breast Ovarian Clinic (in partnership with gynaecology) for BRCA 1 and 2 and high risk women, held quarterly
  • weekly multi-disciplinary team meetings with medical and radiation oncology, radiology, pathology, breast care nurses, genetics
  • inpatient consultations/referrals to Oncology, Radiation Oncology, and Familial Cancer Services
  • Access to Endocrine Physician review
  • TQEH Breast and Endocrine Unit Surgeons work collaboratively with the Plastics and Breast Reconstruction Team to provide patient’s direct access to either immediate, delayed or prophylactic comprehensive breast reconstruction surgery as clinically indicated.

Breast Care Nursing service at TQEH

TQEH Breast Care Nursing service includes:

  • comprehensive counselling, support and expert care co-ordination for women/ men with breast conditions and their families. Specialist wound care and nurse led clinics ensuring timely access to expert clinical care; video conferencing service (nurse-led) for regional clients; comprehensive advanced and extended clinical nursing service from diagnosis and throughout treatment,  also available as part of nurse practitioner role.  

TQEH Breast care team contacts (mobile 0414824015):

Endocrine surgical services provided at TQEH

  • Thyroid surgery, neck dissection, parathyroid surgery (including minimally invasive operations), adrenal surgery (open and laparoscopic) and salivary gland surgery
  • Emergency general surgical cover after hours, supported by a dedicated Acute Surgical Unit
  • Weekly multi-disciplinary outpatient clinics (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
  • Multi-disciplinary care monthly combined meetings with endocrinology, medical and radiation oncology, radiology, nuclear medicine, pathology, genetics, ENT
  • Inpatient consultations


CALHN Breast and endocrine surgical staff

RAH Breast and Endocrine Surgical Unit staff

  • Acting Head of Unit: Dr Melissa Bochner
  • Dr Jim Kollias        
  • Dr Robert Whitfield                                           
  • Dr Janne Bingham                                              
  • Dr Linda Madigan – Breast Physician
  • Breast Endocrine Fellow
  • Breast Endocrine Registrar (full-time)
  • Breast Endocrine Registrar (part-time)
  • Breast Endocrine Intern
  • Judy Iasiello: Breast Care Nurse Consultant
  • Trish Harris: Breast Care Nurse Consultant
  • Joya McCormack: Nurse Unit Manager
  • Nicki Bator – Unit secretary

Patients can also be discussed with any of the following:

  • Nurse Unit Manager: Joya Mc Cormack Mobile: 0466027620 joya.mccormack@sa.gov.au
  • Associate Nurse Unit Manager (08) 7074 4646
  • Breast Endocrine Fellow (via switch) (08) 7074 0000


TQEH Breast and Endocrine Surgical Unit staff

  • Head of Unit: Dr David Walsh
  • Dr Robert Parkyn
  • Dr Christine Lai
  • Dr David Walters
  • Breast/Endocrine Fellow
  • Breast Endocrine RMO
  • Karen Redman: Breast Care Nurse Practitioner
  • Katrina Swanson: Breast Care Nurse Consultant
  • Teresa Occhiodoro- Scott: Research Coordinator


CALHN breast / endocrine referral process

All referrals must be in writing and sent or faxed to either the RAH or TQEH.

Please refer to contact details below.

Royal Adelaide Hospital (RAH) referrals

  • Urgent referrals:
    A written referral marked URGENT should be faxed to:
    RAH Outpatients: and can be followed up with a phone call with one of the below:
    • Wing 1 Nurse Unit Manager: Mobile: 0466 027 620
    • RAH Breast Endocrine Fellow via switchboard: (08) 7074 0000

The Queen Elizabeth Hospital (TQEH) referrals

  • Urgent Breast and Endocrine referrals:
    A written referral marked URGENT should be faxed to the number below and can be followed up with a phone call with one of the contacts below:
    • TQEH Breast Endocrine Fellow via switchboard: (08) 8222 6000
    • Breast Care Nurse: 0414 824 015
  • Fax (for all referrals): (08) 8222 7244
  • Appointment enquiries and new case appointments - Outpatient area: (08) 8222 7010 / (08) 8222 6162
  • Review or change of appointments - Outpatient area: (08) 8222 7010 / (08) 8222 6162


Appointment locations and staff clinics (RAH and TQEH)

RAH clinics

  • Outpatient clinics are held in Level 3E.1, Outpatient Department
    Royal Adelaide Hospital
    Port Road SA 5000

The RAH Breast and Endocrine Unit secretary and staff are located at RAH on Level 5E.

Staff clinic days — RAH

Day Clinic Doctors/nurses Condition seen
Monday (am)
1.00pm to 5.30pm
Breast (weekly)
Dr Janne Bingham
Dr Linda Madigan
Breast Registrar
Breast Care Nurse
Benign and Malignant breast conditions
(new and review)
Tuesday
8.00am to 12.30pm
Multi-disciplinary Thyroid Surgical
(weekly)
Dr Melissa Bochner (HOU)
Dr Janne Bingham
Dr Jim Kollias
Dr Robert Whitfield
Breast Endocrine Fellow
Benign and malignant thyroid conditions
Parathyroid pathology
Adrenal pathology
Salivary gland pathology
Splenomegaly
Wednesday No clinics

Thursday
8.00pm to 12.30pm
Breast
(weekly)
High Risk Breast Ovarian
(2 monthly)
Breast Reconstruction (monthly)
Dr Melissa Bochner
Dr Jim Kollias
Dr Robert Whitfield
Dr Linda Madigan
Breast Endocrine Fellow
Breast Registrar
Breast Care Nurse
Dr Bochner
Dr Kollias
Dr Whitfield
Dr Bingham
Dr Martin Oehler – gynaecology
Gynaecology Oncology Fellow
Dr Nicola Poplawski - genetics
Adult Cancer Genetic Counsellor
Dr Janne Bingham
Dr Marcus Wagstaff - plastics
Dr Marcus Pyragius - plastics
Benign and Malignant breast conditions
(new and review)
Friday
8.00am to 12.30pm
Thursday
8.00am to 12.30pm
Dr Linda Madigan
Routine mammogram annual review patients
Friday
1.00pm to 5.30pm
Breast (weekly)
Dr Janne Bingham / Dr R Whitfield
Dr Linda Madigan
Breast Endocrine Fellow
Breast Registrar
Breast Care Nurse
Benign and Malignant breast conditions
(new and review)

  • All patients require a valid referral prior to receiving treatment in an outpatient clinic. Referrals must be submitted in writing and should contain the required minimum data to ensure timely and appropriate decision making.
  • A patient can be referred to and see a specialist doctor of choice, provided the doctor is available for appointment within suitable timeframes, based on clinical need. 

To be treated as a Medicare bulk billed (private) patient in an outpatient clinic and see a specialist doctor of choice, a patient can be referred to a named specialist. Not all breast specialists have / use rights of private practice.

  • If a referral is not written to a named specialist, the patient will be seen by a doctor of the hospital’s choice as a public patient.

All outpatients are seen on the basis of clinical need. If the named specialist doctor is not available within a clinically appropriate timeframe another doctor may see the patient to ensure the necessary care is provided.

TQEH clinics

  • The Queen Elizabeth Hospital
    8A Women’s Health, Level 8 Main Building 
    28 Woodville Road, Woodville SA 501
  • Please view the TQEH Map

Staff clinic days —TQEH

Day Clinic/theatre Doctors/nurses Condition seen

Monday Theatre all day session
Breast Reconstruction Clinic (Plastics), 8A Women’s Health

Dr David Walsh (Head of Unit)
Dr Christine Lai

Dr Phoebe Prowse

Breast/Endocrine/
General Surgery

Tuesday Breast and Surgical Endocrine Clinic 8A Women’s Health 8.30 am – 12.30 pm

Dr David Walsh
Dr Robert Parkyn
Dr David Walters
Dr Christine Lai
Senior Fellow/RMO

Breast Care Nurse Practitioner available 8.00 am to 4.00 pm.

Breast Nurse led Clinic 9am-1230pm 8A Women’s Health
mobile: 0414824015

Benign/ malignant breast conditions, endocrine conditions
Accredited for Paediatric
Breast/Surgical Endocrine conditions
LN biopsy infusaport referrals
Surgical Oncology
Thyroid, Parathyroid Adrenal
Salivary gland Splenomegaly
General Surgery
Wednesday Breast Reconstruction Clinic (Plastics),
8A Women’s Health clinic
1.30 pm to 3.30 pm

Dr Michelle Lodge

Breast Care Nurse Consultant available
9.00 to 2.00 pm
Mobile: 0414824015


Thursday

Theatre all day session 8.00 am to 5.00 pm

Breast/ Ovarian (High Risk) Clinic, 8A Women’s Health
(3 monthly)

Dr Robert Parkyn
Dr David Walters
Dr David Walsh

Breast Care Nurse Consultant available 9.00am to 2.00 pm 
Mobile: 0414824015

Benign and malignant Breast conditions
Accredited for Paediatric
Breast/surgical endocrine conditions
LN biopsy
Infusaport referrals
Surgical oncology

Thyroid, Parathyroid Adrenal
Salivary gland
Splenomegaly
General surgery
BRCA 1 and 2 women (new and review)

Friday

Multi-Disciplinary Meeting
6A Seminar Room
8.30 am – 9.30 am

Breast Endocrine Clinic
8A Women’s Health
10.30 am – 12.30 pm

All Multi-Disciplinary Team members.
GP’s welcome

Dr David Walsh
Dr Robert Parkyn
Dr David Walters
Dr Christine Lai
Senior Fellow
RMO
Breast Care Nurse Practitioner/Consultant available
8.00 am 4.00 pm.
Nurse Led Clinic 10am-12.30pm 8A Women’s Health
Mobile: 0414824015

Benign and malignant Breast conditions
Accredited for Paediatric Breast/Endocrine patients
LN biopsy
Infusaport referrals
Thyroid, Parathyroid
Adrenal
Salivary gland
Splenomegaly
General Surgery

  • All patients require a valid referral prior to receiving treatment in an outpatient clinic. Referrals must be submitted in writing and should contain the required minimum data to ensure timely and appropriate decision making.
  • A patient can be referred to and see a specialist doctor of choice, provided the doctor is available for appointment within suitable timeframes, based on clinical need. 

To be treated as a Medicare bulk billed (private) patient in an outpatient clinic and see a specialist doctor of choice, a patient can be referred to a named specialist.

  • If a referral is not written to a named specialist, the patient will be seen by a doctor of the hospital’s choice as a public patient.

All outpatients are seen on the basis of clinical need. If the named specialist doctor is not available within a clinically appropriate timeframe another doctor may see the patient to ensure the necessary care is provided.

We aim to:

  • allocate all new referrals to the Breast and Endocrine Surgical clinics within the category 1 timeframe
  • allocate all newly diagnosed breast cancer patients to an appointment to occur 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. 

Triaging process for referrals for Breast Clinic TQEH

All new breast referrals will be triaged by the Nurse Practitioner in conjunction with the Consultant Surgeons. All new Endocrine referrals are triaged by a Consultant according to the Clinical Urgency

  • Category 1 – urgent within 1 week
  • Category 2 – semi-urgent within 3 weeks
  • Category 3 – non-urgent, no later than 6 weeks 

We aim to allocate all new referrals to the Breast and Endocrine Surgical clinics within the category 1 timeframe.  We aim to allocate all newly diagnosed breast cancer patients to an appointment to occur 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. 

Triaging process for referrals (RAH and TQEH)

RAH Breast Endocrine Clinic

The following guidelines have been put in place to allow for correct triaging of referrals and appointments to be made with consultants in the RAH Breast Clinic.

Time from referral received to appointment made
Stated patient condition on referral
Seen in 5 working days
Newly diagnosed breast cancer
Seen in 10 working days
Undiagnosed breast lump (i.e. no imaging or cytology/histology)
Seen in 4 working weeks
Breast cyst on imaging
Fibroadenoma on imaging
Newly referred patients for breast cancer follow-up
Breast Pain
Gynaecomastia
Nipple discharge (if bloody 2 weeks)
Papilloma 2-4 weeks
Asymptomatic family history referrals
Patient sent questionnaire on return of information assessment made of breast cancer risk. If high risk an apt sent for review. If not high risk letter dictated to patient and referring doctor re management of risk
Combined breast and plastic reconstruction clinic
Referrals direct to this clinic via consultants
  • Patients requiring core biopsy at first appointment – check if on anticoagulants (show referral to consultant for possible cessation of drug therapy) and document on referral.
  • Any complex referrals will be discussed with consultants.

RAH Thyroid/Surgical Endocrine Clinic

The following guidelines have been put in place to allow for correct triaging of referrals and appointments to be made with consultants in the RAH Thyroid Clinic.

Time from referral received to appointment made
Stated patient condition on referral
Seen in 5 working days
Newly diagnosed thyroid, adrenal cancer
Seen in 10 working days
Undiagnosed solid thyroid nodule ( i.e. imaging but no cytology/ histology)
Symptomatic multinodular goitre
Thyrotoxic patients referred for surgery
Adrenal incidentalomas >4cm (JK/RW)
Functioning adrenal tumours
Symptomatic hyperparathyroidism
- Serum Calcium ≥3.00 mmol/l
- Referrals from Renal Unit for secondary/tertiary hyperparathyroidism
Spleen referrals (ITP, Large spleens for surgery)
Parotid surgical (JK, RW, PG)
Seen in 4 working weeks
Asymptomatic multinodular goitre
Thyroid cyst
Asymptomatic hyperparathyroidism
- Serum Calcium < 3.00mmol/l
Newly referred patients for thyroid cancer follow-up
Patients we don’t see and refer to medical endocrine unless referred by endocrinologist
Hyper/ hypo thyroidism ( no lump)
Graves’ disease
Thyroiditis
Undiagnosed thyrotoxicosis
  • For other referrals into this service, 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

Breast Endocrine clinical information for GPs referring to patients to RAH

GPs are encouraged to provide relevant information about their patient presentations.
Patients can be better assessed and triaged for each of the specialist clinics if GP’s use the guides for each condition / clinics provided below.
  • One Stop Breast Clinic
  • Breast Reduction
  • Thyroid pathology
  • Parathyroid pathology
  • Adrenal pathology

One Stop Breast Clinic (RAH)

The “one-stop” Breast Clinic provides multi-disciplinary assessment for patients with new breast symptoms. Patients will be seen by a breast surgeon and 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 will see the breast surgeon at the same clinic appointment, post diagnostics, to receive results and have a treatment plan developed.

Minimum Information required for referral to OPD RAH breast clinic: Fax (08) 7074 6247

  1. Patient demographics including name, address, date of birth, telephone numbers, Medicare number, language spoken and mobility issues (if relevant)
  2. Presenting problem
  3. Please include relevant information to enable accurate triaging

Tests / investigations:

  • Provide a detailed past medical history including symptoms
  • Patient family history of breast and / or ovarian cancer questionnaire (insert link – GP gives to patient and sends with referral completed)
  • Any previous test results
  • Current medications
  • Allergies
  • Note: Mammograms and ultrasounds can be organised at the one stop breast clinic.
  • Note: Routine staging tests (such as CT, bone scan) are often not needed for patients with early breast cancer and can be arranged if necessary from the breast clinic.

Clinical resources

Breast reduction (RAH)

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, and ensure the table below is completed.

Minimum information required from GP for referral into breast clinic: Fax (08) 7074 6247

  1. Patient demographics including name, address, date of birth, telephone numbers, Medicare number, language spoken and any mobility issues (if relevant)
Please include tests / investigation and relevant information to enable accurate triage including the information below:
  • Provide a detailed history including symptoms caused by mammary hypertrophy
  • patient weight
  • patient height
  • patient BMI
  • smoking status
  • current medications
  • allergies

Thyroid disease (RAH)

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

Information required from GP for referral into the RAH Thyroid Surgical clinic: Fax (08) 70746247

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

Suggested tests / investigations to be completed and results provided with referral to RAH OPD:

  • Provide a detailed family history of thyroid disease or thyroid cancer if any
  • any personal history of radiation exposure
  • TFTs / antibodies
  • Ultrasound of thyroid
  • current medication list
  • allergies
  • any other relevant information

Suggested GP management

  • Nil

Clinical resources

Parathyroid disease (RAH)

Parathyroid disease may be primary, secondary or tertiary.

Refer to RAH Thyroid Surgical Clinic: Fax (08) 7074 6247 with information below:

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

Suggested tests / investigations with results provided for referral to RAH OPD:

  • PTH
  • vitamin D level
  • renal function
  • serum beta-crosslaps
  • 24 hour urinary calcium level
  • bone mineral density scan
  • current medication list
  • allergies
  • any other relevant information

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.

Clinical resources

Adrenal lesions (RAH)

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

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

Suggested tests / investigations with results provided for referral to RAH OPD:

  • results of blood tests:
    Serum K+, serum cortisol, plasma metanephrines and normetanephrines, DHEAS, aldosterone / renin ratio, plasma biogenic amines (adrenaline, noradrenaline and dopamine)
  • results of Urine tests: 24 hour urine sample for cortisol, metanephrines and normetanephrines
  • relevant medical imaging – CT scans of adrenal mass
  • blood pressure
  • current medication list
  • allergies
  • any other relevant information

Suggested GP management

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

Clinical resources

Clinical trials and research

  • The Unit has a strong history of contributing to national and international clinical trials in breast cancer.  It works closely with the Departments of Medical Oncology and Radiation Oncology, providing patients with the opportunity to participate in numerous clinical trials assessing new breast cancer treatments.
  • The Unit has a longstanding history in clinical and translational research, having published hundreds of articles in scientific journals relating to new advances in breast and endocrine surgery.

Training (RAH and TQEH)

The Breast Endocrine 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 to 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
  • the opportunity to 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.



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