The Royal Adelaide Hospital 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, DTI reconstruction, Latissimus Dorsi and TRAM Flap reconstruction, therapeutic mammoplasty, 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 Endocrine Unit comprises of five 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, one intern and two Breast Care Nurses.

The Outpatient breast clinic provides comprehensive diagnostic services including a “One-Stop” radiology (mammography/breast ultrasound) and biopsy service. Breast MRI is available at the RAH.

Elective breast and endocrine surgery is performed at TQEH.

Breast services provided at the RAH:

• ‘One Stop’ triple assessment outpatient clinics for the diagnosis and management of benign and malignant breast conditions
• High Risk Breast and Ovarian Clinic (combined with gynaecology) for BRCA 1 & 2 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 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 RAH surgeons provide opportunities for patients to enter relevant national and international clinical trials in breast cancer

Breast Care Nurse Consultants

There are two Breast Care Nurse Consultants based at the RAH. They provide:

• Expert consultative and liaison services for patients with breast cancer, as well as their families, carers and health service providers
• Counsel patients and their families in regard to their diagnosis of breast cancer. This includes first diagnosis, pre-admission, surgery, post-operative period & 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 MDT meetings which includes preparation of list, presentation of cases and patient communication regarding treatment decisions.

RAH Breast care nurse consultants:

• Sarah Siedlaczek: Mobile: 0402 398 692

• Trish Harris: Mobile: 0429 312 751

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 that the unit provides, several of the unit surgeons also contribute to emergency general surgical cover after hours, supported by a dedicated Acute Surgical Unit.

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
• Monthly combined MDT meetings with endocrinology, medical and radiation oncology, radiology, nuclear medicine, pathology, genetics, ENT
• Inpatient consultations

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.

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.

GPs are encouraged to provide relevant information about their patient’s presentations. Patients can be better assessed and triaged for each of the specialist clinics if GP’s use the guides for each condition/clinic provided below

• One Stop Breast Clinic (see below)
• Breast Reduction (see below)
• Thyroid pathology (see below)
• Parathyroid pathology (see below)
• Adrenal pathology (see below)

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.

All new referrals at the RAH will be triaged by the NUM of the Breast Endocrine Surgical service 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

GPs caring for patients with acute breast or endocrine surgical conditions can discuss their patient with the Breast Endocrine Fellow (contact via hospital switchboard (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 and based on the referral information received. A detailed referral note must be provided to enable effective triage of patients.

The one-stop breast clinic provides a 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 initial appointment. 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.

Clinics are supported highly dedicated nursing staff (including 2 dedicated 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.

Minimum Information required for referral to RAH OPD 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 triage

Clinical Resources

• National Breast Cancer Foundation
• Cancer Council Australia
• Breast Cancer Network Australia
• Australian Government (Breast Cancer)

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.

Minimum Information required from GP for referral into breast clinic:

Fax 7074 6247

1. Patient demographics including name, address, date of birth, telephone numbers, Medicare number, language spoken and any mobility issues (if relevant)
2. Please include relevant information to enable accurate triage including the information below

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 Thyroid Surgical clinic:

Fax 7074 6247

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

Suggested Investigations to be completed and results provided with referral to RAH OPD:

Clinical Resources

• Australian Government (Thyroid Cancer)
• Australian & New Zealand Endocrine Surgeons/Thyroid glands

Parathyroid disease may be primary, secondary or tertiary.

Information Required from GP for referral into the Thyroid Surgical clinic:

Fax 7074 6247

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

Suggested Investigations with results provided for referral to RAH OPD:

N.B. 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

• Australian Government (Thyroid Cancer)
• Australian & New Zealand Endocrine Surgeons/Parathyroid glands