Breast and Endocrine outpatient services in CALHN

Breast and Endocrine Surgery outpatient service in Central Adelaide

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 (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, and for patients referred from rural and remote areas.

Contact details – outpatients

Royal Adelaide Hospital 

  • RAH clinic fax (for all referrals): (08) 7074 6247

The Queen Elizabeth Hospital 

  • TQEH clinic fax (for all referrals): (08) 8222 7244

Appointment enquiries

Royal Adelaide Hospital

RAH: Urgent new case appointment enquiries:

  • Area 1 Nurse Unit Manager: 0466027620 or HealthRAHFAXWHC@sa.gov.au
  • Area 1 Team Leader: 70741114 
  • RAH Breast Endocrine Fellow via switchboard: (08) 7074 0000

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

  • RAH Outpatient Call Centre: 1300 153 853

The Queen Elizabeth Hospital 

TQEH: Urgent new case appointment enquiries:

  • TQEH Outpatient area: (08) 8222 7010/ 8222 6162

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

  • TQEH Breast Endocrine Fellow via switchboard (08) 8222 6000

Appointment locations – outpatients

Royal Adelaide Hospital

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

The Queen Elizabeth Hospital

8A Women’s Health, Level 8 Main Building 
The Queen Elizabeth Hospital  
28 Woodville Road, Woodville SA 501

RAH: Breast and Endocrine Surgical Unit

RAH staff:

  • Dr Melissa Bochner (Head of Unit)
  • Dr Robert Whitfield
  • Dr Janne Bingham
  • Dr Leong Tiong 
  • Dr Linda Madigan – Breast Physician 
    Breast Endocrine Fellow 
  • Breast Endocrine Registrar (full-time)
  • Breast Endocrine Registrar (part-time)
  • Breast Endocrine Intern
  • Trish Harris – Breast Cancer Nurse Consultant
  • Sarah Siedlaczek – Breast Cancer Nurse Consultant
  • Stephanie Kipirtoglou – Area 1 Nurse Unit Manager
  • Nicki Bator – Unit secretary

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

The unit comprises four 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 BRCA 1 & 2 women
  • 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 oncology, 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

RAH: Endocrine surgical services provided are:

  • 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 multidisciplinary endocrine / endocrine surgery (MDT) meetings with endocrinology, medical oncology, radiation oncology, radiology, nuclear medicine, anatomical 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

All clinics are supported by a dedicated group of nursing staff who provide information and nursing care in a sensitive and supportive manner to address the needs of patients attending the clinics.

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 5.30 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  1.00 pm to 5.30 pm

Surgical D general (alternate weeks)  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:

  • BRCA 1&2 women (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 mammogram annual review patients

Friday   1.00 pm to 5.30 pm

Breast (weekly)  conditions seen below:

  • Benign and Malignant breast conditions (new and review)

RAH: Breast Endocrine Clinic referrals

CALHN prefers all referrals to be addressed to a named clinician providing the service. One or more clinicians can be named. If a referral is written to a named specialist, patients out of the catchment area can be seen in the clinic.

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.

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

RAH: Urgent referrals

A written referral marked URGENT should be faxed to:

  • RAH fax: (08) 7074 6247           

Urgent breast referrals can also be discussed with:

  • Breast Care Nurse Consultant - Trish Harris – 0429312751 
  • Breast Care Nurse Consultant - Sarah Siedlaczek – 0402398692 
  • Breast Endocrine Fellow via switchboard (08) 7074 0000

RAH: Non-urgent referrals

  • Preferred method of referral is by fax or letter.
  • RAH fax: (08) 7074 6247 

All new referrals at the RAH will be triaged by the consultants 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

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.

Breast Endocrine GP clinical information sheets

The following information sheets about presentations commonly seen in the breast and endocrine surgical clinics provide some information which is helpful for assessing a referral under the headings of eligibility.

  • One Stop Breast Clinic 
  • Breast reduction 
  • Thyroid pathology 
  • Parathyroid pathology 
  • Adrenal pathology 

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 diagnostics, to receive results and have a treatment plan developed.

Information required from GP

Note: Mammograms and ultrasounds can be organised at the one stop breast clinic.

Note: Routine staging tests (e.g. 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

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 specific diseases

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 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

TQEH: Breast and Endocrine services

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 unit comprises four consultant surgeons , 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.

TQEH: Breast Care Nursing service

  • 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):

  • Karen Redman, Breast Care Nurse Practitioner  
  • Katrina Swanson, Breast Care Nurse Consultant 

TQEH: Endocrine surgical services

  • 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

TQEH: Inpatient consultations

TQEH Breast and Endocrine Surgical Unit staff

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

TQEH: Referrals

TQEH: 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

TQEH: Staff clinic days

TQEH clinic location

The Queen Elizabeth Hospital   
8A Women’s Health, Level 8 Main Building   
28 Woodville Road, Woodville SA 501

Monday

Clinic/theatre:

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

Conditions seen – Breast, Endocrine and General Surgery

Doctors/nurses:

  • Dr David Walsh
  • Dr Christine Lai
  • Dr Phoebe Prowse

Tuesday

  • 8.30 am to 12.30 pm
  • Breast Care Nurse Practitioner -  8.00 am to 4.00 pm.
  • Breast Nurse led Clinic - 9.00 am to 12.30 pm 8A Women’s Health. Call: 0414824015
  • Clinic/theatre – Breast and Surgical Endocrine Clinic 8A Women’s Health

Conditions seen:

  • 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

Doctors/nurses:

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

Wednesday

  • 1.30 pm to 3.30 pm
  • No Breast Care Nurse Consultant 
  • Clinic/theatre – Breast Reconstruction Clinic (Plastics), 8A Women’s Health clinic

Doctors/nurses:

  • Dr Michelle Lodge
  • Breast Care Nurse Consultant

Thursday

  • 8.00 am to 5.00 pm
  • Breast Care Nurse - 9.00am to 2.00 pm. Call 0414824015
  • Clinic/theatre – Theatre, Breast/ Ovarian (High Risk) Clinic, 8A Women’s Health (3 monthly)

Conditions seen:

  • 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)

Doctors/nurses:

  • Dr Robert Parkyn
  • Dr David Walters
  • Dr David Walsh
  • Breast Care Nurse Consultant

Friday

  • Breast Care Nurse Practitioner/Consultant - 8.00 am 4.00 pm.
  • Nurse Led Clinic - 10am to 12.30pm Call: 0414824015
  • Clinic/theatre:
    • Multi-Disciplinary Meeting, 6A Seminar Room  8.30 am – 9.30 am
    • Breast Endocrine Clinic, 8A Women’s Health

Conditions seen:

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

Doctors/nurses:

  • All Multi-Disciplinary Team members.
  • GPs
  • Dr David Walsh
  • Dr Robert Parkyn
  • Dr David Walters
  • Dr Christine Lai
  • Senior Fellow
  • RMO
  • Breast Care Nurse Practitioner/Consultant

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. 

TQEH: Triaging process for referrals for Breast Clinic

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.