Breast Endocrine Surgery
We care for people requiring breast and endocrine procedures.
What we do
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.
Breast conditions and services
- Breast cancer/malignancy management
- Benign 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
- Multidisciplinary care: weekly breast 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
Endocrine conditions and services
- 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 multidisciplinary 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.
Surgery services
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.
Outpatient clinics
Clinic days and times subject to change.
Day
Time
Clinic and frequency
Conditions seen
Monday
1:00 pm –
5:00 pm
Breast clinic
– weekly
Benign and malignant breast conditions (new and review)
Tuesday
8:00 am –
12:30 pm
Multi-disciplinary Thyroid Surgical
– weekly
Benign and malignant thyroid conditions
Parathyroid pathology
Adrenal pathology
Salivary gland pathology
Splenomegaly
Tuesday
1:30 pm –
5:00 pm
Surgical D general
– monthly
LN biopsy
Infusaport referrals
Surgical oncology
Wednesday
No clinics
Thursday
8:00 am –
12:30 pm
Breast clinic
– weekly
Benign and malignant breast conditions (new and review)
Thursday
8:00 am –
12:30 pm
High Risk Breast Ovarian
– 2 monthly
For women with diagnosed cancer susceptibility gene (new and review)
Thursday
8:00 am –
12:30pm
Breast Reconstruction
– monthly
Patients considering breast reconstruction (no direct GP referrals to this clinic)
Friday
8:00 am –
12:30 pm
Breast clinic
– weekly
Routine annual review patients
Friday
1:30 pm –
5:00 pm
Breast clinic
– weekly
Benign and malignant breast conditions (new and review)
Where to find us
Outpatient clinic, Level 3 (ground floor), Royal Adelaide Hospital.
Check appointment information and screens on arrival at the RAH, for the specific location.
Who we are
Consultants
- Dr Melissa Bochner – Head of Unit
- Dr Janne Bingham
- Dr Linda Madigan (Breast physician)
- Dr Anand Nathan
- Dr Igor Rychlik
- Dr Leong Tiong
- Dr Robert Whitfield.
Breast care nurse consultants
- Trish Harris
- Sarah Siedlaczek.
Breast care nurse consultants provide:
- expert consultative and liaison service for patients with breast cancer, as well as their families, carers and health service providers
- 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
- first contact for all enquiries, provide literature as well as communicate treatment plans, coordinate investigations and communicate results.
They are also involved in health promotion activities to the South Australian public and health professionals through displays, information forums, professional meetings and seminars.
This page was last updated 12 June 2025.
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.
Outpatient services
Find out information about specialist outpatient appointments, how to be referred, plus information when attending an outpatient clinic.
Your outpatient appointment
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.
Preparing for surgery
The healthier you are going into surgery, the stronger you will be coming out. Find tips and resources to help you get ready for surgery.
This page was last updated 12 June 2025.
We accept GP and specialist referrals to this service.
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).
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.
Urgent and serious referrals
If you are concerned about appointments being delayed or if the patient's condition is deteriorating, or you are caring for patients with acute breast or endocrine surgical conditions, contact the Breast Endocrine Fellow to discuss.
Patients requiring immediate assessment should be sent directly to the Emergency Department.
Treatment and guidelines
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.
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 following information:
- patient demographics including:
- name
- address
- date of birth
- telephone numbers
- Medicare number
- language spoken
- 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.
Clinical resources
See Resources for referrers for more information.
Common thyroid disorders seen at the Thyroid Surgical clinic include multinodular goitre, solitary thyroid nodules and thyroid malignancy.
Please include the following information:
- patient demographics including:
- name
- address
- date of birth
- telephone numbers
- Medicare number
- language spoken
- mobility issues (if relevant)
- patient history
- family history of thyroid disease or thyroid cancer
- personal history of radiation exposure
- results of blood tests.
Suggested investigations:
- TFTs/Antibodies.
Clinical resources
See Resources for referrers for more information.
Parathyroid disease may be primary, secondary or tertiary. Please include the following information:
- patient demographics including:
- name
- address
- date of birth
- telephone numbers
- Medicare number
- language spoken
- 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.
Clinical resources
See Resources for referrers for more information.
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. Please include the following information:
- patient demographics including:
- name
- address
- date of birth
- telephone numbers
- Medicare number
- language spoken
- mobility issues (if relevant)
- patient history
- blood pressure
- any relevant medical imaging
- results of blood and urinary tests.
Suggested investigations:
- 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.
Using the eReferral system or fax, refer:
- urgent: all functioning lesions to the Thyroid Surgical clinic
- all adrenal masses ≥ 2cm to the Thyroid Surgical clinic for workup
- non-functioning adrenal masses to the Thyroid Surgical clinic for ongoing surveillance.
Discharge guidelines
Patients whose medical condition has stabilised or resolved, and where no further appointment has been made, will be formally discharged.
If medical assessment is required again, a new referral should be made explaining the reason.
Resources for referrers
Further reading and resources concerning breast cancer.
Further reading and resources concerning thyroid disease.
Further reading and resources concerning parathyroid disease.
Further reading and resources concerning adrenal lesions.
This page was last updated 12 June 2025.
Find out about research and education opportunities within the Breast Endocrine Surgery Unit.
The Unit has a strong history of contributing to national and international clinical trials in breast cancer.
We work closely with Medical Oncology and Radiation Oncology, providing patients with the opportunity to participate in numerous clinical trials assessing new breast cancer treatments.
The Unit also 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:
- 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.
This page was last updated 12 June 2025.
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.
This page was last updated 12 June 2025.