Dr Diana Hastrich | Perth Breast Surgeon

How do we assess a new breast symptom?

If you experience breast symptoms, your GP or your breast specialist will insist that a thorough diagnosis is essential. That’s because early symptoms of breast cancer can be very subtle. The first step is a visit to your GP. Your GP will arrange some basic investigations. If necessary they may then refer you to a breast specialist like myself. If you are concerned about a symptom, it is important to know that the majority of symptoms are related to benign conditions, especially in premenopausal women. What that means is that your condition can usually be managed simply and conservatively.

breast cancer surgery PerthOf course, I understand that if you have symptoms, you want an accurate diagnosis, and if necessary, the timely planning of your treatment. At my practice, my team’s mission is to make sure you fully understand your diagnosis, and the options for your treatment plan. Here at Mount Hospital in Perth, I work with a multidisciplinary team, in coordination with the Perth Breast Clinic, the Perth Radiological Clinic and Western Diagnostic Pathology. If you need treatment or surgery, we make up a customised specialist treatment plan for you as a patient.

At the end of your initial assessment process, you may be diagnosed with a condition that is regarded as being ‘indeterminate’. It means that atypical lesions are found which may be precursors of breast cancer. In that case you may need the help of an experienced breast surgeon to plan the surgical excision of these lesions.

What is the triple test?

Most breast conditions are diagnosed through a process that is called ‘the triple test’. If you have been scheduled for this type of test, it will consist of three elements:

  • Clinical Assessment: This includes a clinical examination and an assessment of your medical history including family history.
  • Radiology: For example, a mammography, a breast ultrasound and occasionally an MRI scan of the breast.
  • Pathology: Consists of a fine needle aspiration or a core biopsy.

Your GP may arrange a basic triple test for you. When all three elements of the triple test indicate a benign diagnosis this is very reliable. Your GP may refer you to a breast specialist like myself in case the outcome is uncertain or atypical, or in case of a malignant diagnosis. If all three elements of the test indicate cancer, then we will plan your treatment at my practice. In a small number of women, there may be uncertainty, and in that case my team and I will plan further investigation.

If you live in the country or in one of WA’s regional areas, you may find that breast assessments can be hard to access close to where you live. The team here at Mount Hospital in Perth has a long history of supporting patients who happen to live remotely. Through my practice, and through the Perth Breast Clinic, we will explore the most convenient options for your assessment or treatment plan.

Diagnostic services at Mount Hospital Perth

I have built my practice at Mount Hospital in Perth, partly because we have had a very strong multidisciplinary team for over 20 years. When your GP refers you to me as your breast specialist, I review all the clinical information, breast imaging and the pathology results before you come to see me. We always want to make sure your treatment is planned in the most optimal way, and if necessary we pre-arrange further testing, prior to your first consultation. This is especially important, in case you travel to our Perth based practice from a distance.

Breast Surgery Perth - Dr Diana HastrichAfter your initial clinical assessment, we may refer you to the onsite Perth Radiological Clinic here at Mount Hospital, to perform the appropriate imaging. At the clinic, specialist breast radiologists will discuss your situation to plan the most useful investigations. The radiologists at Perth Radiological Clinic are very skilled at performing a needle biopsy if required. They are also known for their ability to discuss and plan the investigations, making sure that you are clear about every step of your treatment plan.

When you are diagnosed with a breast condition, speed and accuracy are pivotal. This is why we also work in close contact with the team at Western Diagnostic Pathology, on campus at Mount Hospital in Perth, for pathology services.

Surgery for Benign Conditions

Other indications for breast surgery may mean that even though a condition is benign, you still speak to a breast surgeon and plan a surgical intervention. For example:

  • The removal of benign lumps such as enlarging or atypical fibroadenomas.
  • A nipple duct excision biopsy for nipple discharge.
  • The removal of papillomas or atypical lesions diagnosed on core biopsy

In very selected situations, we may offer prophylactic surgery - surgical removal of the breasts to prevent cancer.

If you are diagnosed with genetic mutations such as BRCA 1 AND 2 you are at much higher risk of developing breast cancer. A bilateral prophylactic mastectomy - most often combined with immediate breast reconstruction - is the most effective form of breast cancer prevention.

This is a big step and it requires careful planning. We are happy to guide you through your options and will coordinate the team, making sure you are fully informed and supported.