Every woman meets one of our breast surgeons, who will ask about your concerns and examine your breasts.

Concerns frequently raised include:

• breast cancer risk factors and what can be done to decrease breast cancer risk
• breast cancer affecting other family members
• whether or not genetic counselling is necessary
• dense breasts as seen on the mammogram – and what that means
• how the breast screen check is performed

You will have many opportunities to ask questions and receive advice.Following the visit, the breast surgeon will complete a report to the referring GP, which will address the reason for referral and any other concerns. The report will summarise the results of the imaging and give a recommendation for future assessment.

What to expect at the Gold Coast Private Breast Care Centre

Depending on the reason for your appointment, your visit to the breast centre could take up to several hours so all necessary tests can be carried out. You will usually have a breast examination, followed by one or more of the following tests:

• Clinical consultation
• Mammography
• Ultrasound (breast)
• MRI (breast)
• Lymphoscintigraphy
• Breast biopsy
• Breast implant safety checks

The order in which tests are done may vary.While some people prefer to attend on their own, you are welcome to bring a partner, friend or relative with you for company and support. You may be asked to fill in a short questionnaire before you are seen by a doctor or specialist nurse. This includes questions about:

• any family history of breast problems
• any medicines you are taking, including hormone replacement therapy (HRT) or the contraceptive pill
• any previous breast surgery, including breast implants

During your breast examination, the doctor or nurse may want to check both your breasts when you are sitting and again when you are lying down. As part of the examination, it is normal to examine the lymph nodes (also called glands) under your arm (axilla) and around your neck.

Having a breast examination, breast imaging (for example, a mammogram, MRI or ultrasound scan) and tissue removal (for example, a core biopsy) is known as a triple assessment. This may be necessary to make a definite diagnosis.

Mammogram is the most common breast imaging tool used in Australia and one most women over the age of 40 are familiar with.

There are two types of mammography - screening and diagnostic.

Screening Mammograms are performed if you have no breast abnormality or family history, while diagnostic exams are performed when you have a symptom such as a lump. There is no technical difference in the actual mammogram you will undergo.

A breast Tomosynthesis exam or 3D Mammogram is very similar to a traditional mammogram but it shows the breast tissue in thin ‘layers,’ typically one millimeter thick. This is much like an X-ray compares to a CT.

Multiple low dose images of each breast are taken from different angles, while an X-ray tube moves around the breast in an arc. 3D imaging reduces the overlap and uncovers distortions and speculated masses, which is a better outcome with no extra radiation.

What happens during a mammogram?

You will be asked to remove your robe from one shoulder at a time and lean towards the machine, placing your breast on a flat plate that is moved to your chest height.

A plastic paddle is then lowered onto the breast, essentially compressing the breast. It will be done as quickly and discreetly as possible for your comfort. The compression only lasts a short amount of time and although it may be a little uncomfortable, it is essential to the success of the examination.

This is usually repeated on both breasts.

You may be asked to have an Ultrasound straight after the Mammogram. These two imaging modalities work hand in hand to allow the Radiologist the best chance of seeing the smallest lesions and making an accurate diagnosis.

Following the Mammogram, we will ask you to stay robed while our Mammographer and Radiologist review the images to make sure we have captured everything they need.

Any tenderness experienced after the examination should settle within a few days. It is advisable to wear a well supporting bra during this time.

What happens after a mammogram?

Mammogram results are usually available on the same day, once the Radiologist has reviewed them.

What if my mammogram is abnormal?

First of all, do not panic. Nine out of 10 women with abnormal mammogram results do not have breast cancer but you will require further investigations to find out the exact abnormality seen on the mammogram.

These tests may include a diagnostic mammogram (mammogram in more detail) or breast ultrasound.

If the investigations result in suspicious findings, the doctor may do a biopsy where a sample of the breast tissue is taken and sent to the pathologist. A biopsy is usually performed during an ultrasound or mammogram using a needle. In some cases, a small surgery may be needed to sample the abnormal breast tissue.

Technology and Team

The Gold Coast Private Breast Care Centre uses a Holgic system, which is considered the gold standard in breast imaging by specialists.

Your Mammogram will be performed by a Mammographer who is a trained medical professional. The images the Mammographer captures are then viewed by a Radiologist who makes a diagnosis.

All our Mammographers are female.

A breast ultrasound is done by our skilled Breast Sonographers. Ultrasound is a very sensitive test that reveal valuable information, particularly if the breast tissue is dense or you have an increased risk of developing breast cancer.

Ultrasound is generally used after a mammogram but it might be the first test for younger, pregnant or breast-feeding women.

How do I prepare?

Please arrive early for your exam as you will be asked to change into a gown. Wearing a two-piece outfit can make this easier for you.

We also ask you to refrain from using deodorant or lotions on the area as this can interfere with the quality of the images.

On arrival, please present to reception. You will be asked to complete a short questionnaire about your medical history.

What happens during a breast ultrasound?

You will be asked to lay down on a bed and your breast will need to be visible throughout the examination. Some women find this awkward but our Sonographers are discreet and professional and will do everything they can to make you feel comfortable.

The Sonographer will move the probe over the whole breast area and armpit to capture a complete set of images.

The examination can take up to 30 minutes. The Sonographer and Radiologist will work together to ensure all the necessary images are captured. This means that sometimes the Radiologist will come into the room and you will be consulted before this happens.

Technology and Team

Your Breast Ultrasound will be performed by a Sonographer who is a specially trained medical professional. The images the Sonographer captures are then viewed by a Radiologist who makes a diagnosis.

We endeavour to have all Breast Ultrasounds performed, by a female Sonographer. However, if you would like to ensure this happens, please let us know at the time of booking.

MRI is an advanced medical imaging tool that uses a strong magnetic field and radio waves to produce detailed imaging of soft tissues and muscle, which makes it ideal for imaging the breast.

Breast MRI is most commonly used for screening and diagnosis of breast cancer.

Some types of breast cancer are better viewed on MRI and others using Ultrasound and Mammograms.

How do I prepare?

You will be asked certain safety questions when you book in for your MRI and at your appointment. This is because an MRI machine is essentially a large magnet and certain implants are not MRI safe or only safe on certain machines. Please let bookings staff and the MRI Radiographer know if you have any of the following:

• Cardiac Pacemaker
• Defibrillator
• Cochlear Implant
• Neurostimulator
• Aneurysm Clips
• Active Implanted Biomedical Devices
• Infusion Pump
• Any implants or devices in your head or body

Routine Breast MRIs are performed on Day 7-10 of your menstrual cycle. If you do not have a cycle or your scan is urgent, it can be performed any time.

Please indicate at the time of booking if you are pregnant or breastfeeding.

In some instances, you may find the MRI machine claustrophobic which could prevent you from having the imaging done. If this is the case or you have experienced this previously, let us know and we will talk through options available to you.

What happens during my examination

When entering the MRI room, your MRI Radiographer will explain exactly what will happen during your procedure.

In most cases we will insert an intravenous (IV) line into your arm. We will use this to administer contrast, which will enhance the images we take of the breast tissue.

You will be asked to lie down on the MRI bed on your stomach with your breasts inside what we call a coil. The coil is essentially a table on top of the MRI bed that has holes for the breasts to go in.

We will make you as comfortable as possible using pillows and blankets.

When the images are being taken, you will hear loud banging noises made by the MRI machine. You will be offered headphones through which the MRI Radiographer can talk to you and play a selection of music to help reduce the noise and pass time more quickly. You will be given a button to press should you at any time want to talk to the Radiographer or stop the exam.

Once in position, the MRI Radiographer will leave the room and the bed will move slowly into the scanner so you are positioned in the centre of the machine.

You will need to lay very still for up to 45 minutes. We usually scan both breasts.

Technology and Team

We have both 3T and 1.5T MRI machines available. The number refers to the strength of the magnetic field created by the MRI machine. The 1.5T is still considered completely adequate for most MRI scans but your referrer may prefer you to have the scan completed on the 3T.

We also have a wide bore option available at Queensland X-Ray, also located within the hospital. The wide bore offers slightly more space inside the MRI tube so it may help those who suffer from claustrophobia.

Your Breast MRI will be performed by an MRI Technician. These technicians are Radiographers who have undergone additional training and exams in order to operate an MRI scanner. The images the MRI captures are viewed by a Radiologist who makes a diagnosis based on what they can see.

Lymphoscintigraphy is a special type of nuclear medicine imaging that provides pictures called scintigrams of the lymphatic system.

Nuclear medicine is a branch of medical imaging that uses small amounts of radioactive material to diagnose and determine the severity of or treat a variety of diseases, including many types of cancers, heart disease, gastrointestinal, endocrine, neurological disorders and other abnormalities within the body. Because nuclear medicine procedures are able to pinpoint molecular activity within the body, they offer the potential to identify disease in its earliest stages, as well as a patient’s immediate response to therapeutic interventions.

What happens during a Lymphoscintigraphy

Except for intravenous injections, most nuclear medicine procedures are painless and rarely associated with significant discomfort or side effects.

No anesthesia is needed for a scintigram unless a lymph node biopsy is performed in the operating room following the procedure.

When the radiotracer is given intravenously, you will feel a slight pin prick when the needle is inserted into your vein for the intravenous line. When the radioactive material is injected into your arm, you may feel a cold sensation moving up your arm but there are generally no other side effects.

For lymphoscintigraphyor sentinel node studies, the radiotracer is not injected intravenously but near the tumour site.

It is important you remain still while the images are being recorded. Though nuclear imaging itself causes no pain, there may be some discomfort from having to remain still or stay in one particular position during imaging.

Unless your physician tells you otherwise, you may resume your normal activities after your nuclear medicine scan. If any special instructions are necessary, you will be informed by a technologist, nurse or physician before you leave the nuclear medicine department.

Through the natural process of radioactive decay, the small amount of radiotracer in your body will lose its radioactivity over time. It may also pass out of your body through your urine or stool during the first few hours or days following the test. You should also drink plenty of water to help flush the radioactive material out of your body as instructed by the nuclear medicine personnel.

A breast biopsy is a procedure in which a sample of the breast tissue is taken to examine for the presence of disease. Its cause and extent may also be identified. The breast tissue can be sampled by either using a needle or through surgical exploration of the breast region and taking out the abnormal tissue partially or completely.

Your doctor might advise a breast biopsy if there are signs of diseased tissue in your breasts.

What happens during the biopsy of breast tissue?

The exact experience might differ depending upon the type of biopsy you are having, the size and location of the suspected abnormal area in your breasts and its appearance on ultrasound and/or mammogram. There are three main types of biopsies, most of which can be performed under local anaesthetic:

Fine needle biopsy

Fine needle biopsy uses a small needle that a doctor uses to remove a small amount of fluid or tissue from the abnormal breast area. This is sent away to the laboratory for testing.

Core needle biopsy

Core needle biopsy uses a larger needle with a special tip. The doctor may use imaging methods during the biopsy to locate the abnormal tissue. This is sent away to the laboratory for testing.

Core needle biopsy can be performed by using imagining techniques such as:

Ultrasound guided breast biopsy: the patient lies on their back and the doctor uses ultrasound as a guide before sampling the abnormal breast tissue

Stereotactic biopsy: the patient lies on their stomach and the doctor uses X-rays to help locate the area of breast to sample

The doctor may place a small metal clip in the breast where the biopsy was taken to mark the area of concern for future reference. This small metal clip is safe, cannot be felt and will not cause any issues during future imaging tests or at airport screenings.

Surgical biopsy:

Surgical biopsy involves surgical exploration and excision of the abnormal breast tissue. This procedure might be performed under general anaesthetic, depending on the depth of excision and other factors.

What happens after a breast biopsy?

A breast biopsy is usually a minor procedure but it may cause slight bruising, bleeding or pain and, as with any procedure, you are at risk of infection. These issues are less common in fine needle biopsy and core needle biopsy compared to surgical biopsy due to its invasive nature. Biopsy results are usually available within 24-hours.A follow-up appointment will be scheduled on the day of your initial biopsy so the doctor can discuss your results.