A diagnosis — or even the possibility of one — raises immediate questions about what comes next. What treatment will I need? Will I need surgery? What are my options? How long will it take? At Breast & Surgical Oncology at The Poche Centre, our role is to answer those questions clearly, honestly, and without rushing you.

Treatment for breast cancer and other breast conditions has evolved significantly in recent years. It is no longer a case of one standard approach applied to everyone. Today, treatment is highly personalised — shaped by the specific type, stage, and molecular characteristics of your condition, as well as your individual circumstances, priorities, and preferences. What is right for one patient may be quite different for another, even with a similar diagnosis.

Every patient at our practice is discussed at a multidisciplinary team meeting, attended by breast surgeons, medical oncologists, radiation oncologists, radiologists, and pathologists, before a treatment recommendation is made. This ensures that every plan reflects the combined expertise of the full team — not just one specialist's opinion.

Our treatment capabilities span the full spectrum of breast cancer care, from breast-conserving surgery and sentinel node biopsy through to mastectomy, immediate reconstruction, and advanced oncoplastic techniques that prioritise both cancer outcomes and aesthetic results. We also coordinate systemic treatments — chemotherapy, radiotherapy, hormonal therapy, and targeted therapy — in close collaboration with our oncology colleagues. For patients with benign conditions, we offer evidence-based surgical and non-surgical management tailored to each situation.

Treatment decisions are always made with you, not for you. We take the time to explain every option in plain language, answer your questions honestly, and ensure you feel genuinely informed before any decision is made. If you need more time, or a second opinion, we support that too.

Breast Imaging — What Each Test Does

Mammography

A mammogram is an X-ray of the breast that remains the gold standard screening tool for breast cancer. It uses low-dose X-ray to produce detailed images of the breast tissue, detecting masses, microcalcifications (tiny calcium deposits that can be an early sign of cancer), and areas of architectural distortion — often before they are palpable.

Mammography is the only imaging modality proven to reduce breast cancer mortality in population screening. Results are reported using the standardised BI-RADS classification, which guides the need for further investigation.

3D Mammography (Tomosynthesis)

Tomosynthesis is an advanced form of mammography that takes multiple low-dose X-ray images from different angles to produce a three-dimensional reconstruction of the breast tissue. This allows radiologists to examine the breast layer by layer, reducing the masking effect of overlapping tissue that can obscure abnormalities on a standard two-dimensional mammogram.

Tomosynthesis is particularly valuable in women with denser breast tissue, where conventional mammography has lower sensitivity. It improves cancer detection rates and reduces false-positive recalls compared with standard 2D mammography. It is performed using the same compression and technique as a standard mammogram.

Breast Ultrasound

Ultrasound uses high-frequency sound waves to produce real-time images of breast tissue. It is excellent at distinguishing between solid masses and fluid-filled cysts, and is a valuable supplement to mammography — particularly in younger women, women with dense breast tissue, or when a specific area of concern needs further characterisation.

Ultrasound is widely used as a diagnostic tool but is not recommended as a standalone screening test, as it has not been shown to reliably reduce breast cancer mortality when used alone for population screening.

Breast MRI

Breast MRI uses a strong magnetic field and intravenous contrast to produce highly detailed images of the breast. It is significantly more sensitive than mammography or ultrasound for detecting breast cancer in certain groups, particularly women with dense breast tissue and those at high genetic risk (such as BRCA1 or BRCA2 mutation carriers).

Because of its high sensitivity, MRI can also identify findings that turn out not to be cancer — leading to additional investigations and, occasionally, unnecessary biopsies. For this reason, breast MRI is not recommended for average-risk women and is reserved for specific clinical indications: annual screening of high-risk women, assessment of extent of disease before surgery, evaluation of the opposite breast after a new cancer diagnosis, and selected diagnostic scenarios. Your specialist will advise if MRI is warranted for your situation.

Contrast-Enhanced Mammography (CEM)

Contrast-enhanced mammography combines standard digital mammography with an intravenous contrast injection to highlight areas of increased blood flow — a feature of many cancers. It provides improved sensitivity compared to standard mammography and can be a useful alternative to MRI in certain situations,in breast cancer surveillance in particular, with the advantage of being more widely available and faster to perform.

Breast Biopsy — Confirming a Diagnosis

When imaging identifies an area of concern, a biopsy is the only way to establish a definitive tissue diagnosis. The most commonly performed biopsy in our practice is a core biopsy — a minimally invasive, outpatient procedure performed under ultrasound or mammographic guidance and local anaesthetic, in which several small cylinders of tissue are removed from the area of concern. The tissue is examined by a pathologist who can determine whether cancer is present and, if so, characterise its type, grade, and receptor status.

A fine needle aspiration (FNA) collects individual cells rather than tissue and may be used to assess lymph nodes or cysts in specific situations, though core biopsy is preferred for characterising breast lumps.

Biopsy is not a reason to panic — it is simply the definitive next step when imaging findings need clarification.

Breast Self-Examination

While formal monthly self-examination routines are no longer specifically recommended, familiarity with your own breasts is genuinely valuable. The goal is not to follow a prescriptive technique but to be familiar enough with how your breasts look and feel that a change stands out.

If you do choose to examine your breasts regularly, a useful approach is to include both a visual check — standing in front of a mirror with arms at your sides, then raised — and a physical check, feeling systematically through the entire breast including up to the armpit, ideally lying down with one arm behind your head.

The timing does not need to be exact, but many women find it helpful to choose a consistent point in their cycle — for example, a few days after their period — when hormonal swelling has settled and the breasts are at their least lumpy. For postmenopausal women, any regular time each month works well.

The most important thing is not the technique — it is acting on anything that doesn't feel normal for you.

Clinical Breast Examination

A clinical breast examination (CBE) performed by your GP or specialist remains an important component of breast health care — particularly when a symptom is present. Your doctor will systematically examine both breasts and the regional lymph nodes, assess the nipples, and note any skin or contour changes. The findings of clinical examination, combined with your history and imaging, form the basis of the triple assessment that guides diagnosis and management.

A CBE during a routine GP appointment, combined with regular screening mammography, provides a comprehensive approach to breast health monitoring.

When Should I See a Specialist?

See your GP for a referral to a specialist breast surgeon if you notice any of the changes described in the breast awareness section above, or if:

• You are due for a screening mammogram and have not had one in the past two years
• You have a family history of breast cancer and are unsure whether your current screening is sufficient
• You have been recalled after a BreastScreen mammogram and want specialist assessment
• You have had a previous breast condition and want specialist review
• You simply want reassurance and a professional breast assessment

Our team at Breast & Surgical Oncology at The Poche Centre provides specialist breast assessments for women across the North Shore, Northern Beaches, and greater Sydney. We see both GP-referred patients and self-referred patients who have specific concerns.

Book a Clinical Breast Examination in North Sydney

Our specialist breast surgeons at The Poche Centre in North Sydney provide thorough, expert clinical breast examinations for women referred by their GP and for self-referred patients with breast concerns. We take the time to listen, examine carefully, explain our findings clearly, and ensure every patient leaves with a plan.

If you have a breast concern, a family history you're worried about, or simply haven't had a specialist breast assessment in some time, we are here.