In Australia, Medicare may cover breast reduction surgery, but it depends on specific criteria. Medicare will typically cover a breast reduction if it is deemed medically necessary rather than purely cosmetic. Typically, patients who have been unable to treat the issues caused by overly large breasts with other non-surgical measures, such as with medication, may be eligible for a Medicare rebate.
In this article, Dr Turner, a Specialist Plastic Surgeon in Sydney, will discuss what factors influence Medicare coverage for breast reduction surgery, the conditions that may make your procedure eligible, and what you can expect when it comes to out-of-pocket costs.
Medicare and Breast Reduction Surgery
Medicare primarily covers medically necessary procedures rather than those performed for cosmetic reasons. To determine whether your breast reduction surgery will be covered, the key consideration is whether the surgery is essential for your health or primarily for aesthetic purposes.
The surgery must address physical issues like:
- Chronic back, neck, or shoulder pain caused by large breasts
- Skin irritation or rashes underneath the breasts
- Postural problems
- Difficulty with physical activities due to breast size
Breast Reduction Medicare (MBS) Item Numbers
To receive a breast reduction Medicare rebate, patient’s need a medical referral from their General Practitioner (GP), confirming that the procedure is a medical necessity and Dr Turner will select the right Medicare item number for you.
- 45523: Bilateral breast reduction (surgery performed on both breasts).
- 45520: Unilateral breast reduction (surgery performed on one breast only).
Can I have a Breast Reduction done in the Public System?
Short answer today is NO. There is limited capacity to patients having breast reduction surgery performed in NSW public hospitals, with a waiting list often spanning several years. You can check with the NSW Government Surgery Access Line on 1800 053 456 to see if there is a surgeon near you that may be able to put you on a waiting list.
Why the big price range for Breast Reduction Surgery in Sydney?
The cost of breast reduction surgery in Sydney can vary depending on several factors, including the surgeon’s fees, hospital fees, anaesthesia costs, and whether Medicare or private health insurance provides any coverage. On average, the total cost for breast reduction surgery in Sydney can range between $10,000 and $30,000.
Dr Turner’s fees:
Patients seeking a standard breast reduction
- Privately Insured – $11,500
- Uninsured – $17,000
A formal quote will be provided after your consultation with Dr Turner that gives a better estimate of costs involved in your planned rhinoplasty procedure.
Do we ‘No-Gap’ Breast Reductions?
Dr Turner does NOT offer ‘no-gap’ breast procedures like breast reduction surgery. The private health funds simply do not compensate surgeons, anaesthetists and other medical professionals adequately. This is due to the gap payment which is often less than 30% of what the average surgeon is charging for plastic surgery in NSW, making it impossible to run a modern plastic surgery practice in Sydney.
How Much Will Medicare Cover?
To qualify for Medicare coverage, you will need a referral from your general practitioner or specialist, and the procedure must be performed by a specialist surgeon who is registered with Medicare. If your condition meets the medical necessity guidelines, Medicare may cover a portion of the surgery under the relevant item number. The rebate itself is around $1000 but more importantly, you must be entitled to the Medicare number to ensure that your private health insurance to kick in which may cover the private hospital fees.
Will my Private Health Fund Cover my Breast Reduction?
Your private health funds only cover a breast reduction surgery if you meet current Medicare eligibility criteria and has an MBS item number provided by your surgeon. While part of the benefit of private health insurance is that you are eligible for larger surgeon and anaesthetist rebate for your breast reduction, the health insurance often covers the private hospital fees. Which in procedures like breast reduction surgery can be over $5,000.
Can I Use My Super Fund to Pay for Breast Reduction Surgery?
Superannuation is accessible when there is a serious medical condition, and the patient has no other means to fund the surgery. Many patients have made successful claims to undergo breast reductions surgery for medical need.
The process is currently managed by the Australian Taxation Office and if they approve the release, your super fund will then consider the grounds and release the funds if appropriate under the rules of your fund.
Accessing your superannuation is a serious process given it will impact your retirement savings. For that reason, we encourage prospective patients to seek financial advice before going down this path.
Next Steps
If you’re considering functional rhinoplasty surgery in Sydney, scheduling a consultation with Dr. Turner is the first step. Medicare may cover part of the procedure if it is deemed medically necessary, but purely cosmetic procedures are not eligible for coverage.
- Schedule a Consultation: Contact us at 1300 437758 or visit drturner.com.au to book your appointment.
- Prepare for Surgery: Follow any preoperative guidelines provided, such as avoiding certain medications and arranging for post-surgery care.
- Plan for Recovery: Set aside time for rest and healing and arrange for assistance during your initial recovery phase if needed.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Consult with a qualified healthcare professional to determine the best treatment options for your individual needs
