Will Medicare Cover Breast Implant Removal in Sydney? 2026 MBS Guide

Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney

Will Medicare cover breast implant removal? It’s one of the most common questions patients ask when they’re considering explant surgery.

The answer is sometimes yes, but not always. Medicare doesn’t cover breast implant removal simply because a patient no longer wants implants. However, a rebate may apply when there’s a recognised medical reason, such as capsular contracture, rupture, implant-related complications, or specific findings that meet the Medicare Benefits Schedule criteria.

This is where many patients become confused. Some arrive expecting a rebate based on what they’ve read online. Others assume they won’t qualify, only to find that their imaging or examination findings may support an MBS item number.

I’m Dr Scott J Turner, a Specialist Plastic Surgeon (FRACS) consulting at Bondi Junction and Manly in Sydney. This guide explains how Medicare eligibility for breast implant removal works in Australia, what the relevant MBS item numbers mean, and what documentation is usually required before a claim can be made. For the practical recovery side of explant, see recovery after breast implant removal. For the clinical position on en-bloc and surgical options, see the patient safety advisory.

Quick Answer: Does Medicare Cover Breast Implant Removal?

Medicare may contribute to the cost of breast implant removal when there’s a recognised medical indication and the procedure meets the criteria for a relevant MBS item number. Common examples include capsular contracture, implant rupture, implant-related complications, capsular masses, or suspected implant-associated malignancy.

Medicare does not cover breast implant removal purely because a patient no longer wants implants, wants a different size, or is seeking cosmetic revision only.

Even when an MBS item number applies, Medicare usually covers only part of the scheduled surgical fee. Hospital, anaesthetic and other out-of-pocket costs may still apply.

Breast Implant Removal Consultations in Sydney

Dr Turner consults with patients considering breast implant removal at his Bondi Junction and Manly clinics in Sydney. Patients commonly attend from Sydney’s Eastern Suburbs, Northern Beaches, North Shore, Inner West, and wider New South Wales. Dr Turner also consults at Brisbane, Canberra, and Newcastle.

For Medicare eligibility, the important factor isn’t the clinic location. It’s whether your clinical situation meets the relevant Medicare Benefits Schedule item number criteria. At consultation, Dr Turner will review your symptoms, examine the breasts, assess any imaging, and explain whether an MBS item may apply to your specific case.

The Core Principle: Medical Necessity

Medicare in Australia may provide rebates for breast implant removal when the procedure is medically necessary. It does not cover purely cosmetic procedures. “Changing your mind” about implants is not a Medicare-eligible indication.

This is the most important point to understand. MBS item numbers for breast implant procedures have specific clinical criteria that must be met and documented. A surgeon can’t assign an MBS item number to a patient whose clinical situation doesn’t fit the criteria. Where a clinic suggests they can, this should be regarded cautiously.

A note on costs: even when a Medicare item number applies, Medicare typically covers approximately 75% of the MBS scheduled fee for the surgical component only. It doesn’t cover hospital fees, anaesthetist costs, implant costs, or most other associated expenses. Even with MBS eligibility, patients should expect meaningful out-of-pocket costs for explant surgery. Public hospitals may offer some procedures at no cost, but waiting periods can extend to years.

Current MBS Item Numbers for Breast Implant Removal

As of 2026, four MBS item numbers relate to breast implant removal procedures. Each has specific criteria.

Item 45548: Breast Implant Removal Without Replacement

Item 45548 may apply to straightforward implant removal without capsulectomy and without replacement. Whether it’s appropriate depends on the planned procedure, the clinical context, and the surgeon’s assessment. Medicare does not provide benefits for purely cosmetic surgery, so the reason for removal and documentation still matter.

Item 45551: Removal with Capsulectomy

This covers implant removal with excision of at least half of the fibrous capsule, without inserting a new implant. The specific MBS criteria for 45551 are important because they’re often misrepresented in patient-facing content.

Per the current MBS description, 45551 is intended to be claimed when there’s a medical indication for performing capsulectomy, such as:

• Capsular contracture (particularly Baker III or IV)
• Presence of a mass within the capsule, seen on pre-operative imaging or intraoperatively
• Evidence of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) or other malignancy

Additional documentation requirements: the excised specimen must be sent for histopathology, and the volume of capsule removed must be documented in the histopathology report.

Items 45553 and 45554: Removal and Replacement

These two items cover removal and replacement of a breast prosthesis following medical complications. The criteria are significantly narrower than many patients expect.

45553: Removal and replacement with another prosthesis, following medical complications (rupture, migration of prosthetic material, or symptomatic capsular contracture).

45554: Removal and replacement including excision of at least half of the fibrous capsule or formation of a new pocket, or both, following the same medical complications.

The critical limitation: Medicare benefits are not payable under 45553 or 45554 where the original implants were inserted for purely cosmetic reasons, unless either intra-operative photographs demonstrate that removal alone would cause unacceptable deformity (specifically, a discrete concavity in the chest contour), or the original implant was inserted in the context of breast cancer or developmental abnormality.

Asymmetry from single-implant removal isn’t considered “unacceptable deformity” under the MBS criteria. The practical effect: for most patients who had cosmetic breast augmentation and who want replacement implants after a medical complication, Medicare and private health insurance generally do not contribute to the replacement cost.

If your original implants were placed following mastectomy or for a developmental abnormality, 45553 or 45554 may apply when medical complications arise. If your original implants were purely cosmetic, the pathway for replacement is typically self-funded.

Medical Indications That May Qualify for a Medicare Rebate

The medical indications most commonly associated with Medicare-eligible explant are:

Capsular contracture is the formation of thickened scar tissue around the implant, causing firmness, distortion, or pain. Baker III or IV contracture, where visible distortion or pain is present, is the most common MBS-eligible indication for explant.

Implant rupture or leakage confirmed through diagnostic imaging (MRI is most reliable for silicone gel implants). Silent rupture picked up on surveillance imaging can qualify.

Infection caused by the implants, where conservative management hasn’t resolved the issue.

Implant extrusion (where the implant becomes exposed through the skin) is a clear medical indication.

Interference with breast cancer diagnosis or treatment where implants need to be removed to allow appropriate oncological management.

Siliconoma or granuloma formation, inflammatory reactions to silicone that have caused palpable masses or symptoms.

Implant migration from its original position where this has caused deformity or symptoms.

BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma), a rare cancer linked specifically to certain textured implants.

Confirmed mass within the capsule identified on pre-operative imaging or intraoperatively.

Your specific clinical situation is assessed at consultation to determine which MBS item number (if any) applies.

Where Breast Implant Illness Fits

Breast Implant Illness, often shortened to BII, is one of the areas where Medicare eligibility is most confusing.

Some patients experience symptoms such as fatigue, joint aches, brain fog, rashes, sleep disturbance, or generalised inflammation and wonder whether implant removal will be covered by Medicare. The difficulty is that BII symptoms alone aren’t specifically listed as an indication under the current MBS item criteria for capsulectomy.

That doesn’t mean your symptoms are dismissed. It means Medicare eligibility usually depends on whether there’s also a documented physical finding, such as capsular contracture, rupture, a seroma, a mass, or another implant-related complication.

For this reason, a careful assessment, examination, and imaging are important. In some patients, the primary concern may be BII, but the Medicare pathway (if one applies) is based on a documented physical finding such as rupture or contracture. Patients who initially expect their BII concerns to be the basis of a Medicare claim are sometimes advised after workup that their physical findings (such as a confirmed capsular contracture) are the actual basis of eligibility.

For more on the clinical position on BII, see the breast implant illness guide.

The Patient Journey for Medicare Eligibility

GP Referral

Start with a GP appointment to discuss your symptoms and concerns. A valid GP referral addressed to Dr Scott J Turner is required for Medicare eligibility. GP referrals are generally valid for 12 months (specialist referrals are valid for 3 months).

Your GP consultation may include an initial examination, documentation of your symptoms, and any initial blood work or imaging that helps characterise the clinical picture.

Specialist Consultation in Bondi Junction or Manly

At your initial consultation, Dr Turner will assess your medical history, examine you, review any imaging you’ve had, and discuss whether your clinical situation meets MBS criteria for breast implant removal. If an MBS item number applies, the specific item and its criteria are explained. If your situation doesn’t meet MBS criteria, the honest answer is given at this stage, not after surgery.

The consultation also covers surgical options, risks, realistic outcome expectations, and the costs involved including what Medicare and private health insurance may and may not contribute. For Sydney patients, consultations are available in Bondi Junction and Manly. Patients should bring previous implant records, imaging reports, Medicare details, and their GP referral where available.

Imaging and Documentation

Depending on your symptoms and examination findings, diagnostic investigations may be required to confirm medical necessity and support the MBS claim:

• Ultrasound scans can identify capsular issues, seromas, or extracapsular silicone
• MRI is the most reliable investigation for detecting silent rupture in silicone gel implants
• Photographic documentation of breast appearance, symmetry, and any visible distortion
• Clinical examination findings documenting contracture grade, masses, or other physical signs

Comprehensive documentation is central to an MBS claim being accepted. This includes a detailed surgeon’s report outlining the specific medical indication, diagnostic imaging reports, photographic evidence where relevant, and documentation of any failed conservative management.

Surgery and Claim Submission

Following surgery, the clinic team will assist with Medicare claim submission, providing the documentation required. For 45551 claims, the histopathology report confirming capsule excision volume is an essential part of the claim.

Private Health Insurance and Out-of-Pocket Costs

If your procedure qualifies for a Medicare item number, your private health insurance may provide additional benefits. Where an MBS item number doesn’t apply, private health insurance will generally also not contribute because it follows the Medicare pathway.

Where private health insurance does apply, it typically covers hospital accommodation and theatre fees, contributions toward anaesthetist fees, and part of out-of-pocket gap expenses depending on policy.

The level of coverage depends on your specific policy. Most patients need appropriate hospital cover (Silver or Gold tier) for plastic surgery item numbers. Always check directly with your private health fund, citing the specific MBS item number, to confirm your specific policy coverage. Bronze tier policies often exclude plastic surgery categories entirely.

The total cost of breast implant removal surgery is made up of multiple components: the surgeon’s fee, the anaesthetist’s fee, the hospital facility fee (theatre fee and any overnight stay), and costs associated with any additional procedures (such as a breast lift if performed at the same time).

Even with Medicare rebates and private health insurance, patients should expect meaningful out-of-pocket expenses. The clinic provides a detailed cost quote following consultation, outlining all anticipated fees and what rebates may apply. For patients whose clinical situation doesn’t meet MBS criteria, the full cost of surgery is self-funded. The clinic can discuss payment options in that situation.

Frequently Asked Questions

Does Medicare cover breast implant removal for BII? BII symptoms alone, without coexisting physical findings, are not listed in the current MBS criteria for breast implant removal (item 45551). Many patients who attribute symptoms to BII also have physical findings such as capsular contracture or confirmed rupture that do meet MBS criteria, in which case Medicare may apply. A thorough workup before surgery clarifies what Medicare items, if any, are relevant to your specific case.

Does Medicare cover breast implant replacement? For patients whose original implants were inserted for purely cosmetic reasons, Medicare typically doesn’t cover replacement even when medical complications arise. Items 45553 and 45554 (removal and replacement) have strict criteria requiring either that the original implant was for cancer or developmental abnormality, or that intra-operative photographs demonstrate a specific unacceptable deformity. If your implants were originally for reconstruction or developmental reasons, 45553 or 45554 may apply when medical complications arise.

What MBS item numbers apply to breast implant removal? Four MBS item numbers relate to breast implant removal. Item 45548 covers basic removal without capsulectomy. Item 45551 covers removal with excision of at least half the fibrous capsule, requiring a medical indication. Items 45553 and 45554 cover removal and replacement following medical complications, with strict eligibility criteria.

Is a GP referral required for a Medicare rebate? Yes. A valid GP referral is required for Medicare to pay any rebate on specialist services. GP referrals are valid for 12 months. Without a current referral, the Medicare rebate doesn’t apply to your consultation or surgery, regardless of whether your clinical situation meets MBS criteria.

How much will I pay out of pocket for breast implant removal? Even with Medicare and private health insurance, patients should expect meaningful out-of-pocket expenses. Medicare typically covers approximately 75% of the MBS scheduled fee for the surgical component only, and there’s usually a gap between the scheduled fee and the actual surgeon’s fee. Hospital fees, anaesthetist fees, implant costs (for replacement procedures), and associated costs add to the total. A detailed cost quote is provided following consultation.

Book a Breast Implant Removal Consultation in Sydney

If you’re considering breast implant removal and want to understand whether Medicare may apply, Dr Scott J Turner offers consultations at his Bondi Junction and Manly clinics in Sydney. Dr Turner also consults at Brisbane, Canberra, and Newcastle.

Please obtain a GP referral before your appointment and bring any previous implant records, imaging reports, operation notes, or documentation of symptoms. During consultation, Dr Turner will assess your history, examine the breasts, review available investigations, and explain whether your situation appears to meet the criteria for a relevant MBS item number. You’ll also receive a clear explanation of the likely surgical options, risks, recovery, fees, Medicare rebates, and private health insurance considerations.

Contact the clinic on 1300 437 758 to arrange a consultation.

This information is general only and does not guarantee Medicare eligibility. MBS item numbers and fees can change. Eligibility can only be assessed after consultation, examination, and review of relevant documentation.