Whether you’re undergoing a breast reduction, breast lift, revision (to remove or replace implants), or reconstruction, the costs of your procedure will be an important factor to think about. In some cases, it can be possible to receive breast surgery Medicare cover.
In this blog, we’ll discuss when breast surgery Medicare cover can be granted, and what types of breast procedures it can apply to. During your consultation with Dr Perron in Brisbane, you will be able to discuss your reasons for undergoing your chosen breast procedure, and if these reasons align with Medicare’s eligibility requirements. You can also discuss other factors to consider when it comes to your procedure costs, allowing you to prepare.
Medicare’s requirements for covering the costs of breast surgery
Breast surgery Medicare cover will only be available for procedures that are deemed medically necessary.
This means that cosmetic procedures – surgeries that are performed purely for aesthetic purposes – are not typically covered. Breast surgery that is performed for reconstructive or health-related reasons may be eligible for Medicare cover.
Medicare can also only cover a portion of the total surgery fees – however, it is often a significant amount, depending on the type of procedure you will undergo. Often, when patients are eligible for Medicare cover, they may also be able to receive cover from their private health insurance provider, depending on their provider’s requirements and their level of cover.
What types of breast surgery can Medicare cover?
Medicare can cover a portion of the costs of various different types of breast surgeries. The reasons for undergoing breast surgery must be medical and not aesthetic-based.
A common breast procedure that patients often meet Medicare’s requirements for is a breast reduction. Breast reduction surgery, also known as reduction mammoplasty, is performed to reduce the size of the breasts. While this procedure can be performed for cosmetic reasons, many women seek breast reduction for medical reasons. Women with overly large breasts may experience chronic pain in the back, neck, or shoulders, as well as skin irritation, postural problems, and difficulty with physical activities.
Another procedure is a breast reconstruction. Breast reconstruction surgery is often performed following a mastectomy, which is the removal of one or both breasts due to breast cancer or a high risk of developing it. In this case, Medicare can provide cover for reconstruction surgery as it is considered part of the overall treatment plan for cancer patients.
A breast lift may also be performed for reasons that could be considered medically necessary. A breast lift, or mastopexy, is typically a cosmetic procedure to lift the breasts, addressing skin laxity. While the procedure is not covered by Medicare when performed purely for aesthetic reasons, if the skin laxity is caused by a medical condition, trauma, or as part of a reconstructive process after a mastectomy, patients may be eligible for cover.
Sometimes, a breast revision procedure may need to be performed after a previous breast augmentation to remove or replace the breast implants. Breast implant removal or replacement surgery can be required for a variety of reasons, including implant rupture or capsular contracture. In some cases, women may also opt for removal or replacement due to health risks, personal discomfort, or lifestyle changes. Medicare may cover implant removal or replacement surgery if it is necessary due to complications like rupture, infection, or significant pain.
Another less-known breast procedure that can be covered by Medicare is gynecomastia surgery, also known as a male breast reduction. Gynecomastia is the enlargement of breast tissue in men, and surgery to treat this condition may be performed for medical or cosmetic reasons. If gynecomastia causes pain or discomfort, Medicare may help cover the cost of the surgery.
Find out if you are eligible for breast surgery Medicare cover
To find out if you may be eligible for Medicare to cover some of the costs of your breast surgery, you can start by visiting your general practitioner (GP) or a specialist. Your plastic surgeon will also play an important role in the process.
Your GP or specialist will assess your personal situation and provide a referral if they believe the surgery is necessary for medical reasons. Your consultation with your GP or specialist is key, as they can provide documentation to support the medical need for surgery.
You can also look for the relevant item number under the Medicare Benefits Schedule (MBS), but your GP, specialist or plastic surgeon can also find the right item number and outline the requirements. Your Medicare item number will list the requirements, as well as how much of the procedure’s costs may be covered.
While you can research eligibility for breast surgery Medicare cover, the process essentially requires guidance from your GP, specialist or plastic surgeon. You will need the help of their knowledge, skillset and qualifications to find out if your procedure can be deemed medically necessary.
Dr Justin Perron: Specialist Plastic and Reconstructive Surgeon in Brisbane
As a Canadian-born, Australian-trained Specialist Plastic and Reconstructive Surgeon, Dr Justin Perron can provide breast surgery patients with personalized advice and highly tailored procedure plans.
Before moving to Australia in 2000, Dr Perron began his studies in Chemistry and Biochemistry at the University of Calgary. He then completed his Bachelor of Medicine and Bachelor of Surgery at Flinders University in Adelaide before relocating to Queensland.
As a fully qualified surgeon, he is a member of the Royal Australasian Society of Surgeons (RACS), Australian Society of Plastic Surgeons (ASPS), Australasian Society of Aesthetic Plastic Surgery (ASAPS Aust), American Society of Aesthetic Plastic Surgery (ASAPS USA) and the Queensland Hand Surgery Society.
During a consultation, Dr Perron can discuss your eligibility for Medicare cover, assess your personal needs, and discuss the details of your chosen breast procedure. Your consultation will help you gain an in-depth knowledge of how your procedure will be performed and the results you can expect.
To arrange your consultation for breast surgery, please contact our team. As a key part of the Medicare process and as our requirement, all patients will need a GP referral to see Dr Perron for a consultation.
