Breast Reduction Medicare: What You Need to Know
Breast reduction surgery can be a cosmetic choice or a medically necessary operation. If the procedure is considered medically necessary, patients may be eligible for a Medicare rebate.
By reducing the size and weight of the breasts after removing excess tissue, breast reduction can reduce the symptoms of physical issues that can interfere with daily life, which can make the procedure a medical need.
To be eligible for Medicare cover, each breast reduction patient will need to find out if they will meet the requirements. During a consultation with Dr Fraser-Kirk, you will be able to discuss your reasons for undergoing the procedure and any physical issues you may be experiencing due to the size and/or weight of your breasts.
Contact our team at Vie at Fraser-Kirk on the Sunshine Coast If you’re ready to book your consultation with Dr Fraser-Kirk or would like to ask any questions about breast reduction procedures.
What is a breast reduction?
A breast reduction surgery aims to decrease breast size and weight by removing excess fat, glandular tissue, and skin. It can also include repositioning the nipples and areolae to better match the newly shaped breasts.
While the goal of the procedure is to reduce the size and weight of the breasts, the results should be newly shaped breasts that will aesthetically align with the patient’s preferences and body shape. Each breast reduction surgery is highly customised, with the process tailored to the unique needs of the patient and their expectations.
The procedure is often recommended for those who experience discomfort or pain due to the large size or heaviness of their breasts. Issues such as back, neck, and shoulder pain, as well as restrictions in physical activity or movement, are common reasons to consider undergoing the procedure.
Does Medicare cover breast reduction surgery?
At this point in time, breast reduction procedures can be covered by Medicare in Australia. However, the procedure will need to be considered medically necessary. Every breast reduction performed has a Medicare eligible item number, which outlines the requirements that a patient must meet to be considered eligible. This information can be difficult to understand, so your surgeon can explain it to you during your consultation.
While breast reduction Medicare coverage is possible, this does not mean all your fees are covered. You will get a set rebate on your surgeon’s and anaesthetic fees, which can still make a significant difference to your overall costs.
Certain costs, such as hospital fees, aren’t covered by Medicare; however, depending on your provider and your level of cover, they may be covered by private health insurance.
Will Private Health Insurance cover the costs of breast reduction surgery?
If you have private health insurance, including hospital cover with no exclusions, your health fund should cover all hospital fees (with the exception of any co-payment arrangement you may have).
You may still have out-of-pocket costs for your anaesthetist and surgeon. When you discuss the costs of your procedure during your consultation, you can learn more about each fee and what may be covered.
Your surgeon’s theatre booking staff will also be able to give you exact information on what will and won’t be covered with your level of cover.
However, before your surgery, we recommend checking directly with your private health insurance provider to confirm your level of cover and receive all other necessary information.
How does breast reduction Medicare work?
If Medicare covers part of your breast reduction surgery, your costs will be paid for before your surgery.
After the surgery date, you can claim the scheduled fee rebate of $1029.25 on a bilateral breast reduction.
Your surgeon can explain how the process works during your consultation, as well as the steps you may need to take to apply for your cover.
The costs of the procedure will vary from one surgeon to the next, as costs typically reflect the experience level of the surgeon, so you will also need to wait until you receive personal costs information before you can find out the exact amount of your total costs that Medicare will cover.
Who is eligible for breast reduction Medicare cover?
Essentially, if a patient’s reasons for undergoing a breast reduction is considered to be medically necessary, they may be eligible for Medicare cover. However, it’s important to get clear on what is meant by medical necessity.
A breast reduction surgery may be medically necessary when a patient experiences significant physical discomfort due to the size and weight of their breasts. Some examples of physical discomfort can include neck pain, back pain, skin irritation or infection, posture concerns, and nerve compression.
Chronic pain is a common issue, particularly in the neck, back, shoulders, or chest. Persistent pain can sometimes become severe enough to interfere with daily activities, which means that surgery may be needed to ease the discomfort.
Those with large breasts may also have difficulties with mobility, as the weight and size of the breasts may limit physical movement. Mobility difficulties can include difficulty with exercising or performing everyday tasks and can be hard to address without specifically addressing the breasts.
Skin issues can also occur as a result of larger breasts. This is because the skin beneath the breasts can be prone to irritation and infections due to moisture buildup. It can be hard to treat these skin concerns alone as if the size and weight of the breasts are the cause, the skin conditions may often reoccur.
The weight of the breasts can also cause posture issues, potentially leading to spinal curvature and related complications. Correcting posture can also be difficult without addressing the breasts when the breasts are the cause of the concerns, as when attempting to treat mobility issues.
Nerve compression is another concern, resulting in symptoms like pain, numbness, or tingling in the shoulders or chest. This is another concern that may be improved by addressing the size and weight of the breasts.
During a consultation, you will be able to discuss the symptoms you are experiencing, have a physical evaluation, and find out if you may be eligible for Medicare to cover part of the costs of a breast reduction.
How are the costs of a breast reduction calculated?
The costs of breast reduction surgery will vary from patient to patient, depending on the individual’s needs, the specific details of the procedure, and the level of reduction needed.
A variety of factors will influence the total costs of a breast reduction, including the amount of tissue that needs to be removed, whether the nipples or areolae need repositioning, and if additional procedures like liposuction are necessary.
Other costs include hospital fees, anaesthesia fees, surgeon’s fees, and post-operative care expenses such as medications and compression garments.
The surgeon’s experiences and skills influence the surgeon’s fees – however, this should not be a limiting factor when choosing a surgeon to perform your procedure.
When it comes to body surgery, cost should be your last consideration. We recommend choosing a surgeon based on his/ her level of skill and the results posted on their website rather than cost.
When it comes to the costs of your personalised procedure, your surgeon will need to discuss your goals and conduct a physical examination to assess your breast size, shape, skin elasticity, and nipple position.
Vie at Fraser-Kirk on the Sunshine Coast
Dr Grant Fraser-Kirk is a qualified Plastic Reconstructive Surgeon and a Fellow of the Royal Australian College of Surgeons, with extensive experience performing various breast procedures.
Taking a focused approach to all surgical procedures, he believes in empowering patients by offering highly tailored solutions.
If you want to see Dr Fraser-Kirk for a breast reduction consultation, you are welcome to contact our team at Vie at Fraser-Kirk.