Breast Reduction Medicare: What You Need To Know

A breast reduction can be performed to remove excess breast tissue and reduce the size of the breasts. Sometimes, patients undergo the procedure for aesthetic reasons, but some may need to undergo surgery for medical reasons.

When a breast reduction surgery is considered medically necessary, it may mean that you are eligible to apply for breast reduction Medicare cover.

Medicare may cover a portion of your total procedure costs, but some out-of-pocket costs will still be required. If you do meet the requirements for Medicare cover, your private health insurance may also be able to provide partial coverage.

Read on to learn the basics of how breast reduction Medicare cover works. After that, you can contact our team at Valley Plastic Surgery to arrange a consultation in Brisbane.

What is a breast reduction, and why is it performed?

A breast reduction reduces the size of larger breasts. The procedure involves removing excess breast tissue in an approach that achieves a suitable new shape for the patient’s unique frame. It can be performed for aesthetic reasons, aligning with the particular patient’s preferences.

However, a breast reduction is often performed to reduce the size of breasts that are causing mobility issues or other concerns such as chronic pain or skin conditions.

Purposes for undergoing the procedure that do not fall under the aesthetic category and can be considered medically necessary, may make a patient suitable for Medicare cover.

Breast reduction Medicare cover eligibility

Essentially, Medicare can only provide cover for breast reduction when the procedure is deemed medically necessary.

Common medical conditions that might justify a breast reduction include chronic back, neck, and shoulder pain, skin infections under the breastfold, and other complications that may be impairing daily activities and overall quality of life.

The weight of larger breasts can put a strain on the muscles, causing continuous pain or stiffness over time. Heavy breasts may also impact posture and interfere with mobility. Since it may be hard to keep the area underneath the breasts clean and dry, some patients can experience skin rashes and infections, which can become hard to manage with specialised skin treatments alone.

To qualify for a breast reduction Medicare rebate, you will need a referral from a general practitioner or a specialist who can document the medical necessity of the procedure. The medical need for the procedure will need to be clearly shown. The referral will need to include information such as current health issues directly related to breast size, and other factors that can make surgery necessary, such as the previous ineffectiveness of non-surgical treatments.

Your surgeon will then need to assess your personal case by assessing the condition of your breasts and discussing the impact that they may be having on your health or general wellbeing. A thorough evaluation by your surgeon is an essential part of the process, as they will need to document your condition and recommend surgery as a viable treatment option.

The thorough process highlights the importance of careful documentation, and adherence to the specified criteria, to ensure that cover for the procedure is reserved for those who genuinely require it for medical reasons, rather than for purely cosmetic purposes.

What reasons for undergoing a breast reduction will not be considered medically necessary?

Cosmetic reasons for undergoing breast reduction surgery can include focusing on the appearance of the breasts and meeting personal preferences without needing to address any health concerns.

Larger breasts may not always lead to concerns that can warrant a surgical change, but patients may still choose to undergo the procedure for personal reasons.

While cosmetic reasons for undergoing breast reduction surgery are entirely valid and important to many patients, they are not deemed medically essential. This is because medical necessity, in the context of Medicare cover, generally refers to procedures that are required to treat a diagnosed medical condition or alleviate symptoms that significantly impact a person’s health or quality of life.

A breakdown of breast reduction procedure costs

Breast reduction costs have multiple components. Medicare coverage can account for some, but not all, of your procedure costs.

Firstly, there’s the surgeon’s fee, which is influenced by their experience and qualifications. Then, there will be a fee for the anaesthetist, who will monitor your anaesthesia during your surgery. Like the surgeon’s fees, the anaesthetist fees are determined by the anaesthetist’s experience level, but the duration of your surgery can also influence this fee.

Facility fees will also factor into costs. Hospital fees will cover the use of equipment, the operating room and the recovery room. The time spent in the operating theatre and recovery room will influence these costs.

After your procedure, post-surgery costs can include compression garments, prescribed medications for pain management and infection prevention, and any other items you may need during your recovery. You may also be required to cover the costs of follow-up appointments to monitor your healing.

Each of these fees can be influenced by individually varying factors. These factors can include your total procedure time, the complexity of the procedure, and if any procedures will be combined with your breast reduction (such as a breast lift).

You will be able to discuss all of these factors during a consultation with your surgeon before deciding to follow through with your procedure.

Receiving a personalised quote

The costs of a breast reduction will vary from patient to patient, which is why you will need to have a consultation to discuss your costs.

Every patient has unique physical characteristics and needs. A personalised quote considers the specifics of your case, including the extent of the reduction needed. While you may be able to find an estimation online, discussing your case in person ensures that the cost estimate is directly relevant to your situation.

Your quote will help you to better understand the reason behind your total costs, as it will break down each fee. A quote that is tailored to your personal needs will also help you to prepare for the costs of your surgery with transparency.

Book your consultation at Brisbane’s Valley Plastic Surgery to discuss your breast reduction costs

Established by Plastic and Reconstructive Surgeons Dr Matthew Peters and Dr Raymond Goh, Valley Plastic Surgery in Brisbane has a team of highly experienced and qualified surgeons. Our surgeons take a personalised approach to every procedure, focusing on each patient’s personal goals and reasons for undergoing surgery.

With our commitment to the latest techniques and advanced technology, we aim to provide our patients with high-quality care throughout their surgical journey.

Located in Fortitude Valley, we offer a variety of surgical procedures, including breast reduction, augmentation, lift and reconstruction. To learn more about the costs of your breast reduction, you and your surgeon can discuss the details of your procedure plan and how these details can influence costs.

Valley Plastic Surgery team can provide further advice on Medicare cover eligibility to help you manage procedure costs. Our surgeons can assess your personal needs and advise you on whether or not your breast reduction may be deemed medically necessary.

Please contact our team to book your consultation or ask any further questions about breast reduction, the costs of the procedure, or Medicare coverage.