When it comes to mastopexy, also called a breast lift, Medicare is a common topic to discuss. There is often a great deal of planning that goes into breast surgery, and many patients can benefit from understanding the costs and whether they are eligible for help from Medicare towards their surgery.
Breast lift (mastopexy) is a surgery that can be performed for a multitude of reasons. For some, breast ptosis after pregnancy is a concern. For others, there is a desire to adjust a naturally irregular breast shape. Others still have concerns about stretched skin and laxity after weight loss. Whatever the reason, whether medical or cosmetic, every mastopexy surgery comes with risks, costs, and a recovery period.
Since there are so many personal factors to take into account, breast mastopexy must always be tailored to the patient in consultation with a specialist surgeon. These personal factors can also impact whether a patient is eligible for Medicare aid. For individualised advice, contact our team at Rodin Clinic in Perth.
What determines the cost of a breast lift (mastopexy)?
Anyone who is planning to get surgery should consider the costs involved. Choosing a skilled and experienced specialist plastic surgeon might be more expensive in the short term, but it allows patients to avoid the complications that could come with choosing a less experienced surgeon. A surgeon with less experience and skill may be more costly in the long run due to the costs of additional ‘correction’ surgeries.
In general, we must take into account a few factors when discussing the costs of breast lift (mastopexy) surgery. These include:
- The duration and complexity of the surgery
- Whether the procedure is combined with others (such as augmentation mammoplasty)
- The surgeon, anaesthetist, and hospital fees
- Any aftercare and medications
Medicare coverage for cosmetic vs reconstructive surgery
Medicare generally helps cover a surgical procedure when the patient qualifies for a specific item number. The relevant MBS item numbers for breast lift (mastopexy) are 45556 or 45558.
Typically, in order to be eligible for an item number, it must be provable that you are seeking the procedure for medical reasons (which is considered ‘essential’ surgery), rather than simply cosmetic reasons. Not all surgery falls under this category.
So, what’s the difference? A surgery done for medical reasons may be considered ‘reconstructive.’ This means that it aims to address a physical or medical concern, such as a deformity or persistent pain and discomfort. On the other hand, a ‘cosmetic’ surgery is one that is done for aesthetic reasons and is considered elective.
Medicare does not typically provide any coverage for surgeries that are ‘cosmetic’ – i.e. that target aesthetic concerns according to the patient’s personal preference. On the other hand, if your surgery is considered medically necessary (and if you meet the specific Medicare criteria), then you may be eligible for a rebate.
Will Medicare cover my breast lift?
For a mastopexy breast lift, Medicare rebates might be available. However, this is subject to whether you meet the Medicare criteria, as discussed above. In order to qualify for a mastopexy rebate:
- You will need a valid referral from a qualified GP
- The degree of breast ptosis must be assessed by your GP or plastic surgeon
- You should have significant breast ptosis, chronic skin infections, or other breast-related health conditions
- You must not have been pregnant within a certain period of time before surgery
In some cases, a medically-required mastopexy may be part of a breast reconstruction. Breast reconstruction can involve multiple breast-surgery techniques and can be performed after trauma, mastectomy, or to treat congenital deformities like tuberous breasts.
If you don’t meet the criteria, you’ll likely have to pay for the procedure from your own pocket. Make sure that you discuss costs with your surgeon during your consultation with us at Rodin Clinic.
Choose Rodin Clinic for your breast lift mastopexy surgery in Perth
The most reliable way to determine whether you are eligible for (mastopexy) breast lift Medicare cover is to speak with a qualified plastic surgeon. This happens during your initial consultation after getting a referral from your GP. It is important to choose a qualified surgeon who understands your personal circumstances and goals for surgery.
At your private consultation at Rodin Clinic in Perth, we aim to cater to each patient’s preferences whilst prioritising quality care and patient health. We will discuss your needs to determine whether you are a candidate for surgery and develop a surgical plan appropriate for you. We will also discuss various factors, such as your goals and motivations, physical health, expectations, risk factors, and recovery period. This will help us determine whether you are eligible for Medicare cover.
If you wish to learn more about the costs of mastopexy surgery, you are welcome to book a consultation with us to begin your path to surgery.