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Breast reduction — Medicare

Monday, July 7, 2008

I am 159cm tall and wear a G-cup bra. I am constantly weighed down by my large breasts and can't remember a time when I didn't have back and neck pain, as well as other problems. I believe that I should be entitled to a breast reduction through Medicare. I was wondering if Medicare covered the entire procedure and fees or if they just cover a small amount? How much out of pocket would I be responsible for? As I am paying off a mortgage, surgery isn't a luxury I can afford.

A breast reduction can be performed for two reasons. The first is cosmetic and the second is functional. In cases where the excess weight of the breast tissue causes pain and limits activity, Medicare will recognise the procedure as medical not cosmetic.

To have your eligibility determined you'll need to be assessed by a plastic surgeon who is able to perform the operation in a public hospital. This way Medicare will cover all the costs of the procedure. If you choose to have the procedure performed privately — as in you have the surgeon of your choice, the hospital and the time the procedure will be performed — then there will be additional costs.

Private health insurance will cover most of the hospital costs and some of the surgical fee, but there will be a "gap cost" or out-of-pocket cost. The decision of whether to go private or public may come down to what sort of access you have to a public hospital (and your GP can help with this) versus the choices you want to make with regard to the treating surgeon and hospital.

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