Are breast reductions covered by Medicare?

Q & A’sAre breast reductions covered by Medicare?
AvatarAnonymous asked 6 years ago

Hello i am having a LOT of troubles with my breasts and just want to no if breast reductions are still covered by medicare as my doctor has said they are not…? I am 23 and have size 14-16H/HH boobs…
i have ALWAYS had very large breasts and always suffer rashes, headaches, depression and deep grooves in my shoulders…

4 Answers
Dr Damian MarucciDr Damian Marucci Contributor answered 6 years ago

Hi I’m sorry to hear about the problems you’ve been having. You have to check with your local plastic surgeon as to whether the local public hospital allows breast reductions to be performed. Generally speaking, it is not possible to have breast reductions performed in the public hospital system, although medicare will pay part of the fees if the procedure is performed in the private sector.

Dr Damian Marucci

Dr Damian Marucci is a highly trained plastic surgeon. He specialises in major reconstructive surgery after breast cancer, skin cancer, and head and neck cancer, as well as facial and lower limb reconstruction after trauma. Additionally, he performs a number of cosmetic surgeries to enhance people’s appearance. Dr Marucci is known for his patient care and attention to detail, and is well-respected for his life-changing work with the charity Interplast.

Dr Patrick BriggsDr Patrick Briggs Contributor answered 6 years ago

Breast reduction for medical reasons may attract a Medicare item number. A registered plastic and cosmetic surgeon, need to assess your situation as each patients circumstances is different.  Recommendations can be made by your surgeon.

Dr Patrick Briggs

Dr Patrick Briggs is an internationally trained Plastic and Cosmetic Surgeon based in Perth, Western Australia.

Dr Naveen SomiaDr Naveen Somia Contributor answered 6 years ago

Medicare Item numbers exist for Breast Reduction Surgery. So if you call Medicare, they will tell you it is covered. NSW Health has classified them as Cosmetic and hence not done in Public Hospitals. Other states may differ. Medicare does not fund Breast Reduction in Private Hospitals, hence you will have to pay for it. Ask your local GP to refer you to your local Public Hospital.

Dr Gavin SandercoeDr Gavin Sandercoe Contributor answered 6 years ago

The answer to your question is fairly tricky. Medicare still does have an item number for a breast reduction, however most public hospitals do not allow breast reductions to be performed as they do believe that this is discretionary surgery and limits the ability of the public hospital budget to treat cancer and trauma patients. Some hospitals will allow the procedure to proceed if you are able to show enough evidence of physical and mental distress due to large breasts. Your best bet is to get private health insurance that will cover you for the item number (45520), as this is usually a substantial help in covering the costs in treating this in the private sector.

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