A breast lift, or mastopexy, is a procedure designed to surgically remove excess skin from the breasts.
Over time, breasts can move downward from their original position on the chest wall, and sometimes, the nipples can also begin to shift downwards. A mastopexy can address these changes in a way that aligns with each unique patient’s needs. In Australia, the costs of surgeries that are performed for medically necessary reasons may be partially covered by Medicare.
In this blog, we’ll discuss what may make a patient eligible for a breast lift (mastopexy) Medicare rebate, and what this can mean for the patient’s total procedure costs.
Why would a patient undergo a breast lift mastopexy?
Essentially, the reasons for undergoing a mastopexy will determine if a patient is eligible for a partial Medicare rebate.
Patients choose to have a breast lift mastopexy for a variety of reasons – most of the time, these reasons fall under the aesthetic category and mean that patients are not eligible for Medicare coverage.
A breast lift (mastopexy) can address breast ptosis, which can occur after pregnancy, breastfeeding, weight fluctuations, or as the body naturally ages over time. We lose skin elasticity as we age, which can slowly lead to breast ptosis or excess skin on the breasts. The nipples can also move towards, which can be surgically addressed by adjusting the position of the nipples and areolae.
However, breast ptosis can sometimes cause concerns that are not aesthetic-based. Sometimes, excess skin on the breasts can carry weight, which can cause discomfort or even put stress on the neck and back. Excess skin can also lead to chronic skin infections and rashes underneath the breasts, which can be recurring if the main cause (excess skin) is not addressed.
For patients who are seeking surgery for medical reasons, mastopexy Medicare coverage may be possible. However, these patients will need to ensure that they meet Medicare’s criteria. Your general practitioner and Dr Rastogi will be able to help you through the process.
Breast lift mastopexy Medicare criteria
In Australia, Medicare provides coverage for procedures that are deemed medically necessary. However, cosmetic procedures, including breast lift surgery (mastopexy) performed purely for aesthetic reasons, are generally not covered by Medicare. To qualify for Medicare funding, mastopexy patients will need to meet their specific criteria.
A variety of factors will influence whether Medicare will fund a breast lift mastopexy. If breast ptosis is causing physical discomfort or functional impairment, such as back, neck, or shoulder pain, Medicare may provide coverage for the procedure’s costs. Documentation detailing the medical necessity of the procedure is typically required.
Other aspects of the breasts will need to be considered, such as if the breasts are considered overly large and heavy or asymmetrical to the point where the procedure is deemed necessary. For those who have large breasts that cause other medical concerns, such as posture concerns, stress on the neck, back and shoulders and skin infections, Medicare cover may be possible for a breast reduction (mammoplasty). This type of procedure removes excess tissue from the breasts, reducing their size and weight.
In some cases, mastopexy surgery may be performed in combination with other medically necessary procedures, such as breast reduction mammoplasty or reconstruction after a mastectomy. Medicare may provide partial coverage for the mastopexy component of the surgery if it is considered to be an essential part of the patient’s overall treatment.
What is the process for applying for a (mastopexy) breast lift Medicare rebate?
The process of applying for Medicare funding for a breast lift mastopexy will require careful planning, and clear communication with Dr Rastogi.
Before undergoing a mastopexy, you’ll need to have a consultation with Dr Rastogi. He will assess your individual circumstances, medical history, and reasons for undergoing the procedure. If Dr Rastogi thinks that your reasons would qualify as medically necessary, they can then assist you with pursuing a Medicare rebate. Typically, initial documentation and supporting evidence of medical necessity will need to be submitted.
During your consultation, Dr Rastogi will need to thoroughly assess the condition of your breasts, and discuss a variety of health factors. You will need to provide information about any associated health conditions, symptoms, or functional limitations you may be experiencing.
Dr Rastogi can then assist you with gathering the necessary documentation and submitting a pre-approval request to Medicare. This may include medical records, imaging studies, and a detailed treatment plan, outlining the reasons for the procedure.
Will there be out-of-pocket costs?
Even though Medicare may provide cover for breast lift (mastopexy) procedures in some cases, there will still be out-of-pocket costs, and you will only be able to receive a partial cover for your total surgery costs.
Overall, your costs will need to include surgeon’s fees, hospital fees, and anaesthesia fees. Before undergoing any procedure, you’ll always need to discuss financial aspects and payment options with Dr Rastogi during a consultation.
Discuss your reasons for undergoing a breast lift mastopexy with Dr Rastogi in Double Bay, Sydney
Medicare funding for a breast lift mastopexy is generally reserved for cases of medical necessity. Navigating the process can be a little overwhelming, so having the guidance of an experienced surgeon like Dr Rastogi can help.
During a consultation with Dr Rastogi, you can discuss your reasons for undergoing a mastopexy, your health history, and any other important factors to consider. He can also assess the condition of your breasts, particularly focusing on the level of skin laxity and the amount of excess skin.
Dr Rastogi can discuss whether your reasons for having a breast lift mastopexy may be considered medically necessary and guide you through the next steps to applying for a Medicare rebate.
If you have any more questions about the costs of a breast lift (mastopexy), or if you’re ready to book your consultation, please contact our team!
