Breast implant removal Medicare is an important topic for women needing their implants removed. When wondering “does Medicare cover my breast implant removal” it's important to know that it depends on the reason why you need them removed.
Whether or not Medicare will contribute depends on whether your procedure is elective or medically necessary. This article will explore the Medicare guidelines for breast implant removal as well as important information about explant surgery.
“Breast implants are not lifelong devices and will need to be removed at some stage after implantation.” - Dr Isolde Hertess.
Image 1: Removal of breast implants. Real patient of Dr. Isolde Hertess, Specialist Plastic Surgeon.
Why women choose to remove breast implants
There are many reasons why women would choose to remove their breast implants, including:
Implant Failure
Deterioration of the implant, including leakage or rupture. Breast implants are not lifelong devices, and can fail over time. The estimated lifespan of a breast implant is 10 to 15 years. However an implant can fail sooner. On the contrary, it can also remain intact for over 20 years without issues.
Breast Implant Complications
Complications such as breast implant malposition, capsular contracture, or a cancer diagnosis are all means for explant surgery.
Implant failure and complications may mean breast implant removal is medically necessary. This can attract some coverage from Medicare.
*Please note that Medicare will NOT fund your entire procedure and there will always be out of pocket costs. One benefit of attracting a Medicare code however, is that Private Health Insurance may contribute to your hospital and anaesthetic costs. This is only available with certain insurance policies so always check your inclusions.
Changes in Breast Tissue
Breasts can change due to age, pregnancy or breastfeeding. These changes may result in a desire for implant removal with or without replacement.
Changes in Lifestyle
Some women experience a change in lifestyle and have a personal preference for smaller breasts. This is mainly for personal reasons as priorities change, larger breasts may no longer be the look you desire.
These reasons for explant can be broken down into two categories, medically necessary and cosmetic. Typically, implant rupture and breast implant complications are considered medically necessary reasons for removal, while breast and lifestyle changes are cosmetic.
Does Medicare cover breast implant removal Australia?
The Medicare Benefits Schedule (MBS) is a publicly funded health insurance scheme for Australian citizens. The program subsidises the cost of medically necessary procedures and appointments.
Medicare will not cover any procedures that are not essential to someone’s health, such as breast augmentation, liposuction or facelift surgery. Typically it will only cover surgery that is for function or reconstruction.
When it comes to Medicare breast implant removal, this can be categorised as either medically necessary or aesthetically driven.
The reason for explant surgery will determine what financial help you will receive from Medicare.
Explant surgery with the primary goal to improve physical appearance, including the replacement of the old implants with new larger sized ones, will most likely not be funded by medicare. These procedures are considered elective, and are not eligible for a rebate.
An exception here is if breast augmentation was originally performed to improve the symptoms of existing health problems, abnormalities or breast cancer. Medicare is much more inclined to help financially with this type of surgery. If you need replacement after explant because you would be left with substantial deformity of the chest, you would be eligible for a Medicare rebate.
Another scenario in which Medicare will help with costs is when implants that were originally placed for aesthetic reasons and cause health problems later on. If the implants cause significant pain, are leaking and ruptured or affecting health in other ways, this is considered medically necessary.
Be sure to research the fine print and difference between plastic surgery (covered by Medicare under a strict criteria) and cosmetic surgery (usually not covered by Medicare).
Medially necessary reasons for breast implant removal
- Pain and discomfort due to capsular contracture
- Any infection associated with your breast implants
- Rupture or leaking of an implant that causes distortion of the breast area
- Complications, trauma or weakened tissue that causes breast implant extrusion
- Your implants are preventing the detection of breast cancer through mammograms
- Other complications that put a patients health at risk
What will Medicare NOT cover with Explant Surgery
Medicare won’t cover cosmetic surgery procedures such as breast augmentation or breast lift. If you want to get a breast lift at the same time as your explant surgery, it’s unlikely to be covered.
The same goes for the replacement of breast implants, the only way that Medicare will cover breast implant removal and replacement surgery is if removal alone would cause unacceptable deformity. See in-depth guidelines below:
Medicare Guidelines for Breast Implant Removal
There are currently four item numbers that cover medically necessary breast implant removal with or without replacement.
BREAST PROSTHESIS, removal of, as an independent procedure
Breast prosthesis, removal of, with excision of at least half of the fibrous capsule, not with insertion of any prosthesis. The excised specimen must be sent for histopathology and the volume removed must be documented in the histopathology report.
Breast prosthesis, removal of and replacement with another prosthesis, following medical complications (for rupture, migration of prosthetic material or symptomatic capsular contracture), if:
(a) either:
(i) it is demonstrated by intra-operative photographs post-removal that removal alone would cause unacceptable deformity; or
(ii) the original implant was inserted in the context of breast cancer or developmental abnormality; and
(b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes
Breast prosthesis, removal and replacement with another prosthesis, following medical complications (for rupture, migration of prosthetic material or symptomatic capsular contracture), including excision of at least half of the fibrous capsule or formation of a new pocket, or both, if:
(a) either:
(i) it is demonstrated by intra-operative photographs post-removal that removal alone would cause unacceptable deformity; or
(ii) the original implant was inserted in the context of breast cancer or developmental abnormality; and
(b) the excised specimen is sent for histopathology and the volume removed is documented in the histopathology report; and
(c) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes
In summary, Medicare is more likely to cover removal of breast implants as a stand alone surgery. When a replacement is involved, it becomes a tricky topic as this is partially considered a cosmetic procedure.
When considering whether Medicare will pay for breast implant removal, it's best to speak with a Specialist Plastic Surgeon like Dr Hertess. A consultation with Dr Hertess Plastic Surgery Gold Coast can you clarity around which item numbers and treatment you may qualify for.
How much does it cost to remove breast implants in Australia?
The cost to remove breast implants will vary on how much financial support you get from Medicare. The best way to gauge the costing of this procedure is to book a consultation with Dr Hertess Plastic Surgery. Dr Hertess will be able to break down costs with you and also give recommendations on how to apply for a Medicare rebate for your implant extraction.
Book a consultation: click here.
Note on Breast Implant Removal Medicare and Out of Pocket Costs
When considering ‘will Medicare pay for breast implant removal’, it’s important to know that Medicare rebates are subject to change. Even if your surgery is partly covered by Medicare, you will still have expenses when it comes to your Medicare breast implant removal. They also only provide the funds after your surgery, so you will need to cover the full costs before these funds are available.
A consultation with Dr. Hertess will allow an open discussion of your desires and outcomes for breast explant surgery.
