The 'new boob job' that thousands of women are getting Medicare to pay for, and how.

Content warning: this post contains nudity.

Actress Ariel Winter had one, as did Queen Latifah, Drew Barrymore, Patricia Heaton and Jeneane Garofolo. Each said it changed their lives for the better physically and psychologically, that a weight was lifted.

That weight was lifted courtesy of a procedure thousands of Australian women are getting every year: breast reduction.

As blogger/author/Queen Constance Hall put it on Instagram just this week, “I felt so free.” And, unlike breast augmentations, the cost of that freedom doesn’t have to come out of your own pocket.

Australian Bureau of Statistics data shows that in the 2016-17 financial year, Medicare claims were made for the reduction of 10,473 individual female breasts – more than 2000 greater than five years ago.

It puts the procedure among the most commonly carried out cosmetic surgeries, with 2546 surgeries in 2016-17 performed on women between the ages of 45-54, and 1476 carried out girls aged 15-24.

So, how are so many women claiming plastic surgery via their Medicare card?


As well as being linked to lower self-esteem and emotional wellbeing in teens, large breasts that are deemed medically abnormal – known clinically as macromastia – can lead to back and neck pain, skin irritation and can often, in extreme cases, interfere with a woman’s ability to lead an active lifestyle.

For this reason, breast reduction is listed on the Medicare Benefits Schedule under item number 45520, which means it can be considered a necessary medical procedure, and not simply a cosmetic one.

However, that doesn’t mean it will always be paid for via the public health system.

As Sydney-based surgeon and member of the Australian Society of Plastic Surgeons Dr Jeremy Hunt told Mamamia:

“The difficulty is that there is a certain amount of money in the Medicare budget, and that must also cover needs such as cancer and trauma. So different area health services will have different policies on whether they will provide breast reductions to public patients at no cost.”

For women in an area where it is available, Dr Hunt said, they will need to be referred by their GP to a local teaching hospital for assessment at the outpatient clinic. Doctors there will decide if the procedure is ‘medically necessary’ and, if so, will place patients on the waiting list.


Depending on location, the wait can be substantial. In some cases, several years.

Before and after. Images: Getty.

Sometimes, the public health system in certain locations won't be able to cover the cost at all. It depends completely on location and the way the public health system works according to that individual area, in individual states. In that case, if the breast reduction has been deemed medically necessary, private health insurance is the best bet. But this involves a considerable personal cost.

If the woman is a private patient, wait-time between initial consultation and the procedure, for example, can be a matter of weeks depending on the surgeon and your location (New South Wales, Dr Hunt notes, requires a seven-day cooling off period for cosmetic surgery).

"In the private sector the patient picks their day, they pick their surgeon," Dr Hunt noted. "If you're in the public system, you can't really pick your day, you can't really pick your surgeon."

So, let's break it down: how does claiming breast reduction surgery on both Medicare and private health actually work?

The MBS fee for breast reduction is set at $900.45 per breast, toward which Medicare will pay a 75 per cent ($675.35) benefit.

Presuming your health insurance policy covers the Medicare item number for breast reduction (that's that 45520 number we mentioned above), they will - at a minimum - foot the remaining 25 per cent.

That total $900.45 will generally cover a significant portion of the hospital costs and a portion of the surgical and anaesthetic fee.

Anything left to pay is what's referred to in insurance land as the 'gap'.

The surgeon's fee will likely be what most influences the size of that gap payment - they typically hover around the $6000-8000 mark, though it varies depending on the surgeon's credentials/level of experience, the nature of the procedure, and so on.


Some specialists will have arrangements with insurance providers as a part of a 'gap cover' scheme, which could mean that your out of pocket payment is eliminated or at least significantly reduced.

But unfortunately, with breast reduction, the chances of walking away without having to fork out extra are slim.

In fact, as The Australian reported last year, data from private health insurer Bupa revealed that breast reduction carried among the highest routine gap fees: 28.7 per cent of the procedures had gaps of $5001-$10,000.

Apparently, nipple size goes in and out of fashion. (Post continues below.)

The cost is roughly the same as a breast augmentation (implants), which Dr Hunt notes is a contentious issue, given one is medical and the other usually cosmetic.

Regardless, Dr Hunt said, the pay-off for patients can be significant.

"It's one of the most positively life-altering procedures we offer people. It relieves back, neck and shoulder pain, it allows people to do exercise, it allows people to run down the beach with their kids, jump on a trampoline, buy clothes off the rack," he said.

"All these things that we take for granted are effectively things that patients, after a breast reduction, are able to enjoy. It's one of the best things that I can offer in terms of patient satisfaction."

For more information on breast reduction contact your local GP and visit the Australian Foundation for Plastic Surgery website here.