Would Medicare cover a breast reduction and tightening for my size 10 F/G breasts? (photo)

My breasts always hurt and my bras leave marks on my shoulders everyday. I can't pole dance properly cuz I have these massive boulders on my chest. I had to quit qymnastics. They make me cry. I hate them. They are so saggy. I'm only 19 but they have always sagged and it makes me feel so horrible. I always cover them up because I'm so self conscious of them. They don't even look good in a bra, and it's so hard and expensive to buy a properly fitting bra. It's almost impossible.

Doctor Answers 4

Breast reduction

A breast reduction is one of the most gratifying procedures I perform as the patients are so happy with the result. I would anticipate that the back neck and shoulder pain will be resolved, and you will be able to be more active following the procedure.Medicare will recognise the procedure, and this would likely mean a Private Health will cover hospital costs.The answer is to seek an expert opinion and consultation so you can assess the pros and cons of the procedure and make an informed decision as to if it is for youAll the bestJeremy Hunt

Sydney Plastic Surgeon
5.0 out of 5 stars 118 reviews

Would Medicare cover a breast reduction

Yes, Breast Reduction attracts Medicare Benefits. If you have private health insurance, then you can opt to have this operation in a Private Hospital provided you have an appropriate level of cover.  You will benefit from a Breast Reduction.  Please contact a Plastic Surgeon for a consultation.

Naveen Somia, MBBS, PhD, FRACS
Sydney Plastic Surgeon
5.0 out of 5 stars 73 reviews

Breast Reduction covered by Insurance?

Under certain circumstances Breast Reduction is covered by insurance. Unfortunately, each insurance company has their own criteria. Large breasts (macromastia) or breast hypertrophy can occur in a variety of conditions (family trait, post pregnancy, excessive adolescent growth). In general when the excessive breast size causes functional problems, insurance will generally pay for the operation if more than 400 – 500 grams are removed from each breast dependent on your individual insurance company requirements. These problems may include neck pain, back or shoulder pain, hygiene difficulty, and breast pain. Other problems which are less likely to be covered by insurance include skin irritation, skeletal deformity, breathing problems, psychological/emotional problems, and interference with normal daily activities. Pre-authorization by the insurance company is required prior to surgery, and the process takes approximately one month. Each insurance policy has different guidelines and exclusions.
This procedure is commonly covered by insurance through insurance criteria are becoming more and more restrictive. Although we do not accept insurance, our staff will assist you in obtaining pre-authorization so that you can attempt to be reimbursed for out of pocket expenses

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews


hi. In Australia there is a Medicare item number for breast reduction provided it is giving you symptoms. You sound like a worthy candidate and in most of my patients I am able to achieve a breast reduction through a minimal scar technique. Having an item number means that about half of your costs will be covered if you have private insurance. Unfortunately there are no longer many hospitals that offer this operation in the public.RegardsDamien

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.