Sydney

Breast Reduction

Sometimes. You get a rebate only when your situation fits the wording of a Medicare Benefits Schedule item. Item 45523 is the main one. It covers bilateral reduction mammaplasty with surgical repositioning of the nipple, for patients with macromastia who have pain in the neck or shoulder region, and it rules out any case where a prosthesis is inserted.

There are two unilateral items as well. Item 45520 applies to reduction with nipple repositioning where breast cancer or a developmental abnormality of the breast is involved. Item 45522 applies to reduction without nipple repositioning, and it excludes treatment of gynaecomastia. All three are hospital-only items, and you cannot claim any of them if a breast implant goes in at the same time. Simply wanting smaller breasts will not qualify you. Someone has to make a clinical judgement against the item wording, usually backed up by examination findings, documented symptoms and clinical photographs. So ask at your consultation which item applies to you, if any, and get the answer in writing before you book anything.

Usually only when a Medicare item number applies. Funds take their lead from Medicare, so surgery that does not meet the criteria of an MBS item will generally get you nothing towards hospital or theatre costs. And even when an item does apply, your policy tier and any waiting periods still decide what you actually receive.

Where qualifying really counts is the hospital and anaesthetic side. Those bills are the big ones. The Medicare rebate itself is small next to them. Cover does not wipe out your costs either. You will still be out of pocket on the surgeon’s fee, the anaesthetist’s fee and the assistant’s fee. Funds tend to want paperwork before they commit, often examination findings and clinical photographs. Do it in this order: get the item number from your surgeon, ring your fund and quote it, then ask about waiting periods if your policy is new or you upgraded it recently.

That depends on why you are having it. The Medical Board of Australia’s cosmetic surgery guidelines cover plastic surgery done only for cosmetic or aesthetic reasons, and they say plainly that they do not apply to reconstructive surgery. So a medically justified breast reduction sits outside them. A breast reduction done purely to change how you look sits inside them.

Where they do apply, here is what has been required since 1 July 2023. You need a referral from an independent medical practitioner. You need at least two pre-operative consultations, and one of those has to be in person with the surgeon who will operate. You have to be assessed for psychological conditions using a validated screening tool. And once you have given informed consent, at least seven days must pass before the surgery can be booked or a deposit paid. Under 18, the bar is higher again: evaluation by a psychologist, psychiatrist or general practitioner working independently of the operating surgeon, and a cooling-off period of at least three months. Ask at your first appointment which pathway you are on, because it changes your timeline.

Yes. You need a GP referral to see A/Prof Bish Soliman about any type of surgery. A current referral is also what lets you claim a Medicare rebate on the specialist consultation. And if the surgery is classified as cosmetic, the referral stops being a billing formality and becomes a regulatory requirement.

GP referrals last 12 months. A specialist-to-specialist referral only lasts three. Ask your GP to write down your symptoms, how long you have had them and what you have already tried, since that history matters later if Medicare eligibility is assessed. There is a GP referral form on A/Prof Soliman’s website. Consultations are booked by paying the consultation fee in advance, at the time you make the appointment.

Possibly. Breast reduction can make successful breastfeeding less likely, though, and nobody can promise you an outcome either way. From the published evidence, a lot seems to hinge on one thing: whether the technique used keeps intact the column of breast tissue that sits beneath the nipple.

A systematic review in PLOS ONE in 2017 put median breastfeeding success at 4 per cent when that column of tissue under the nipple was not preserved, 75 per cent when it was partially preserved, and 100 per cent when it was kept fully intact. Its authors argued that women should be told before surgery whether their technique preserves this tissue. If breastfeeding is something you might want later, bring it up at the first consultation. Ask directly whether the technique planned for you preserves the tissue under the nipple, and what that is likely to mean for you.

Changed nipple sensation is a recognised risk of this operation. It might be dulled, it might be heightened, or it might simply feel different, and the change can be temporary or permanent. Bigger reductions move the nipple further, and with that comes more risk of a lasting change.

Sensation often picks up over the first several months as the nerves recover. Some patients are left with a permanent difference, though, and one side can be affected more than the other. If sensation matters to you, say so at consultation. It is one of the trade-offs that is easiest to skim past while you are focused on size and shape, and it belongs in your consent discussion alongside the effect on breastfeeding.

You will have permanent scars. There is no version of this operation without them. Two patterns are common: the lollipop, with incisions around the areola and running straight down to the breast crease, and the anchor or inverted T, which adds a horizontal scar along that crease. How much tissue is coming out largely determines which pattern suits you.

They are placed so that a bra or swimwear hides most of them, although the vertical portion and the scar circling the areola are not always fully covered. Expect them to look their worst in the first few weeks. After that they flatten and fade over the following months, and most keep changing for something like 12 to 18 months. Stick to your wound care instructions, keep new scars out of the sun, and only use scar treatments as directed. It is also reasonable to ask for the planned incision pattern to be drawn out before surgery, so you can see where the scars will sit.

One to two weeks off work suits most patients, and longer if the job involves heavy lifting or other strenuous work. You wear a surgical bra for six weeks to support the breasts as they heal. Swelling can take up to three months to settle, so the final shape is slow to show itself.

Line up someone to drive you home afterwards and to lend a hand around the house for the first few days. The usual instructions run like this: sleep on your back with your head raised, skip exercise and heavy lifting, keep arm movements above your head to a minimum, keep the incisions clean, and stay off cigarettes and alcohol while you heal. Hold off on buying new bras as well, since the swelling takes months to go down. Follow-up appointments check both how the wounds are healing and how the breasts are settling into their final shape.

Risks reported for this operation include pain, bleeding and bruising, infection, swelling, scarring, fluid build-up, skin discolouration, asymmetry or a result you are unhappy with, temporary or permanent changes in nipple sensation, reduced ability to breastfeed, damage to deeper structures, complications of general anaesthesia, and the possibility of needing revision surgery.

Smokers and patients in the obese weight range carry higher risk for some of these, so general health, weight and smoking all get discussed before any surgery is planned. Tell your surgeon about medication that affects bleeding or healing, and about any past trouble with anaesthetic. If pain is increasing after your operation, or redness is spreading, or you have a fever or unusual swelling, contact the practice or get medical help. Do not sit on it until your next appointment. There is a dedicated risks and complications page on A/Prof Bish Soliman’s website that goes into surgical risk in more detail.

If you have significant weight loss planned, reaching a stable weight first is usually the better order. Weight that shifts after surgery can change breast size and shape, and it affects how well the result holds. Mention any plans you have, medication and bariatric surgery included, at your consultation.

A few months at a steady weight before surgery makes the result more predictable and can bring some risks down. Waiting is not always the right call, though. Sometimes breast size is part of what makes exercise hard to begin with, and then the advice can go the other way. There is no fixed rule here. Work it through with your surgeon, and bring your GP into the conversation if that helps.

To some degree, yes. Breasts keep responding to weight change, pregnancy, hormonal shifts and ageing after a reduction. The tissue removed does not come back, but the remaining tissue can enlarge again with significant weight gain or during pregnancy, and some settling over the years is normal.

A pregnancy after a breast reduction can change both size and shape, so plans for future pregnancies are better raised before surgery than after it. Skin quality and gravity do their work over the years too, exactly as they do with breasts that have never been operated on. What you can control is fairly short: keep your weight stable, and wear a supportive bra when you exercise. Results vary from patient to patient, and no particular outcome or size can be promised.