Am i eligible for removal under private health.
I have implants that are huge, one has flipped and mild capsular contracture. They are painful and cause back pain. I need them removed. My private health does cover explanations surgery but will they look like flat pancakes after ?
I'd suggest you use the 'Find a Surgeon' feature on our ASAPS website to seek out the services of a Specialist Plastic Surgeon near you who can guide you on the best course of action.
Thanks for your question.
Where there is medical need for a removal, Medicare allows surgeons to provide an "Item Number" for removal - it is 45551 which you can confirm with your fund to ensure the cover (as the rules change all the time!).
This means Medicare will provide a modest rebate, and your health fund will assist with the costs of the hospital. However for most Specialist Plastic Surgeons there will still be an out-of-pocket cost given the complexity of the procedure.
In terms of what it will look like afterwards, it depends on a variety of factors including your age, how large the implants are (so if very large as you say yours are, it means the skin will be less likely to snap back) and how long the implants have been in.
I find most of my removal patients want a lift to address this excess skin.
If you decide to have the existing implants removed and replaced, Medicare may also provide a small rebate under some strict conditions they imposed in late 2018. This would also trigger your health fund coverage if you have the applicable level of cover.
This Medicare Item Number relies on photographic evidence taken during the operation to demonstrate deformity if the implant is not replaced in cases of medical need.
I hope that helps.
Dr Nick Moncrieff
Thank you for reaching out to us here at Ask ASAPS. My name is Dr Gary Avery and I am a Specialist Plastic Surgeon.
With regards to removing your implants, yes, there are Medicare item numbers that may apply – 45548 or 45551. As you said, your private health will cover you for this surgery with regards to the hospital fees and they will contribute to the surgeon and anaesthetist fees also.
Your options following implant removal also include a breast lift procedure in addition to implant removal. If your implants are causing symptoms such as pain my recommendation is a consultation to assess and discuss what you could expect if you were to remove the implants and if having the remaining breast tissue lifted to reconstruct the breast would be helpful. To help with the “flat pancakes”, once you have recovered from the removal and lift, you may opt to re-insert smaller implants or you may consider the result of the removal and lift to be what you desire. The cost for the re-augmentation will not be covered by Medicare.
There are certainly options available to you and I recommend searching the ASAPS database to locate a surgeon close by and book a consultation to discuss these options in person.
All the best, Dr Gary Avery.