Comparison of public versus private breast reconstruction surgery

It is your choice whether you have breast reconstruction in the public or private system. Your decision may affect the financial cost and timing of your surgery.

Having a breast reconstruction as a public patient means that Medicare will cover all or most costs. All claims for breast reconstructions are reviewed by the Medicare Claims Review Panel and decisions are made on an individual basis. The individual may be required to pay the cost of a permanent prosthesis.

Even if you have your breast reconstruction in the private system, Medicare will pay 75% of the scheduled fee for the procedure. However, keep in mind that many surgeons and anaesthetists charge more than the scheduled fee for their services.

System

Pros

Cons

Public patient in a public hospital

  • No costs (breast reconstruction is a reconstructive procedure, not a cosmetic procedure)
    • You cannot choose the breast reconstruction surgeon who will do your breast reconstruction
    • It may be difficult to schedule a breast surgeon (to perform a mastectomy) and breast reconstruction surgeon for the same operation to do an immediate breast reconstruction
    • Waiting list can be months to years

      Private patient in a public hospital

      • No costs for hospital stay
      • You can choose your breast reconstruction surgeon
      • May need to pay excess surgeon fees
      • Waiting list can be months to years

      Private patient in a private hospital (with private health insurance)

      • You can choose your breast reconstruction surgeon
      • It is possible to schedule the breast surgeon and breast reconstruction surgeon to do an immediate breast reconstruction
      • Public hospital waiting lists do not apply
      • Private hospital fund will pay for some of your expenses
      • Private health insurers may not cover the full amount; gap payments will often be required for surgeon and anaesthetist services (may be $6000-10,000)
      • May be waiting periods and restrictions depending on when you join your private health fund
      • Payment may be required before surgery

      Private patient in a private hospital (no private health insurance)

      • You can choose your breast reconstruction surgeon
      • It is possible to schedule the breast surgeon and breast reconstruction surgeon to do an immediate breast reconstruction
      • Public hospital waiting lists do not apply

       

      • You are responsible for paying all hospital costs and gap costs for the surgeon and anaesthetist fees
      • Payment may be required before surgery