Mastectomy Cost

Your healthcare professional may recommend a mastectomy if:²

• You have breast cancer that is large in comparison to your breast
• There are multiple cancers in your breast
• Cancer has returned to your breast
• You’ve previously undergone radiation therapy for the same breast.

Not all breast cancers will require a mastectomy, especially if the cancer is caught early.¹ A lumpectomy (breast-conserving surgery) is an alternative breast cancer surgery that aims only to remove the tumour and affected breast tissue. The best option will vary on a case-by-case basis.

Many women who undergo a mastectomy will then have breast reconstruction surgery.¹ This procedure can be performed at the same time as the mastectomy or a later date.

There are two types of breast reconstruction: one uses silicon or saline implants to reconstruct the breast (which may require single or multiple surgeries), and the other uses tissue, fat and muscle from another part of your body to create the reconstruction (this is also known as autologous reconstruction).⁴

Not all women choose to have breast reconstruction.² There are other options, such as wearing a synthetic breast (breast prosthesis), which can be attached to the skin or inserted into a mastectomy bra.

Private hospital cover can include mastectomies, providing you have the right inclusions in your policy. Insurance will pay a benefit towards treatment as a private patient, either in private or public hospitals. Your policy will need to include the ‘breast surgery (medically necessary)’ clinical category for mastectomy cover.

Luckily, this is a minimum requirement for Bronze-tier hospital policies and higher. Depending on the procedure, you may also require cover for ‘plastic and reconstructive surgery (medically necessary)’ which is a minimum requirement for Silver-tier hospital policies and higher.

Breast reconstruction can be covered by private health insurance, providing the surgery is medically necessary, such as after a mastectomy. These procedures will also fall under the ‘breast surgery (medically necessary)’ and ‘plastic and reconstructive surgery (medically necessary)’ categories. Your policy won’t cover cosmetic surgery or plastic surgery that isn’t medically necessary.

If you’re looking for cover in the event you’re diagnosed with breast cancer, remember that you may have multiple different treatments, including chemotherapy, along with your surgery. It may be worth considering clinical categories such as ‘Chemotherapy, radiology and immunotherapy’ as part of your policy as well.

If the cancer spreads to other parts of the body, you may require additional clinical categories to be included on your policy. It is therefore a good idea to speak to a health insurance expert if you are unsure what to include on your cover.

Keep in mind that your specialist can charge more than the MBS fee (the fee set by the government) for a procedure. The difference between the specialist fee and the MBS fee is known as a gap payment, and it may mean you’ll incur out-of-pocket costs even if you have insurance. Whether your health fund will cover some, all or none of the gap will depend on your policy, treating doctors and chosen hospital.

Medicare will cover the cost of a mastectomy performed in a public hospital, provided you’re being treated as a public patient. While the public health system provides a valuable service to millions of Australians, it’s in such high demand that elective surgeries can have long waiting times. You’ll also have less say over who performs your surgery and when the procedure will take place.