Post-Pregnancy Body: Are there any Medicare rebates for Mummy Makeover Surgery?

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Has pregnancy seemingly wrecked your breast skin, nipple location and abs? Do you miss your pre-baby body?  For many new Mums, it’s not just a matter of getting back to Pilates or eating less. It’s often a matter of the body having undergone radical changes to the skin and internal structures related to having children.  If you’re wanting cosmetic or plastic surgery to repair your post-baby body, you’ll probably be asking us this important question: “Are there any Medicare REBATES for Mummy Makeover Surgery or combined Breast Surgery and Tummy Tuck surgery?”

Is Cosmetic Surgery after Pregnancy covered by Medicare?

No. Corrective Plastic Surgery may be covered for some conditions after weight change and BMI changes.

But cosmetic surgery is never covered by Medicare.

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Medicare Rebates and Health Funds | Mummy Makeover Surgery

+-What plastic surgery is currently eligible for a Medicare Rebate or Health Fund after pregnancy?

Pregnancy and breast-feeding DOES alter most women’s breasts skin and abdominal areas. But it’s important to understand that every patient is unique – so each Mum’s surgery needs can vary significantly.

Plastic Surgery and rebates can be confusing, however. That’s because SOME of the surgery you may require after having babies MAY be eligible for by a rebate from Medicare (or hospital cover by your Health Fund).

  • Breast Ptosis, for example, can be fixed with a Breast Lift & Nipple Lift to correct for sagging breast skin.
  • That procedure may be eligible for a Medicare rebate if your youngest child is between 1 and 7 years of age.

But rebates can not only seem confusing, they can also be subjected to sudden changes. This happened a few years ago with Abdominoplasty rebate criteria changes.

+-Medicare Code 30177: Abdominoplasty Surgery after Weight Change

  • Although Medicare MBS Codes and rebates are subject to sudden changes.
  • These codes apply to selected patients who have severe Breast Ptosis, and/or damaged abdominal muscles after pregnancy OR after significant weight loss.

Abdominoplasty Surgery – MBS 30177 – definition accessed online (Nov 2018)

  • Lipectomy, excision of skin and subcutaneous tissue associated with redundant abdominal skin and fat that is a direct consequence of significant weight loss, in conjunction with a radical abdominoplasty (Pitanguy type or similar)
  • With or without repair of musculoaponeurotic layer and transposition of umbilicus, not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30179, 45530, 45564 or 45565 applies, if:

(a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and

(b) the redundant skin and fat interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

Multiple Operation Rule

Fee: $985.70

Benefit: 75% = $739.30

Current: accessed of 8 November 2018: Note these codes are subject to sudden changes as of the 1 November 2018 Medicare Changes to Plastic Surgery.

New Tummy Tuck criteria as of 2016-2017:

  1. Significant weight loss, defined as greater than 5 BMI units
  2. Weight stability for > 6 months
  3. There is intertrigo or evidence of skin irritation that has failed 3 months of conservative treatment
  4. Skin folds are interfering with activities of daily living

According to the Plastic Surgery Hub, 5 BMI units translates as 10 kg for 150cm tall, 12 kg for 160cm tall, 14 kg for 170cm tall, 16 kg for 180 cm tall.

Breast Surgery Medicare Rebates – Codes for Breast Reduction & Breast Lift Surgery

  • Bilateral Breast Reduction (Item no. 45520) – Medicare Rebate is $675.35 (1 side)
  • Breast Lift after pregnancy – Your youngest child must be between the age of 1 year and 7 years old  (Item no. 45558) – Medicare Rebate $861.75 (both sides)
  • Breast Augmentation for Asymmetry (Item no. 45524) – Medicare Rebate $556.25 (1 side)
  • Breast Lift for Asymmetry (Item no. 45556) – Medicare Rebate $574.55 (1 side)

We hope this has cleared up some of the confusion you may have about rebates for Plastic Surgery.

+-What about combined surgery procedures?

Patients often ask, what about combining a Medicare rebatable plastic surgery procedure with cosmetic surgery at the same time?

The other aspect of Medicare Rebates for Post-Pregnancy Surgery that can be frustrating to many Mums, is the question of COMBINED procedures (such as breast AND tummy surgery).

Sometimes more than one surgery procedure is required.

Combined surgeries may be required because most Mums experience changes to multiple areas of their body after having babies. The areas most affected are the breast tissues, nipples and abdomen.

It’s not surprising, then, that Mummy Makeover surgery options are so appealing to Mums who want to get their ‘pre-baby’ bodies back. Whilst you can’t fully recover your pre-baby body, you can certainly get it to look more like it did before the children came along (or at least, get firmer skin in the areas impacted by pregnancy).

So a Mummy Makeover surgery generally means Breast & Tummy Surgery (Abdominoplasty), performed separately or combined. Vaginal laser treatments to remedy lax vaginal skin are also an option with the Mona Lisa Touch laser system (there’s also a Labiaplasty option).

+-Multiple procedure rules

Typically, Medicare & Health Fund rebate eligibility applies only for single surgery sessions.

This means that rebates from Medicare – and Private Heath Fund cover – will often NOT apply if you want to combine your breast surgery and tummy tuck surgery into one procedure.

The other reason you MAY or MAY NOT be eligible for a Rebate is the indication (reason) for having surgery.

  • Medicare and Health Fund Rebates tend to only apply if the reasons for your surgery are medical in nature, rather than cosmetic.
  • There are also stringent criteria that you’ll need to meet.

Ask your GP for details about your post-pregnancy conditions and if they meets the Medicare criteria for a rebate on your breast OR tummy surgery (but typically, not both, if you are combining them into one session).

+-Diastasis Recti can be corrected by a Tummy Tuck Surgery or as part of a Mummy Makeover

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Then there’s the problem of “Diastasis Recti” – damage to your core ab muscles – along with vaginal stretching. These can both contribute to problems with urinary incontinence.

These may be other medical reasons for needing beneficial surgery such as a Belt Lipectomy or Abdominoplasty with correction of Diastasis Recti conditions. Your GP should be able to help assess your eligibility.

That noted, any rebates or Private Health Fund cover for Plastic Surgery or hospital stays tends to involve a lot of paperwork and numerous forms (you might even need to send photos).

It can certainly be confusing for patients.  And there are other ways to fund your surgery (ask us for a Guide by phoning 03 8849 1444).

 

+-Do I need a referral from a GP before a consultation?

Yes, if you have any conditions that qualify for Medicare or Health Fund insurance.

The best thing to do is to see your GP with your post-pregnancy health complaints, such as back pain, breast drooping or urinary incontinence, to get a referral for a Plastic Surgery consultation.

+-The Post-Pregnancy Body - Effects of Pregnancy and Birth on Breasts and Abdomen

Pregnant women undergo “significant anatomical and physiological changes in order to nurture and accommodate the developing foetus”, according to researcher A. K. Hoffman et al. (Read the science behind those changes here).

Essentially, having a baby – especially if you have more than one OR a big baby or TWINS or TRIPLETS – does a lot of damage to the skin and underlying structures.

You’ll find the impacts of pregnancy on the body:

  • stretches the skin, resulting in loose, saggy skin after pregnancy (typically on the breast and belly area, but sometimes also on the upper arms and thighs)
  • damages the surface of the skin; meaning you’ll have stretch marks
  • loosens or splits the abdominal muscles to accommodate the size of the growing fetus (meaning you’ll have a belly bulge that is simply not fixable by exercise and diet alone, as your underlying ab muscles are ‘split’ or ‘broken’)


Specialist Plastic Surgeons such as Dr Rubinstein, Dr Sackelariou, Dr McManamny, Dr Barnett, Dr Wyten and Dr Maxwell are highly adept at helping MUMS get their bodies firmer, tighter, smoother and more uplifted after pregnancy.

  • Plastic Cosmetic Surgery can help you get firmness back to your belly and breast areas, where lifestyle changes have failed to remedy the situation.
  • Contact our leading team of Surgeons for more information about Mummy Makeover surgery options.

There are many good reasons to have separate surgeries as well, rather than combining everything into a single surgery session when you’ve still got young children at home to care for.


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For more information about Cosmetic and Plastic Surgery options and research in Australia.

Download our free guides or phone (03) 8849 1444 today – and ask for a no-obligation consultation.

 

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Resources

Australian Society of Plastic Surgeons (Find specialist plastic surgeons), Australian Society of Plastic Surgeons (Patient Safety Regulated by Plastic Surgery Regulation Laws), Australian Society of Plastic Surgeons (Information for patients), Australian Health Practitioner Regulation Agency AHPRA (Register of practitioners), Health Victoria (The Department of Health and Human Services)

 

Last updated: 25/06/2019
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Dr Rebecca Wyten
Dr Rebecca Wyten, MBBS, FRACS (Plas), is a Melbourne VIC Female Specialist Plastic Surgeon in Australia. She is very talented in natural looking Breast Augmentation (Breast Implant Surgery), Breast Lift surgery and Breast Reduction, Abdominoplasty (Tummy Tuck), Body Contouring with liposuction, Labiaplasty and other cosmetic surgery, plastic and reconstructive surgery procedures (women only). She is FRACS (Plastic) qualified and has extensive experience and training in New South Wales, Victoria, and has worked alongside some of the world's top Plastic Surgeons whilst in France.Education: Dr Rebecca Wyten BSci, MBBS, FRACS (Plas) graduated in Medicine (MBBS) from the University of Sydney, NSW. She has since dedicated her artisan plastic cosmetic surgery skills to a private practice in Melbourne and Berwick on the Mornington peninsula.Bio Page: https://plasticsurgeons.com.au/dr-rebecca-wyten/