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Achieving balanced breasts through reconstructionThe Women’s Health and Cancer Rights Act (WHRCA) requires that most group health plans cover all stages of reconstruction of the breast(s) on which a mastectomy was performed. It also stipulates coverage of surgery and reconstruction of the other breast to produce a symmetrical or balanced appearance. Surgery on a breast without cancer to establish symmetry with the opposite breast is considered medically necessary when it is related to breast reconstruction following a mastectomy. Methods to create breasts of similar size and shape may include:
Some health insurers consider fat transfer or grafting experimental and refuse coverage of this technique. However, the American Society of Plastic Surgeons states, “Autologous fat grafting should [not] be considered experimental but should be regarded as part of reconstructive surgery when it is performed to approximate a normal appearance of the breasts following mastectomy or lumpectomy.” Medicare & MedicaidMedicare and Medicaid are public programs that are not bound by the WHRCA. They have their own rules. Medicare covers breast reconstruction after a "medically necessary" mastectomy typically associated with a cancer diagnosis, while Medicaid coverage varies by state. See the Insurance & Paying for Care section of our website for more information. Paying For Care
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©2022 FORCE-Facing Our Risk of Cancer Empowered, Inc. All rights reserved. Disclaimer: Health links are made available for educational purposes only. This information should not be interpreted as medical advice. All health information should be discussed with your health care provider. Please read our full disclaimer for more information. Some patients get coverage for fat grafting to breasts and face through Medicare in Australia using the NEW Medicare item numbers
45589, 45535, and 45534. It is of
critical importance that the procedure is seen as a medical necessity by both your surgeon and Medicare. It means that you are getting fat grafting to the face and breasts due to an underlying medical condition. If you wish to get the procedure done for purely aesthetic or cosmetic reasons, Medicare will not cover it. Dr Scott Turner is an experienced Plastic Surgeon and Sydney Fat
Grafting expert – find out more about his Sydney Fat Grafting procedures and look at the before and after photos. There are several health concerns that can help qualify you for Fat Grafting to the face and breasts and make it medically necessary including: Fat grafting or Autologous Fat Transfer is a surgical procedure that involves the transfer of fat from one part of the body to another (Face and Breasts
in this case). The surgical goal of the treatment is to improve/ augment the face and breasts. It can be performed for both cosmetic and medical reasons. The surgical technique involves the extraction of fat through liposuction. The fat is then processed, purified and reinjected into the areas that need improvement. There are many reasons why you might want to consider a fat grafting to the face or breasts. Besides fixing the obvious visual defects, there are many other reasons why this is a preferred choice for many. For starters, the surgery is highly flexible and can be customised to suit your individual needs and concerns. Dr Turner will extract the fat needed and transfer it to the desired location to achieve the expected results. As the surgery involves your own
body fat, the chances of getting infections are minimal. Moreover, the recovery period is relatively easier as compared to other procedures. That is why it is considered to be one of the safest surgeries when performed by an experienced surgeon. Many patients prefer using their
own natural fat rather than a dermal filler – a chemical product. You’ll need a Medical Referral with Documented concerns In order to claim your surgery on Medicare, you will need a Medical Referral from your General Practitioner. You can get it prior to booking an initial consultation with a cosmetic surgeon or after the first appointment. It is important to demonstrate medical necessity. While consulting with your GP, it is worth discussing your symptoms to ensure the clinical need is documented in your referral. So will my Fat Grafting be covered by Medicare?The answer to this is ‘MAYBE’ – Medicare offers rebates on Fat Grafting procedures if you meet the special criteria and conditions as listed below. How Do You Qualify for Medicare Rebate for Fat Grafting to Breasts or Face? – MBS Codes & Item NumbersThese MBS Item Numbers may be applicable for Fat Grafting Surgery: Medicare Item Number 45589 – Facial Asymmetry or Burns / Scar Fat GraftingAutologous fat grafting (harvesting, preparation and injection of adipocytes) if: (a) the autologous fat grafting is for either or both of the following purposes: (i) the correction of asymmetry arising from volume and contour defects in craniofacial disorders—up to a total of 4 services if each service is provided at least 3 months after the previous service; (ii) the treatment of burn scar or associated skin graft in the context of scar contracture, contour deformity or neuropathic pain, for patients who have undergone a minimum of 3 months of topical therapies, including silicone and pressure therapy, with an unsatisfactory or minimal level of improvement—up to a total of 4 services per region of the body (upper or lower limbs, trunk, neck or face) if each service provided per region of the body is provided at least 3 months after the previous such service; and (b) both: (i) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes; and (ii) for craniofacial disorders, evidence of a diagnosis of the qualifying craniofacial disorder is documented in the patient notes. Medicare Item Number 45535 – Breast Cancer Fat GraftingAutologous fat grafting, bilateral service (harvesting, preparation and injection of adipocytes) if: (a) the autologous fat grafting is for one or more of the following purposes: (i) the correction of defects arising from treatment and prevention of breast cancer in patients with contour defects, greater than or equal to 20% volume asymmetry, post-treatment pain or poor prosthetic coverage; (ii) the preparation of post-mastectomy thin or irradiated skin flaps in patients intending to have breast reconstruction; (iii) breast reconstruction in breast cancer patients; (iv) the correction of developmental disorders of the breast; and (b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes Up to a total of 4 services. Medicare Item Number 45534 – Breast Cancer Reconstruction & Developmental DisordersAutologous fat grafting, unilateral service (harvesting, preparation and injection of adipocytes) if: (a) the autologous fat grafting is for one or more of the following purposes: (i) the correction of defects arising from treatment and prevention of breast cancer in patients with contour defects, greater than or equal to 20% volume asymmetry, post-treatment pain or poor prosthetic coverage; (ii) the preparation of post-mastectomy thin or irradiated skin flaps in patients intending to have breast reconstruction; (iii) breast reconstruction in breast cancer patients; (iv) the correction of developmental disorders of the breast; and (b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes Up to a total of 4 services per side (for a total treatment of a single breast). What is a Developmental Disorder of the Breast? A Developmental Disorder is not acquired or Iatrogenic ie includes Tuberous breast . Polands Disorder – abnormality ie described condition and the key will be “the need” for the procedure . Ie not cosmetic or aesthetic, but functional , and this will need to be documented and evidenced in photographs. What are the Medicare fat grafting criteria in Australia?People who meet the conditions associated with these item numbers 45534, 45535, and 45589 qualify for Medicare rebates in Australia. Will health insurance help cover the cost of the Fat Grafting surgery?You need to meet the strict criteria for your insurance or Medicare to pay for the surgery. It is important to be fully aware of Medicare codes and rebate eligibility criteria as these two factors will change/ affect your claim. If you qualify for Medicare you may also be eligible for rebates on the fat grafting surgery from your Private Health Insurance Provider. This only applies if your condition meets the criteria for Medicare Item Number. It is important to check directly with your own Private Health Fund, regarding your policy as they can differ. Why is the Medicare Rebate for Breast/ Face Fat Transfer Confusing?This is due to the variables of the situation. Each patient is different and has different reasons for getting the surgery done. It is important to note that rebates are generally available for fat grafting to breasts/face surgery only if the surgery is deemed ‘essential’. For a lot of patients, fat grafting will be under this category. When it comes to Plastic & Cosmetic Surgery, the Medicare REBATE guidelines are quite clear. Medicare does not cover ‘non-therapeutic cosmetic surgery’ NOR ‘non-therapeutic plastic surgery’ procedures. NOTE – Medicare Rebates are subject to change and reviewPlease note that MBS Item codes are reviewed regularly and can be changed/eliminated from the Medicare rebate schedule at any time. If you are currently eligible for a Medicare rebate for fat grafting surgery, it is best to get the procedure sooner rather than later. Will my private health fund cover my fat grafting surgery?Private Health Funds only cover a procedure if:
How much will my Fat Grafting surgery cost if self-funded?The cost of having a Fat Grafting performed by a Specialist Plastic Surgeon in Australia varies depending on the area, experience and expertise of the surgeon, and your unique needs. It is primarily because fat grafting surgery is customised to suit the needs of an individual and the desired outcome. You can contact Dr Turner’s team for an estimate or come for a consultation to get a quote. We will also help you understand the costs and risks associated with the surgery. Our team can also help you access your eligibility for coverage by MBS or your health fund. In order to access your eligibility to claim a Medicare rebate for your Fat Grafting Surgery, visit your GP or other specialist and ask for a referral to Dr Turner. You will need a valid referral at the time of surgery. A GP referral lasts for 12 months. You can also speak to our knowledgeable Patient Care Team on 1300 64 11 99, who are available to answer your questions. Please visit the surgical costs page for more information and download the procedure guides. Can I Use My Super Fund to pay for Fat Grafting Surgery?Some patients use their own super fund to pay for their fat grafting surgery. Before requesting the early release of funds, it is very important to note that:
Medicare for Fat Grafting FAQsHere is a list of frequently asked questions we get regarding fat grafting: How much of an increase in my breast size can I achieve with fat grafting to breasts?
When can I see the results of Breast Fat Transfer?
Is there a right age for getting fat grafting?
Do breasts with fat transfer feel natural to touch?
What is the survival rate of fat cells?
About Dr Scott Turner FRACS (Plas) – Specialist Plastic SurgeonDr Scott J Turner has spent a lifetime acquiring the qualifications, education, training, and hands-on surgical experience to perform superior cosmetic plastic surgery to give you natural, beautiful results and the improved sense of well-being you want. He is one of the top Specialist Plastic Surgeons with a Breast and Body Surgery focus in New South Wales. Achieving this personal goal requires not only in-depth knowledge of human anatomy and refined surgical techniques but an ongoing commitment to learning the latest procedures around the world. This is why Dr Turner regularly attends both local and international surgeon meetings – discussing these advances with the leaders around the world in order to offer you the most natural, effective and safest surgical procedures. He is a committed board member of ASAPS – Australia Society of Aesthetic Plastic Surgeons Dr Turner and his highly trained staff will do everything to ensure that you are fully informed, while providing exceptional, world-class cosmetic plastic surgery, in a personal and caring environment. Next StepsAlways Do Your Research
Do you need a Medical Referral to see Dr Turner?
Making The Most Of Your Consultation
Want more information before scheduling your consultation?
How to Book Your Consultation with Dr Turner
BOOK A PHONE CALL FOR MORE INFO
Contact us or call on 1300 641 199 to arrange your surgeon consultation in Sydney or Newcastle. Email us for more information: [email protected] How long does it take to recover from fat grafting for breast reconstruction?Recovery from Fat Grafting for Breast Reconstruction
Most swelling in the region should subside within three weeks. The donor sites will be bruised, swollen and sore, and swelling there can last longer – up to six months. For the first three weeks, we advise not putting too much pressure on your breasts.
Can belly fat be used for breast reconstruction?Excess belly fat can be used for breast reconstruction to create results that look and feel natural. Many patients have sufficient excess fat in this area to use for the procedure. And when the fat is removed, in a similar manner to a tummy tuck, patients experience the added benefit of a slimmer waistline.
How long does fat transfer last in breasts?How long does a fat transfer breast augmentation last? The results from a fat transfer breast augmentation are lifelong. It can take up to six months to see the final results. During this time, the fat cells settle into their new places, where they remain for life.
Who is a good candidate for fat grafting?A fat transfer works well for women who want to avoid implants or can't have a breast implant. For example, some women who don't have enough skin for an implant can enlarge their breasts with a fat transfer. You may also want to consider a fat transfer to replace breast volume lost due to pregnancy or weight loss.
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Does insurance cover fat grafting for breast reconstruction
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