Several Medicare item numbers may apply to breast implant revision surgery, depending on what is performed and whether clinical criteria are met. Eligibility is assessed individually at consultation.

• Item 45553: Removal and replacement of breast prosthesis following medical complications (rupture, migration of prosthetic material, or symptomatic capsular contracture) — applicable where it can be demonstrated by intra-operative photographs that removal alone would cause unacceptable deformity, or where the original implant was inserted in the context of breast cancer or developmental abnormality. Photographic and/or diagnostic imaging evidence must be documented in the patient record.
• Item 45554: Removal and replacement of breast prosthesis with excision of at least half of the fibrous capsule, or formation of a new pocket — same indications as Item 45553, with the additional requirement that the excised capsule specimen is sent for histopathology and the volume removed is documented in the histopathology report.
• Explant without replacement: Where implants are removed without replacement for medical indications and no rebatable replacement is performed, Medicare benefits may not apply unless the implant was originally placed in a reconstructive or medically indicated context. Dr Cameron will advise on your specific circumstances at consultation.

Where revision surgery is performed for purely cosmetic reasons (e.g. size change without a medical indication), no item number applies and the procedure is self-funded. In practice, many revision procedures involve a combination of insured and cosmetic components. Dr Cameron will clearly outline which components attract item numbers and which are self-funded.

All surgeon fees include the surgical assistant fee. Implant costs are included in the surgeon fee above where applicable.

If you hold private health insurance, we recommend contacting your health fund before booking to confirm:

• Your level of cover for the relevant item number(s)
• Whether your policy has any applicable waiting periods
• Your excess and any co-payment amounts
• Whether pre-authorisation is required

Even if your procedure is eligible for health fund cover, it is important to understand that out-of-pocket costs are still significant. In most cases, private health insurance primarily contributes to hospital-related costs. You may also receive rebates from Medicare and your health fund towards the surgeon’s and anaesthetist’s fees; however, these rebates are limited in comparison to the overall specialist fees.

Dr Cameron will consult with you to determine whether you are medically indicated and advise on the relevant item number for your procedure for you to confirm with your health fund. Our team will provide a formal personalised quote detailing all expected out-of-pocket costs before you commit to surgery.

We understand that navigating the financial aspects of surgery can feel overwhelming. Our aim is to provide clarity and transparency around the costs involved.

Medicare sets a Benefits Schedule (MBS) fee for surgical procedures. However, the MBS fee has not kept pace with the actual costs of delivering specialist plastic surgery care. Medicare reimburses 75% of the MBS fee for in-hospital procedures, and your private health fund typically contributes an additional 25% — together covering only a portion of the scheduled fee, not the actual cost of surgery.

Dr Cameron’s surgical fee reflects the complexity of your procedure, operative time, his level of specialist training and experience (FRACS — Plastic and Reconstructive Surgery, PhD), consumables, surgical equipment, the surgical assistant fee, and the overhead of running a specialist surgical practice. The difference between what Medicare and your health fund contribute and Dr Cameron’s fee is your out-of-pocket gap, and will be clearly outlined in your personalised quote prior to surgery.

Your final surgical plan must be confirmed before a formal quote can be finalised and your booking secured. Our team will guide you through all costs prior to proceeding.

All surgical quotes are based on the planned procedure. In some cases, additional costs may arise if:

• Unforeseen surgical complexity requires a longer operative time or additional procedures
• Post-operative complications require further treatment, dressings, revision surgery or hospital admission
• Additional pathology, imaging or specialist review is required
• Wound care, compression garments or post-operative support beyond the standard recovery period is needed
• ICU admission or an ICU specialist review is required
• Medications on discharge beyond the standard supply

Where possible, Dr Cameron will discuss any anticipated complexity at your consultation. Our team will contact you promptly if any unexpected costs arise during your care.

Please note that post-operative compression garments are a mandatory part of recovery for most surgical procedures. These are not covered by Medicare or private health insurance and are an additional out-of-pocket cost. Garment costs are listed separately in the cost overview above.