Is Breast Lift Surgery Covered by Medicare?

Breast lift surgery is a popular cosmetic procedure, but it is also sometimes required for health reasons. If you fall into the second category, you might be eligible for a breast lift Medicare rebate that covers a portion of the surgery costs.

Medicare for breast lift surgery exists to support women whose breast ptosis (sagging) causes a documented medical problem, or whose lift forms part of breast cancer reconstruction. This guide walks you through exactly when Medicare coverage applies to breast lifts and what the rebate is worth in 2026.

Quick Answers

• Medicare for breast lift is only available under two MBS item numbers: 45558 (bilateral ptosis) and 45556 (unilateral, in the context of breast cancer or developmental abnormality).
• For item 45558, at least two-thirds of the breast tissue (including the nipple) must sit below the inframammary fold, with photographic evidence documented in your file.
• The Medicare schedule fee for item 45558 is $1,340.35, with a 75% benefit of $1,005.30 paid when performed in a private hospital setting (current as of 1 July 2025).
• Item 45558 is once-per-lifetime and cannot be used when a breast implant is inserted at the same time.
• Medicare doesn’t cover breast lift surgery done purely for cosmetic reasons

When Does Medicare Cover Breast Lift Surgery?

There are only two scenarios where Medicare rebates for mastopexy applies in Australia, and both are listed in the Medicare Benefits Schedule (MBS).

MBS Item 45558 – Bilateral Breast Ptosis

This is the item most post-pregnancy and post-weight-loss patients ask about. To qualify, your surgeon must document that at least two-thirds of the breast tissue, including the nipple, lies inferior to the inframammary fold, where the nipple is located at the most dependent, inferior part of the breast contour. Standardised photographs with a marker at the fold must be kept on file, because these claims are subject to Medicare audit. The item is applicable only once per lifetime, except when combined with certain breast reconstruction services.

MBS Item 45556 – Unilateral Ptosis Correction in Reconstruction

This applies when a breast lift on one side is needed in the context of breast cancer or developmental abnormality, to match the position of the contralateral breast. It’s commonly claimed during or after mastectomy reconstruction, or for conditions like tuberous breast deformity.

If your breast lift surgery doesn’t fit into one of these two categories, Medicare won’t contribute, regardless of how much your breasts have changed after children or weight loss.

How Much Is the Breast Lift Medicare Rebate Worth?

Knowing the rebate figure helps you plan, because it’s smaller than most women expect.

For item 45558, the Medicare schedule fee is $1,340.35, with a 75% benefit of $1,005.30 paid when the procedure is performed as a private inpatient.

For item 45556, the schedule fee is $893.60, with a 75% benefit of $670.20. These figures are drawn directly from MBS Online and were last updated on 1 July 2025.

That rebate only applies to the surgeon’s fee for the lift itself. It doesn’t cover the anaesthetist, the hospital stay, theatre fees, garments, or follow-up care. If you hold private hospital cover with an appropriate tier, your fund will usually pay the hospital and theatre costs on top of the Medicare rebate, provided your surgeon uses a valid MBS item number.

Does Medicare Cover Breast Lift Surgery Combined with Implants?

This is one of the most misunderstood parts of Medicare for a breast lift. Under the MBS notes for item 45558, item 45558 should not be used with the insertion of any prosthesis. Item 45556 has the same restriction on the treated side.

In practical terms, if you want a lift with implants (augmentation-mastopexy), the mastopexy portion won’t be Medicare-reimbursable.

Some women still meet the ptosis criteria and choose to stage their surgery, starting with the lift first under item 45558, then review at six months to decide whether an implant is still wanted or needed. This two-stage pathway preserves the rebate and often produces a better shape, particularly for patients with heavier breasts.

What You Need to Claim Medicare for Mastopexy

To be eligible for a breast lift Medicare rebate, you’ll need:

• A current GP referral to a specialist surgeon, valid for 12 months (a specialist-to-specialist referral lasts three months).
• Standardised clinical photographs showing the nipple position relative to the inframammary fold, with a marker at the fold.
• Documented medical need in the patient notes, including symptoms where relevant.
• Compliance with AHPRA’s cosmetic surgery rules, which since 1 July 2023 require a GP referral for any cosmetic surgical procedure and a seven-day cooling-off period before booking.

How Your Cost Changes If You Qualify

If you qualify for item 45558, the $1,005.30 Medicare benefit reduces your out-of-pocket surgeon’s fee directly. Your private health fund (if you have hospital cover at the right tier) will then pay a further amount towards the surgeon, anaesthetist and hospital costs.

Most women still have a meaningful gap payment because private fund rebates generally fall well short of the true cost of specialist plastic and reconstructive surgery in Sydney. We’ll quote you a clear out-of-pocket figure at your consultation so there are no surprises.

Book Your Breast Lift Consultation with BB Clinic

Not sure whether you meet the Medicare criteria for mastopexy? The only way to know is an in-person assessment with a specialist surgeon. At BB Clinic, Dr Michael Yunaev will examine your breasts, review the MBS criteria with you, take the required clinical photography where appropriate, and give you a transparent quote showing both the Medicare-eligible and any self-funded portions.

Call (02) 9819 7449 or book a consultation online to find out where you sit.