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For many women in Newcastle considering mastopexy (breast lift surgery), one of the first questions is whether Medicare will contribute toward the costs. Dr. Yezdi Mistry, Specialist Plastic & Reconstructive Surgeon based in Charlestown, understands how important clear information is when weighing up surgical options.
Medicare coverage can be complex, and many patients find the rules confusing. This guide brings together everything Newcastle patients need to know, from item numbers and eligibility to private health insurance and recovery.
Mastopexy is a surgical procedure that repositions and reshapes the breasts by addressing ptosis (drooping). Breast ptosis occurs when the skin and supportive tissues stretch, causing the nipple and breast tissue to sit lower on the chest.
Common causes include:
Mastopexy does not alter breast size significantly. It focuses on repositioning existing tissue and skin. Sometimes it is combined with augmentation (using an implant) or reduction, but mastopexy itself is specifically for lift and contour correction.
While some women choose mastopexy for aesthetic reasons, others experience genuine physical and functional difficulties. Understanding this distinction is critical for determining whether Medicare may provide support.
Medicare distinguishes between cosmetic surgery (performed to change appearance) and medically necessary surgery (performed to treat a condition or restore function).
Mastopexy may qualify for Medicare coverage if there is evidence of:
Dr. Yezdi Mistry carefully evaluates each patient to determine whether their situation fits Medicare’s strict definition of medical necessity.
The Medicare Benefits Schedule (MBS) includes item numbers for mastopexy in specific circumstances:
These item numbers are not automatically applied. A patient must meet all outlined eligibility requirements before a claim can be submitted.
It is also important to note:
The “two-thirds rule” is one of Medicare’s most specific eligibility requirements for mastopexy under item 45558.
To qualify:
Evidence required includes:
This assessment must be performed by a qualified surgeon, and photographs must comply with AHPRA privacy and record-keeping standards.
Navigating Medicare eligibility involves several steps:
Your GP is the first step in the process. They will assess your symptoms and determine whether referral to a specialist is appropriate. A referral is essential to claim Medicare rebates for consultations.
At his Charlestown rooms, Dr. Yezdi Mistry conducts a thorough assessment. This includes:
If eligibility is likely, Dr. Mistry’s team compiles the required documentation, including item numbers, measurements, and photographic evidence. Medicare may request this before or after surgery to confirm compliance.
Once Medicare eligibility is confirmed, Dr. Mistry develops a surgical plan tailored to your needs. This may include discussion of incision patterns, scar placement, and whether additional procedures are appropriate.
It is important for patients in Newcastle to understand Medicare’s limitations on mastopexy coverage:
Private health insurance may cover hospital and theatre costs if the mastopexy is recognised as medically necessary by Medicare. However:
Dr. Mistry’s staff provide written quotes with item codes to help patients confirm with their insurer what will be covered.
Even with Medicare and private health cover, patients should expect out-of-pocket expenses. These may include:
Dr. Mistry’s practice conducts a financial consent process before surgery. This ensures every patient has a clear, written outline of expected costs and understands where rebates may apply.
Recovery after mastopexy is gradual. Most Newcastle patients can expect:
Follow-up appointments are scheduled at regular intervals, and Dr. Mistry’s team provides ongoing support by phone or in-person review.
Although Medicare focuses on physical necessity, Dr. Mistry recognises the emotional impact of significant breast ptosis. Many women report:
Dr. Mistry takes time to understand not only physical symptoms but also how these issues affect daily life, helping patients make informed decisions about surgery.
Dr. Yezdi Mistry offers patients across the Hunter region:
No. Only medically necessary mastopexy procedures qualify. Cosmetic-only procedures are excluded.
At least two-thirds of the breast tissue, including the nipple, must sit below the inframammary fold to qualify for mastopexy (45558 – bilateral, 45556 – unilateral).
Yes, if breast ptosis after pregnancy, breastfeeding, or weight change leads to functional issues or discomfort and meets Medicare’s strict criteria.
Yes, if Medicare recognises the procedure as medically necessary and you have the right level of hospital cover.
Generally once per lifetime, unless the surgery is performed as part of breast cancer reconstruction.
Yes. A referral is essential to access Medicare rebates and ensures proper documentation.
If you are considering mastopexy in Newcastle and would like to know whether Medicare may apply, the first step is arranging a consultation. Dr. Yezdi Mistry and his team in Charlestown guide patients through every stage – from eligibility assessment and documentation to recovery planning.
Contact Dr. Mistry’s practice to book your consultation and explore your options.
Dr Yezdi Mistry is a Specialist Plastic and Reconstructive Surgeon based in Newcastle, NSW. With extensive training and experience in both reconstructive and aesthetic surgery, Dr Mistry is committed to providing safe, evidence-based care that is tailored to each patient’s individual needs.
After completing his Fellowship of the Royal Australasian College of Surgeons (FRACS) in Plastic Surgery in 2013, Dr Mistry relocated to Newcastle with his family in 2015. He began his work as a Visiting Medical Officer (VMO) in Plastic and Hand Surgery at John Hunter Hospital before establishing his private practice in 2017. His practice offers a comprehensive range of reconstructive and aesthetic procedures for the breast, body, face, and skin.
Dr Mistry’s approach to patient care is grounded in trust, respect, and open communication. From initial consultation to recovery, he aims to ensure patients feel informed, supported, and comfortable throughout their surgical journey. He is dedicated to maintaining the highest professional and ethical standards in all aspects of his work.
To remain at the forefront of modern surgical techniques, Dr Mistry continues to pursue ongoing professional development both in Australia and internationally. He was Australia’s first delegate at the Body Contouring Academy in Paris, where he received advanced training in body contouring and skin-tightening techniques, including VASER and RENUVION technologies.
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Please Note: Information provided on Dr Mistry’s website is provided as a basic guide, it does not constitute a diagnosis and should not be taken as medical advice. Any surgical or invasive procedure carries risks.
“I care because it’s my job as a surgeon, as a plastic surgeon, to do the appropriate thing and to give you a good outcome. I want to leave knowing that I can tell a patient, hand on heart, that I did the very best I could and that I looked after them, so when I see them post op later that day or the next morning, that they feel they were in good hands.”
– Dr Yezdi Mistry
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