How much does a double mastectomy and reconstruction cost

Before you have surgery, find out how much it will cost to have a breast reconstruction. Check with your surgeon, the hospital, Medicare and your private health fund, if you have one, before deciding to go ahead.

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Help with costs
What to consider – reconstruction costs
Public hospital
Private hospital
Can you have a double mastectomy and reconstruction at the same time?
How long is recovery from double mastectomy and reconstruction?
Can you be cancer free after double mastectomy?
How painful is a double mastectomy and reconstruction?

Find out whether you may need to pay for extras. These may include pain medicines, post-surgical bras and check-ups with your breast surgeon.

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Help with costs
What to consider – reconstruction costs

Help with costs

There are services available to help with other costs associated with a reconstruction. These can include transport costs to attend medical appointments and the cost of prescription medicines. Ask the hospital social worker which services are available in your local area and if you are eligible to receive them.

If you need legal or financial advice, you should talk to a qualified professional about your situation. Cancer Council offers free legal and financial services in some states and territories for people who can’t afford to pay – call 13 11 20 to ask if you are eligible.

If you have your nipple tattooed, there is a Medicare rebate for this if the tattooing is done by a health professional with a Medicare provider number. You can also ask your private health fund, if you have one, if they cover the cost for this.With my private insurance, I was significantly out of pocket, due to the anaesthetist charging well above the schedule fee. However, the advantage gained with the reconstruction was well worth the cost.

What to consider – reconstruction costs

Public hospital

Private hospital

Reconstruction after a mastectomy is a medical procedure, not a cosmetic one, so the costs are covered through Medicare for a public patient in a public hospital.
There may be some extra charges if an implant is used.
There may be some charges for private patients who have a reconstruction in a public hospital.
If you choose to have a delayed reconstruction, you will be put on the hospital’s elective surgery waiting list. You may need to wait many months for the operation. Ask your surgeon how long you might have to wait.
You can put your name on a waiting list even if you’re not sure that you want a reconstruction.

Private patients may be covered by their private health insurance or may have to pay the cost themselves.
In a private hospital, Medicare will cover some of the surgeon’s and anaesthetist’s fees. Your health fund may cover some or all of the remaining costs, but you may need to pay a gap fee or a hospital admission fee.
Part or the entire cost of an inflatable tissue expander and any permanent implant may also be covered by your insurance provider.
If you decide to join a health fund before your operation, you will have to wait the qualifying period before you can make a claim. This may be up to 12 months. Check with the different health funds.

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How much does breast reconstruction cost?

The two most common questions among breast cancer patients considering breast reconstruction are "how much does breast reconstruction cost?" and "will my insurance cover it?"

The good news is that even though breast reconstruction is performed by plastic surgeons, it is NOT considered cosmetic surgery. If the mastectomy is for breast cancer then the law states it must be covered by insurance. If the mastectomy is covered, the reconstruction will be too. The bad news is that even though insurance covers breast reconstruction, there are still some costs that the patient will be responsible for. Patients must research this ahead of time to limit the risk of a nasty financial surprise down the line.

While the degree of coverage varies based on the insurance plan, there are some things that are pretty standard. Effective June 1, 2010 even Medicaid will provide a benefit for breast surgery to the unaffected breast for symmetry, providing certain criteria are met. Breast reconstruction after prophylactic (preventive) mastectomy is usually covered as long as the patient is deemed to be high risk for breast cancer (significant family history or BRCA gene positive).

Even though insurance companies are mandated to cover reconstruction, breast reconstruction insurance laws do vary by state. The amount each insurance pays can also vary a great deal. It is important to make sure your surgeon is in-network for your insurance plan if at all possible. This will limit your costs to whatever you've agreed to pay under the terms of your insurance plan (such as your deductible, co-pay and out of pocket expense). Using an out-of-network surgeon will likely subject you to other costs such as "balance billing". This is when the surgeon essentially sets his/her price (just to use an example let's say $1,000), receives whatever the insurance plan pays (let's say $600) and then asks the patient to pay the remainder (ie the "balance" of $400). This example is based on relatively small dollar amounts but you can see how this could add up to tens of thousands of dollars of additional bills for a major surgical procedure, and that's just for the first procedure.

Whether or not you can find an in-network, experienced surgeon depends on the procedure you've decided to have. If you've decided to have an implant reconstruction then you may have several doctors to choose from. Implant breast reconstruction is technically not as challenging as other options and most plastic surgeons perform the procedure.

On the other hand, if you're more interested in an advanced reconstructive procedure that not many surgeons offer (like a DIEP flap), you're likely to have a harder time finding an experienced surgeon to perform your surgery who is in-network. Most patients will unfortunately have to travel for their surgery because of this. Even though this may now add the cost of airfare and hotel stays, these costs are typically significantly less than a "balance bill" from an out-of-network surgeon.

Some breast centers even offer special arrangements to traveling patients such as significantly discounted hotel charges to help ease the financial burden.

Author: Dr. Minas Chrysopoulo

Can you have a double mastectomy and reconstruction at the same time?

Breast reconstruction can be done at the same time as the mastectomy (“immediate”) or at a later date (“delayed”). Many women now get immediate breast reconstruction. However, the timing depends on: Physical exam by the plastic surgeon.

How long is recovery from double mastectomy and reconstruction?

Average recovery time after mastectomy and reconstruction is about 3-4 weeks, but may be up to 6-8 weeks. During that time, there may be restrictions against driving and activities that involve lifting or raising the arms up over the head.

Can you be cancer free after double mastectomy?

Even if the full breast is removed, surgeons will not have removed 100% of the breast cells, explains Jessica Young, MD, a breast surgeon at Roswell Park. The risk of cancer recurring is lower if the whole breast is removed, but it is not zero percent.

How painful is a double mastectomy and reconstruction?

You can expect temporary soreness in your chest, underarm and shoulder, as well as possible numbness across your chest that may be permanent. The surgical drains that were inserted inside your breast area during surgery typically stay in for about one week to 10 days.