Breast reconstruction: public or private system?

After a mastectomy for breast cancer, reconstruction is a medical procedure, not cosmetic surgery. Unfortunately, it is classed as 'elective' (clinically non-urgent). If you use the public health system, you may be on a waiting list for months or even years.

You may need to think about the differences between the public and private systems in:

• how much the surgery costs
• how long you have to wait
• the types of reconstruction surgery available.

In public hospitals

Not all public hospitals provide breast reconstruction surgery. Those that do may not offer all types of reconstruction.

Your breast surgeon or breast care nurse can refer you to a public hospital where you can have your preferred procedure.

If you are planning immediate breast reconstruction

Talk to your breast surgeon as soon as possible if you are thinking about immediate breast reconstruction in a public hospital. Your surgeon may only work in the private sector and may need to refer you to someone else.

If you are planning delayed breast reconstruction

If you choose delayed breast reconstruction at a public hospital, you will join the hospital’s waiting list for elective surgery.

Waiting times vary from hospital to hospital and across different states and territories.

You may have to wait 2 years or more in some places. You can ‘shop around’ to find a hospital with a shorter waiting list or ask your surgeon if they have an idea where wait times are shorter.

One option is to put your name on a waiting list as soon as you decide which type of reconstruction you will have. While you are waiting, you have time to explore the public and private options and make your decision.

Costs in the public system

You do not have to pay if you have your breast reconstruction surgery in the public health system.

In private hospitals

If you plan to go through the private system, check where your preferred surgeon works. Not all surgeons work in every public or private hospital.

You also need to think about the cost.

Even if you have a high level of private health insurance, the out-of-pocket expenses can be high. Some people have told us their out-of-pocket expenses reached $20,000. Others report much smaller expenses.

Ask for a written quote

It’s important to ask your surgeon and anaesthetist for a written estimate before you sign up to any surgery. They decide the fees they charge. Some specialists will negotiate their fees, if you ask. If you are not happy with the estimate you receive, ask your GP or surgeon for a referral to another surgeon.

Ask your private health insurer

Ask your fund what your insurance covers and what the gap will be. They will ask for:

• the provider number (the person who will provide the service)
• the item number (the procedure the provider will do).

Your surgeon can give you this information at your consultation appointment.

There can be a large gap between the cost your surgeon charges and the amount your insurance fund pays. This gap is not covered by Medicare.

About financial consent

Before your surgery, the hospital will ask you to sign a financial consent form. This tells you about the expected out-of-pocket expenses, such as from the surgeon and anaesthetist. This is called ‘informed financial consent’. Make sure you understand what you are signing. If you are unsure, ask someone (such as the specialist's admin staff) to explain it to you.

Indirect costs of breast reconstruction

People having treatment for breast cancer may have large ‘indirect’ costs. Examples of indirect costs are:

• time off work
• travel to appointments, especially in rural or remote regions
• organising support for children or adults you care for.

Support may be available to help you. Talk to your treating team or read Tips to manage the financial impacts of breast cancer.