The question is volume. If your breasts are too big, it is a reduction. If they are the right size but sitting too low, it is a lift. The scars are broadly the same; what differs is whether tissue comes out.
Medicare treats them as two different operations with two different tests, and the tests are objective enough that you can work out in advance which one you are likely to meet.
The two operations side by side
| Breast reduction | Breast lift (mastopexy) | |
|---|---|---|
| What is removed | Breast tissue and skin | Skin, with tissue reshaped rather than removed |
| Effect on size | Smaller | Broadly unchanged, often looks smaller because it sits higher |
| Usual reason | Neck, shoulder and back symptoms | Position and shape, often after pregnancy or weight loss |
| Medicare item | 45523 | 45558 |
| Scars | Around the areola, vertical, usually along the fold | The same patterns |
The Medicare tests, in plain terms
Reduction, item 45523. Macromastia causing pain in the neck or shoulder region, with no prosthesis inserted at the same time. It is a symptom test. Full criteria here.
Lift, item 45558. At least two-thirds of the breast tissue, including the nipple, must lie below the inframammary fold, with the nipple at the lowest part of the breast contour — and photographic evidence with a marker at the level of the fold must be in your notes. It is an anatomical test, and it is claimable once in your lifetime.
That last detail is worth pausing on. If you are likely to want further breast surgery later, using the item now means it is not available then.
What if both apply?
Commonly they do. Large, heavy breasts that also sit low can meet either description, and a reduction inherently lifts. Where symptoms are the main problem, Dr Kumar will usually plan a reduction; where size is acceptable and position is the complaint, a lift. Only one item is claimed for the operation performed.
After major weight loss, it is usually neither on its own
Weight loss empties the breast rather than enlarging it. The result is a breast with poor skin quality, a low nipple and lost upper fullness, and a straight lift can look deflated afterwards. The options are a lift combined with an implant, a lift with fat grafting, or auto-augmentation, which uses your own lower breast tissue to rebuild the upper pole. See breast lift after major weight loss.
If you are still losing weight, the planning conversation changes again.
What does not decide it
- Cup size. There is no size that makes you a reduction rather than a lift.
- Cost alone. The rebate difference is modest against the total; the operation that fixes your problem is the cheaper one in the end.
- Scar preference. Both use the same incision patterns, so this rarely separates them.
Common questions
Can I have a lift and go smaller too? Then it is a reduction. The words describe what is done, not how it is marketed.
Can I have a lift with an implant? Yes — see breast lift with implants. Note that 45523 excludes any procedure inserting a prosthesis at the same time.
Is recovery different? Broadly similar. Breast lift recovery and breast reduction recovery.
How do I find out which I am? Examination and marked photographs at consultation. It is not something that can be settled over the phone.
Next step
Bring a GP referral — it is required to see Dr Kumar — and you will leave the consultation knowing which operation applies to you and which item, if any, you meet. Call 1300 267 726 or request a call from his nursing team. More about breast reduction, breast lift and costs.
The initial consultation with Dr Kumar is $400, with a Medicare rebate of approximately $88 where you have a GP referral. Surgical fees are quoted individually after your consultation, in a written itemised quote.
All surgery carries risks, and individual results will vary. Read more about the risks of surgery here. A GP referral is required to see Dr Kumar.
Dr Rohit Kumar (MED0001630444) Registered medical practitioner, specialist plastic surgeon (specialist registration in surgery – plastic surgery).
