Large breasts are a recognised cause of neck, shoulder and upper back pain, and reduction is the operation Medicare funds for it. Item 45523 turns specifically on macromastia causing pain in the neck or shoulder region — not on breast size alone, and not on appearance.
Studies of breast reduction consistently report improvement in neck, shoulder and back pain afterwards. That is why this is one of the few breast operations with a Medicare item attached to a symptom rather than to a disease.
The pain pattern that fits
Dr Kumar is looking for a picture that hangs together, not a single complaint. The features that usually appear together:
- Aching across the upper back and between the shoulder blades that is worse by the end of the day
- Neck pain, sometimes with headaches that start at the base of the skull
- Deep grooving of the shoulders from bra straps, often with numbness or tingling down the arm
- Rashes or skin breakdown in the fold under the breast that keep returning
- Posture that has changed to compensate, and activities given up because of it
Pain that is clearly coming from a disc, a shoulder joint or a nerve root is a different problem, and reduction is not the answer to it. Part of the consultation is separating the two.
What Medicare requires
| Item | 45523 |
| Requirement | Macromastia with pain in the neck or shoulder region |
| Excluded | Any procedure inserting a prosthesis at the same time |
MBS schedule fee and benefit as at 1 July 2026. The full criteria are set out on the Medicare and breast reduction page.
Why documentation decides this
The single thing that most often weakens a claim is that the pain has never been written down anywhere. A patient who has raised it with a GP over several years, tried physiotherapy, been fitted for supportive bras and still has the symptoms is on firm ground. One describing it for the first time at a surgical consultation is not.
Practical steps before your appointment:
- Ask your GP for a referral — it is required to see Dr Kumar — and ask that the history of your symptoms be noted in it.
- Bring records of physiotherapy, imaging or bra fittings if you have them.
- Be specific about what you have stopped doing: running, carrying, sleeping on your side.
What has usually been tried first
Non-surgical measures are worth doing in their own right, and having tried them strengthens the clinical picture. Professionally fitted supportive bras, physiotherapy for the neck and shoulder girdle, postural work, and weight loss where that is relevant all help some patients enough. Where they have not, that is itself part of the history.
Does the pain always improve?
No, and no surgeon can promise it will. Pain that is chiefly mechanical — load on the neck and shoulders from breast weight — is the kind that responds. Pain from established joint or spinal disease will still be there afterwards. Where both are present, reduction addresses one component. Dr Kumar will tell you at consultation which of these he thinks he is dealing with.
Common questions
Do I need to see a physiotherapist first? Not as a rule set by Medicare, but a documented trial of conservative treatment supports the clinical picture and is usually worth doing anyway.
Will a scan show that my breasts are causing the pain? No. There is no imaging test for this. It is a clinical assessment built on your history and examination.
Does the amount removed matter? Dr Kumar plans the reduction around your frame and your symptoms rather than a target cup size. See how much can be removed.
How long until the pain settles? The weight is gone immediately, but you are healing for six weeks and the shoulders take time to adjust. Most patients notice a difference well before the six-week review. The recovery timeline is here.
Next step
If neck or shoulder pain is why you are reading this, bring a GP referral to a consultation. Dr Kumar consults at Westmead, Penrith and Orange. Call 1300 267 726 or request a call from his nursing team. More about breast reduction surgery and what it 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).
