Gynaecomastia surgery has its own Medicare items, and the test is narrower than most men expect. Item 31526 covers bilateral mastectomy for gynaecomastia with or without liposuction — but only where the breast enlargement is not due to obesity and is not proportionate to your body habitus, and where sufficient photographic evidence is in your patient notes.
That single clause is what decides most claims. It is also the clause almost nobody publishes.
The items
| 31526 | Mastectomy for gynaecomastia, bilateral, with or without liposuction | |
| 31525 | Mastectomy for gynaecomastia, unilateral, with or without liposuction |
, not of the whole cost.
The two conditions, in plain terms
Not due to obesity, and not proportionate to your body habitus. The item is for true gynaecomastia — glandular breast tissue — rather than for chest fat that is part of a generally heavier build. A man carrying weight everywhere, whose chest is in proportion with the rest of him, does not meet it. A man of average build with firm tissue behind the nipple usually does. Telling the two apart is a clinical assessment: see gynaecomastia or chest fat.
Sufficient photographic evidence in the patient notes. Standard views are taken at your consultation and kept in your record. This is a documentation requirement, not an optional extra, and it is one reason the assessment cannot be done over the phone.
What the rebate does not cover
- The hospital, including theatre. This is where private health cover matters.
- The anaesthetist, who bills separately with a separate, smaller rebate.
- The surgical assistant, where one is needed.
- Garments and aftercare.
Dr Kumar’s quotes are itemised so you can see each component and the rebate against it. The hospital quotes after checking your fund. More about costs and payment.
If it followed major weight loss
This is a different problem and often a different operation. After significant weight loss the issue is usually loose skin and a deflated chest rather than glandular tissue, and excising skin is not what items 31525 and 31526 describe. Male chest contouring after weight loss sets out what that involves.
If you are still losing weight, the timing conversation matters — there is useful background at My Weight Loss Journey.
Before your appointment
- Get a GP referral. It is required to see Dr Kumar.
- Ask your GP about causes. Gynaecomastia can be related to medicines, hormonal conditions, liver or kidney disease and some recreational drugs. Investigating that is worth doing in its own right, and a documented history helps.
- Bring any blood tests or imaging already done.
- Mention any new lump or one-sided change to your GP promptly — male breast cancer is uncommon but it exists.
Common questions
Will I definitely get the rebate? Only if you meet the item. Dr Kumar will tell you at consultation whether, in his assessment, you do.
Does liposuction alone qualify? The items read “with or without liposuction”, so technique is not the deciding factor — the criteria are.
Can I have it in the public system? Gynaecomastia is treated publicly through a public outpatient referral where criteria are met. Waiting times vary and are often long.
What if only one side is affected? Item 31525 covers the unilateral operation. One-sided enlargement should always be assessed rather than assumed.
What about puffy nipples only? That is usually glandular tissue confined behind the areola. Puffy nipples.
Next step
Bring a GP referral to a consultation and you will leave knowing whether you meet item 31525 or 31526 and what the operation would cost. Dr Kumar consults at Westmead, Penrith and Orange. Call 1300 267 726, or send photos first if you are travelling. More about gynaecomastia surgery.
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).
