Mastectomy Cost
Expert tips for choosing health insurance
Our health insurance expert, Steven Spicer, shares some tips on looking for the right health insurance for you.
Steven Spicer
Executive General Manager – Health, Life & Energy
Choose the right level of hospital cover
Private hospital insurance policies are available in four tiers: Basic, Bronze, Silver and Gold. The right level for you will be a policy that covers your needs without making you pay for inclusions you won’t use. Everyone’s health needs are different so you’ll have to consider your own medical and family history when deciding on the right level of cover for you.
Know your inclusions
Finding out your policy doesn’t cover what you thought it did can be a nasty shock. To avoid this situation, you should take the time to understand what inclusions your policy has and what procedures these inclusions actually cover. For cancer care, there may be several treatments you’ll require (e.g. breast surgery and chemotherapy) and these treatments may fall under different clinical categories.
Check and adapt your policy regularly
Has it been a while since you had a look over your policy? You may be surprised at some of the inclusions you’re paying for that you no longer need. Likewise, you might realise you’re not covered for the services you need to be covered for. Checking your policy annually gives you a chance to take stock and see whether you have the cover you need or whether it’s time for a change.
What is a mastectomy?
A mastectomy is the surgical removal of your breast.1 This includes the removal of breast tissue and possibly the skin covering your breast, nipple and lymph nodes.2 The most common reason for a mastectomy is for breast cancer treatment.1 Some people who are at high risk of breast cancer may have a prophylactic mastectomy (also known as risk-reducing surgery) as a preventative measure.
The procedure will usually take one to two hours but may take longer if you’re also having breast reconstruction surgery.1 Your hospital stay could be up to a week and your breast care nurse or doctor will advise you on your recovery plan.
Breast cancer can be detected through various means, including breast examination, mammograms, biopsy and ultrasound.3 Whether a mastectomy is the best treatment will depend on your diagnosis.
When is a mastectomy necessary?
Your healthcare professional may recommend a mastectomy if:2
- You have breast cancer that is large in comparison to your breast
- There are multiple cancers in your breast
- Cancer has returned to your breast
- You’ve previously undergone radiation therapy for the same breast.
Not all breast cancers will require a mastectomy, especially if the cancer is caught early.1 A lumpectomy (breast-conserving surgery) is an alternative breast cancer surgery that aims only to remove the tumour and affected breast tissue. The best option will vary on a case-by-case basis.
What is breast reconstruction?
Many women who undergo a mastectomy will then have breast reconstruction surgery.1 This procedure can be performed at the same time as the mastectomy or a later date.
There are two types of breast reconstruction: one uses silicon or saline implants to reconstruct the breast (which may require single or multiple surgeries), and the other uses tissue, fat and muscle from another part of your body to create the reconstruction (this is also known as autologous reconstruction).4
Not all women choose to have breast reconstruction.2 There are other options, such as wearing a synthetic breast (breast prosthesis), which can be attached to the skin or inserted into a mastectomy bra.
How much does a mastectomy cost in Australia?
According to the Australian Government’s Medical Costs Finder website, the typical specialist fee for a total mastectomy is $4,000.5 Medicare pays $1,800 and health insurers typically pay $1,400. Out-of-pocket costs paid by patients are typically $510. Hospital fees are typically $6,800 for this procedure; this can include accommodation fees, theatre fees and medical devices.
For a subcutaneous mastectomy with breast reconstruction using prosthesis, the typical specialist fee is $6,600.6 Medicare pays $2,300 while insurers typically pay $1,600. The median out-of-pocket cost for patients is typically $2,100. Hospital fees for this procedure are typically $8,200.
The cost of your mastectomy will depend on several factors, including:1
- The severity of your cancer diagnosis
- Whether you’re having one or two breasts removed
- Any complexities that arise during surgery
- Your choice of a breast surgeon, plastic surgeon and other oncology professionals
- Your choice of healthcare clinic.
Does private health insurance cover mastectomies?
Private hospital cover can include mastectomies, providing you have the right inclusions in your policy. Insurance will pay a benefit towards treatment as a private patient, either in private or public hospitals. Your policy will need to include the ‘breast surgery (medically necessary)’ clinical category for mastectomy cover.
Luckily, this is a minimum requirement for Bronze-tier hospital policies and higher. Depending on the procedure, you may also require cover for ‘plastic and reconstructive surgery (medically necessary)’ which is a minimum requirement for Silver-tier hospital policies and higher.
Breast reconstruction can be covered by private health insurance, providing the surgery is medically necessary, such as after a mastectomy. These procedures will also fall under the ‘breast surgery (medically necessary)’ and ‘plastic and reconstructive surgery (medically necessary)’ categories. Your policy won’t cover cosmetic surgery or plastic surgery that isn’t medically necessary.
If you’re looking for cover in the event you’re diagnosed with breast cancer, remember that you may have multiple different treatments, including chemotherapy, along with your surgery. It may be worth considering clinical categories such as ‘Chemotherapy, radiology and immunotherapy’ as part of your policy as well.
If the cancer spreads to other parts of the body, you may require additional clinical categories to be included on your policy. It is therefore a good idea to speak to a health insurance expert if you are unsure what to include on your cover.
Keep in mind that your specialist can charge more than the MBS fee (the fee set by the government) for a procedure. The difference between the specialist fee and the MBS fee is known as a gap payment, and it may mean you’ll incur out-of-pocket costs even if you have insurance. Whether your health fund will cover some, all or none of the gap will depend on your policy, treating doctors and chosen hospital.
Does Medicare cover mastectomies?
Medicare will cover the cost of a mastectomy performed in a public hospital, provided you’re being treated as a public patient. While the public health system provides a valuable service to millions of Australians, it’s in such high demand that elective surgeries can have long waiting times. You’ll also have less say over who performs your surgery and when the procedure will take place.
Meet our health insurance expert, Steven Spicer
As the Executive General Manager of Health, Life and Energy, Steven Spicer is a strong believer in the benefits of private cover and knows just how valuable the peace of mind that comes with cover can be. He is passionate about demystifying the health insurance industry and advocates for the benefits of comparison when it comes to saving money on your premiums.
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1 Health direct – Mastectomy. Accessed March 2025.
2 Cancer Council – Mastectomy. Accessed March 2025.
3 Health Direct – Breast Cancer. Accessed March 2025.
4 Breast Cancer Network Australia – Types of breast reconstruction. Accessed March 2025.
5 Medical Costs Finder – Total Mastectomy. Accessed March 2025.
6 Medical Costs Finder – Subcutaneous mastectomy with breast reconstruction with prosthesis. Accessed March 2025.