When is Plastic and Reconstructive Surgery Medically Necessary

When you think about reconstructive or ‘plastic’ surgery, most people’s brains immediately go to the commonality of a rhinoplasty (‘nose job’) or mammoplasty (‘boob job’ or breast augmentation). These surgeries are typically synonymous with celebrities and Hollywood when in reality, plastic surgery is so much more than just a new nose or bigger breasts. 

There are many reasons to get reconstructive surgery that isn’t purely cosmetic and may even be recommended or suggested by your healthcare team. Things such as dog attacks, motor vehicle accidents, excess skin following significant weight loss or even a deviated septum causing breathing difficulties. Some of these come at a cost and others are covered, so what kinds of surgeries may be deemed medically necessary?

Dog bites

Being bitten by man’s best friend is often not a minor incident. Dogs have very strong jaws that are historically designed to rip into flesh, if you’re unlucky enough to have been attacked, you’ll know they can do some extensive damage. 

If you take yourself to an emergency department at your local hospital, oftentimes plastic surgeons will be called in to see you and clean and reconstruct your skin as the wound would likely have jagged edges which will need a steady hand and precision so you end up with a neat scar. 

This is usually covered by medicare if done at a public hospital, as it’s generally a minor procedure.

Skin Grafts

Skin grafting is the process of taking skin from a healthy part of the body such as your thigh or buttock, and grafting that skin to areas on your body where the skin is damaged or missing. This is a major surgery and one that is only performed if other measures are likely not to work. 

Skin grafts can be full thickness, where they take all layers of skin and transplant them over an open wound if the skin surrounding the wound can not be bought together with stitches or they can be split thickness where surgeons will take a “thinner” layer of skin and mesh it like fishnet to get greater coverage with less skin, this also allows for drainage to help with healing. 

Skin grafts are particularly common with burns patients where the skin has died and left an open wound. They’re also common after surgery to remove skin cancers. 

Skin grafts should be covered under the public system by medicare as they’re medically required, if you’re in the public system there may be a bit of wait time. Depending on your private health coverage, you may get in a little quicker but you will have to pay a gap fee.

Cleft Palate Or Cleft Lip

The roof of the mouth, or palate, is developed between weeks 6 and 9 of pregnancy. In children with a cleft palate, this doesn’t join properly and leaves a gap in the roof of the mouth often affecting the shape and appearance of the child’s lip. Some children may only have a cleft lip which doesn’t affect the palate or vice versa. Either way, surgery is required to rectify the cleft in order to salvage speech and feeding abilities. 

This surgery is most often completed in a child’s first 12 months of life. Medicare has a Cleft Lip and Cleft Palate Scheme which covers reconstructive surgery with no gap to be paid in most cases. As well as covering the surgery, medicare may cover some dental costs for the child as their teeth are very commonly affected. 

Deviated septum

Septoplasty, or repair of a deviated septum, is a procedure that is performed to ease snoring and difficulty breathing.

The septum is the cartilage and bone in your nose that separates your two nostrils, when this is misshapen or deviated it can make one nostril bigger than the other and make breathing difficult, often leading to snoring or breathing through your mouth. Having this surgery can give you a better quality of life, you’ll sleep better because you can breathe better. 

Septoplasty is covered under medicare if the patient passes an aptly named NOSE test (Nasal Obstruction Symptom Evaluation) or if the patient has a severe congenital or developmental deformity. To go private in Sydney, this surgery varies from $10,000 to $25,000.

Breast Augmentation

Breast augmentation, or a mammaplasty, can be performed for many medically necessary reasons. 

In cancer patients who need a mastectomy (single or double breast removal), breast implants or reconstruction may be offered and covered under medicare as part of a method of treatment. Patients who have massively enlarged breasts and whose bodies cannot handle the sheer weight of them may also be eligible for a reduction mammaplasty under medicare. 

Skin removal after bariatric surgery or significant weight loss

When a very large amount of weight is lost, especially in a short period of time, there is a lot of excess skin which can cause heat sores and can add extra unbalanced weight putting extra strain on the body that’s worked so hard to lose the weight. The skin is like a balloon, once it has been overstretched for a very long time, it doesn’t go back to its original size.

Abdominoplasty is the removal of the “apron” of loose skin remaining after weight loss and this may be covered under medicare if very strict criteria are met. Patients need to have maintained a lower weight and they need to have referrals from different medical professionals with reasons as to why this surgery is medically necessary just to name a few. To pay for the surgery alone with no private health insurance or any hospital fees, the abdominoplasty can cost around $10,000 out of pocket. 

Plastic or reconstructive surgery isn’t just about looks, it can drastically increase your quality of life, and in some cases even save your life. If in doubt, chat with your medical team and see if you’re eligible.

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