Elective plastic surgery isn't cheap. Revision surgery is definitely not cheap. I guess that is one of the arguments for why patients should actually be consented for the costs of revision surgery when they have something like a primary cosmetic breast augmentation, given that it is a universal requirement for patients with breast implants. But of course, that would certainly decrease the appeal of breast augmentation, and make it much harder to sell!
One way that patients are able to cover the costs for surgery is to access their superannuation funds, and in the last few years it is very clear that more and more patients are choosing to do this.
Releasing funds from super for health care is permitted under ATO rules, but there are very specific criteria which must be met for this to be possible.
I was recently speaking with one of my patients after her surgery and she mentioned that, from a patient's perspective, knowing that super release is possible, and understanding how it works would have helped her to make her decision to have surgery. She told me she wished she'd been able to find out more about super release because it might have meant that, rather than putting off surgery as she did, she would have been able to proceed sooner.
As I said to my patient, that perspective is very valid, and I must admit I hadn't considered it.
My position on releasing super has always been a cautious one - I certainly don't want to be accused to enabling patients to raid their future savings just to have surgery with me. However, I think I also have to acknowledge that my patients are adults who can make their own financial decision, and I guess in a way I should respect their agency in this matter. That being the case, my obligation is really to ensure that if patients choose to follow this path, they do so within the rules that are set out.
There has been some recent negative media about using super for surgery, with claims of "crackdowns" from the ATO and AHPRA. To be honest, good. I think that there probably are some people playing fast and loose with the rules, and certifying for patients to access super without appropriate conditions being met. The classic example has been of patients have dental procedures, where they have been raiding their super to the tune of $70,000 for a procedure! Wow. Those dentists must be driving nice cars.
Anyway, let's look at super release, what the rules are, and how this process works.
You can of course find quite a bit of information on the ATO website. I would suggest you read that very carefully if this is something you're considering.
You will see that most of the application can be made online, but requires supporting documentation. That supporting documentation is where we come in.
What form do you need?
You will need to have ATO form NAT 74927-06.2018 completed by the treating specialist - which is to say, by me, if you're one of my patients.
This form serves as certification from a specialist as to the necessity for surgery, with the requirement being that you meet certain criteria to quality for super release.
What are the criteria?
This is the sticking point for some patients.
In simple terms, super release can be approved to pay for the treatment of certain conditions where: a) the condition is life-threatening (not exactly applicable for my patients); or b) a patient is suffering from chronic pain.
Now, chronic breast pain associated with implants is a well-established problem. But that doesn't mean that every patient has chronic pain.
You can see where this is going.
I ask every patient during consultation about pain or associated symptoms. We discuss the causes of that pain, and the likelihood of resolution of pain with explant procedures. In my experience, breast pain, which can be attributed to capsular contracture, or nerve irritation (by the implant itself or the capsule), is both directly attributable to breast implants, and treatable by explant with a high rate of success. Those points are important.
On the other hand, quite a few of my patients tell me they don't have breast pain. They might present with other concerns entirely (whether aesthetic, functional or BII-related), but no pain.
Some of those patients will then ask about super release. And I will tell those patients, very clearly, that based on their response during consultation, I will not certify them for super release. I appreciate that this may seem arbitrary but these aren't my rules - and I have to abide by them, as do you.
Yes, there are folks out there who will just fudge this process and certify anyone who asks - perverse incentives and all that. But I am not prepared to risk my registration (let alone my own personal ethics) just to get a patient over the line and booked for surgery.
**edit: I had a question sent to me by one of my patients after I posted a link to this article on Instagram, and I thought it best to address this point here (I probably should have anticipated the question to be honest!). In short, the question was: What about chronic pain elsewhere in the body (that is attributed by a patient to BII)? Some patients with BII will present with fibromyalgia, or arthritic symptoms, which they feel is linked to their breast implants (as part of their BII symptom cluster). Now, this may well be the case, but the question (in my opinion) comes back to whether we can demonstrate a direct causal link (between the implants and non-breast pain), and therefore, whether we are able to infer that surgery is likely (or not) to alleviate that pain. This is tricky, because it is entirely possible that this non-breast pain, which for some people is quite debilitating, might improve after explant. I don't believe that there is a clear answer as to whether this would meet criteria for super release (as is often the case when it comes to these sorts of bureaucratic processes). The biggest issue that I can see is that if we were to certify a patient with non-breast pain relating to BII, then any other patient with BII symptoms might (reasonably) argue that we should also be certifying them based on their BII symptoms too, even if they don't have pain. Ultimately, my job is to work within the rules, and where there are grey areas, I have to interpret the intention behind those rules to the best of my ability.
One of the reasons that I have been reluctant to write about super release is that it does of course run the risk that some folks out there will read this article and then, armed with the knowledge of what they need to say in order to qualify for super release, simply spout such things out during consultation. Chances are that is already happening.
But, I am inclined to trust in the honesty and integrity of my patients. And, as I said before, my patients are all sensible, well-informed adults, fully capable of making their own decisions in life (and taking responsibility for those decisions). So I think better to be fully transparent, than trying to somehow gate-keep this information. And, like I mentioned at the start of this article, perhaps this knowledge will allow some ladies who perhaps are struggling with the impact of their breast implants to access the surgery they need, and get on with a better quality of life.
**another little edit: I need to be very clear about one other thing - we assist patients in these processes only if a) they have had (at least) their first consultation with me, b) they have up-to-date quotes, and c) they have booked/confirmed a surgery date. All of those conditions must be met before we will consider providing certification.
I hope that helps.
Please let us know if you have any questions.