The External Breast Protheses Reimbursement Program
Individuals who have undergone mastectomy, breast-conserving surgery or reconstruction for treatment of breast cancer may choose to wear an external breast prosthesis, also known as a breast form or partial breast form (known as a shaper), to help restore comfort, confidence, and breast symmetry. However, the cost can be a barrier to their use.
The Australian Government’s External Breast Prostheses Reimbursement Program (EBPRP) helps reduce this burden by providing financial support for eligible individuals.
This guide explains how the program works, who can access it, and what options are available after having breast cancer surgery.
What is an External Breast Prosthesis?
An external breast prosthesis is an artificial breast form worn inside a bra or under clothing to restore the natural shape of the breast after breast cancer surgery.
They are commonly used following procedures such as:
- Mastectomy (single or double)
- Partial mastectomy or lumpectomy
- Reconstruction
- Prophylactic (preventative) breast surgery
Types of Breast Prostheses
Selecting the right breast form is a personal process. The features and capabilities of breast forms vary. With the innovative technologies now available, there is a broad choice of special shapes, smart options like air-flow channels and even temperature regulation.
Depending on your individual needs, lifestyle and desired activities, you might choose:
- Silicone breast forms with an adhesive back that attaches directly to the chest; this allows freedom of movement and pairs well with tighter clothing
- Lightweight breast form options, particularly in early-stage surgical recovery or for low-impact wear
- A swimming breast form that is suitable for water activities
- Breast forms with soft gel-back layers that are suitable for sensitive skin and adapt to scars
- Temperature regulating breast forms
- Partial breast shapers
Breast forms aren’t just cosmetic; there are also designed for comfort, to fit seamlessly into your life and restore your body confidence. By compensating for the weight of a real breast, a properly fitting breast form can help prevent secondary problems like the development of lymphoedema, poor posture or shoulder/neck pain.
About the External Breast Prostheses Reimbursement Program (EBPRP)
The EBPRP provides reimbursement to help cover the cost of purchasing a prosthesis of:
- Up to $400 for a single prosthesis
- Up to $800 for two prostheses (after a double mastectomy)
How Often Can You Claim?
You can claim once every 2 years for a new or replacement prosthesis.
Who is Eligible for the EBPRP?
To access the program, individuals must:
- Be enrolled in Medicare
- Have had breast surgery due to cancer
- Not have claimed for a prosthesis under the program in the previous 2 years
The program is available regardless of how long ago the surgery occurred, as long as eligibility criteria are met.
What Costs Are Covered (and What Aren’t)?
Covered:
- External breast prostheses
- External swimming prostheses
Not Covered:
- Mastectomy bras
- Post-surgery clothing or swimwear
- Internal (surgically implanted) prostheses
- Nipple prosthetics
It’s important to note that patients must pay upfront and then claim reimbursement.
How the Claim Process Works
The process is relatively simple:
- Purchase your prosthesis
- If applicable, claim through private health insurance first
- Submit a Medicare claim with your receipt and completed form
- Receive reimbursement, typically within 10 business days
If you receive a partial rebate from private health insurance, Medicare may cover the remaining amount up to the program limit.
Understanding the Real Cost of Prostheses
The cost of breast forms can vary depending on the type:
- Silicone prostheses: $300–$500
- Partial prostheses: $150–$200
- Swim prostheses: $150–$200
- Foam prostheses: around $70
The reimbursement often covers most or all of the cost, particularly for lower-priced options.
Key Takeaways
- The EBPRP offers financial support of up to $400 per prosthesis every 2 years
- The program is available to Medicare-eligible individuals after having breast cancer surgery
- Covers external and swimming prostheses but not bras or clothing
- Requires upfront payment followed by reimbursement
- Plays a vital role in improving accessibility and recovery outcomes for individuals who have undergone breast cancer surgery
How Hunter Rehab Hub Can Help
At Hunter Rehab Hub, we support individuals navigating recovery after breast cancer surgery by:
- Supporting rehabilitation, mobility, and return to daily activities
- Providing in-clinic treatment options to assist with symptom management
- Providing guidance on breast prosthesis and compression garment options including assisting with fit, comfort, wear and care
- Helping patients understand funding pathways, like the EBPRP and EnableNSW, and completing necessary paperwork to gain financial support
Based in Newcastle, Maitland, Lake Macquarie, or the greater Hunter region and need help navigating recovery after breast cancer surgery?
Our team are here to support you. Contact us on 0480 604 578, fill out our website enquiry form or book in for an initial consultation online.
References
- Australian Government Department of Health and Aged Care. (n.d.). External breast prostheses reimbursement program. www.health.gov.au/our-work/external-breast-prostheses-reimbursement-program
- Breast Cancer Network Australia. (n.d.). Breast prostheses. www.bcna.org.au
- Breast Cancer Now. (n.d.). External breast prostheses. www.breastcancernow.org
- Cancer Australia. (n.d.). Breast cancer treatment and reconstruction options. www.canceraustralia.gov.au
- Cancer Council Australia. (n.d.). Breast cancer information. www.cancer.org.au/cancer-information/types-of-cancer/breast-cancer
- Services Australia. (n.d.). External breast prostheses reimbursement program. www.servicesaustralia.gov.au/external-breast-prostheses-reimbursement-program
Disclaimer
This content is general in nature and provided for educational purposes only. It is not a substitute for individualised medical advice, diagnosis, or treatment. If you have concerns about symptoms or your health, consult a qualified healthcare professional.
