AFPEA doctor with a breast reconstruction implant (photo from 2022)
NOS Nieuws•vandaag, 06:00
Stikkelorum at sea
interior editor
Stikkelorum at sea
interior editor
Reconstructions after cancer are reimbursed as standard, except in the case of breast cancer. Health insurers reject many of the applications for reimbursement of follow-up operations after an initial reconstruction of amputated breasts. Plastic surgeons speak of legal inequality and distrust, because it concerns breasts.
“There is a special exception for breast cancer reconstructions. This leads to a loss of quality of life for Dutch breast cancer patients,” says Edin Hajder, plastic surgeon at the OLVG hospital in Amsterdam and a board member of the Dutch Society for Plastic Surgery (NVPC).
There is distrust among insurers when it comes to breast operations, says plastic surgeon and fellow NVPC board member Andrzej Piatkowski de Grzymala of Maastricht UMC. “I feel like they secretly think we’re doing breast augmentations, rather than operating on breast cancer patients.”
In response to questions from the NOS, Zorgverzekeraars Nederland will review the exceptional position for breast cancer reconstructions. “We take the signals from the NVPC about possible inequality of treatment seriously and will discuss the current policy with the NVPC and how it can be improved,” the trade association says in a response. The Ministry of Health welcomes the fact that this will be discussed.
Diagnosed in 1 in 7
One in seven women will be diagnosed with breast cancer. Last year there were more than 15,500. Another 2400 women are in a possible precancerous stage and are also receiving treatment. It is the most common cancer among women.
About one-third of breast cancer patients undergo an amputation of one or both breasts. In addition, there are women with a genetic predisposition who choose to have their breasts amputated preventively.
After amputation, women often opt for a reconstruction with silicone implants or their own tissue. That is 5,000 to 5,500 breast reconstructions per year, which take place shortly after cancer treatment or preventive surgery.
Pain or abnormalities
After years of wrangling between health insurers and plastic surgeons, these have been reimbursed as standard since the beginning of this year, without plastic surgeons having to apply for reimbursement from insurers. That’s progress, say the doctors. But it’s still not how it should be.
If a reconstructed breast needs to be operated on again, an application must still be made. This involves many hundreds of operations per year, involving, for example, a teardrop-shaped prosthesis that rotates, pain complaints or a striking contour deviation or dent that needs to be repaired.
“These applications are often rejected,” says Hajder of the NVPC. At the largest health insurer, Zilveren Kruis, 30 percent of the applications are not reimbursed. The three other largest insurers, CZ, VGZ and Menzis, were unable to answer questions, in their own words, partly because of holidays.
Then you have a crying patient in front of you who can’t believe this.
Edin Hajder, board member of the Dutch Society for Plastic Surgery
One of Hajder’s patients, a 28-year-old woman, carries a hereditary gene. Her breasts have been amputated and reconstructed elsewhere. The result was disappointing.
“The patient says: ‘I don’t dare to wear a bikini, my sexuality and relationship are affected. ‘.”
Incomprehensible, says Hajder. “Then you have a crying patient in front of you who cannot believe this. Of course it must be sensible care that is reimbursed. But someone with breast cancer and then say: it is not mutilation, and it cannot be seen in clothing … “
‘Very masculine vision of breasts’
According to the plastic surgeons, there is a form of legal inequality. They point out that other reconstructions after cancer are simply reimbursed without the need for a new application. An exception is the injection of fat, lipofilling, which is mainly done during breast reconstructions. Permission is always required for this.
Insurers view breasts differently than other body parts, says doctor Piatkowski. “It’s a very masculine vision. I don’t have to apply for head and neck reconstructions and penis reconstructions.”
The loss of a breast is not life-threatening, he continues. “But the mutilating nature is overlooked. While the health insurance law states that everything that is a mutilation is reimbursed. Men do not understand what breasts mean to women.”
Criticism of reviews
“It’s not women who come for fun,” says Marc Mureau, professor of oncological reconstructive surgery at Erasmus MC. In addition to the breast cancer treatment itself, women have already undergone amputation and reconstructive surgery. “They do not do a new operation for pleasure. There is no question of improper use of resources.”
The plastic surgeons also criticize the assessment by the health insurers. This starts with the requirement to send photos as standard, which, according to them, does not always make clear the seriousness of the problem. “If a pectoral muscle pulls very hard, it is not easy to see on a photo,” says Hajder of the Dutch Society for Plastic Surgery.
They also find it strange that it is not always doctors who assess the photos. Often they are people who work under the doctor, including physical therapists and nurses, says Piatkowski. “How can someone who sits in an office somewhere and has no training for this form an opinion?”
2023-08-02 04:00:01
#Reconstruction #cancer #reimbursed #standard #case #breast #cancer
