Dutch health insurers cover reconstruction after cancer, except with breast cancer

Dutch health insurers standardly reimburse reconstructive surgery after cancer, except in the case of breast cancer. Doctors first need to apply for a follow-up surgery after an initial reconstruction of amputated breasts, and those applications often get rejected, NOS reports.

“There is a special exception for breast cancer reconstructions. That leads to a loss of quality of life for Dutch breast cancer patients,” Edin Hajder, a plastic surgeon at the OLVG hospital in Amsterdam and a board member of the Dutch Society for Plastic Surgery (NVPC), told the broadcaster.

Health insurers become suspicious when it involves breasts, Andrzej Piatkowski de Grzymala, a plastic surgeon at Maastricht UMC and also on the NVPC board, added. “I feel like they secretly think we’re doing breast augmentation rather than operating on breast cancer patients.”

Breast cancer is the most common cancer among women, with one in seven eventually diagnosed. Last year, 15,500 women in the Netherlands got the diagnosis, and another 2,400 women were in a possible precancerous stage and receiving treatment. About a third of breast cancer patients undergo amputation of one or both breasts. There are also women with a genetic predisposition who choose to have their breasts amputated preventively.

Plastic surgeons in the Netherlands do about 5,000 to 5,500 breast reconstruction surgeries annually. After years of arguing with the health insurers, these first surgeries are now reimbursed without pre-approval. Progress, but still not the same treatment as reconstructive surgery after other forms of cancer, the surgeons told NOS.

If a reconstructed breast requires further surgery, the doctors must first apply for approval from the health insurer. According to NVPC, it involves hundreds of operations per year, for example, fixing a prosthesis's position, treating pain complaints, or repairing a contour deviation or dent. “These applications are often rejected,” Hajder said.

Zilveren Kruis, the Netherlands’ largest health insurer, rejects about 30 percent of these applications, the insurer told NOS. CZ, VGZ, and Menzis couldn’t answer the broadcaster’s questions, partly because many of their workers are on vacation, they said.

The NVPC pointed out that other reconstructions after cancer and their follow-up surgeries are reimbursed without needing pre-approval. The only exception is lipo-filling, an injection of fat mainly done with breast reconstructions. Pre-approval is always required for that.

Insurers view breasts differently than other body parts, said Piatkowski. “It is a very male view. I don’t have to apply for head and neck reconstructions and penis reconstructions.” The loss of a breast is not life-threatening. “But the mutilating nature is overlooked. While the health insurance law states that everything that is mutilation is reimbursed. Men do not understand what breasts mean to women.”

Zorgverzekeraars Nederland, the umbrella organization for health insurers, told NOS that it would 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 Ministry of Public Health Welfare and Sports told the broadcaster that it welcomes the fact that this topic will be discussed.