Breast cancer patients no longer need permission from the insurer for breast reconstruction. From now on, the plastic surgeon will always decide on this. As a result, it is expected that hundreds more women can be operated on each year. Currently, women would end up in a “long and non-transparent process.”
Annually, about six to seven hundred women undergo reconstruction surgery after their breast has been amputated due to breast cancer. The Dutch Association for Plastic Surgery (NVPC) expects about three to four hundred additional women each year, whose surgery would previously not be reimbursed by the insurer.
“Women can now simply talk to their doctor and immediately know if they are eligible for surgery,” says a spokesperson for umbrella organization Zorgverzekeraars Nederland (ZN). “This also prevents a surgeon from giving the green light first, and the woman being disappointed by the insurer after a long wait.”
For a first breast reconstruction, no agreement from the insurer was required. The decision therefore applies to operations that take place afterwards, for example because the woman experiences pain or because there are dents or contour abnormalities on the breast. This may include a nipple areola tattoo, nipple areola reconstruction, or the removal of a breast prosthesis.
The plastic surgeon must still adhere to the same conditions as the insurer before performing an operation. The fact that more women are expected to be operated on is because women ended up in a “long and non-transparent process” with the insurance company, the NOS noted after investigation.
Women had to send photos to insurer despite ban
The research also showed that women had to send photos of their breast to the insurer when applying for surgery, while this has been prohibited since 2023. Since then, the photos must be taken in the hospital and sent by the plastic surgeon.
Breast cancer is the only form of cancer where not all reconstruction operations were standardly reimbursed by health insurance. Zorgverzekeraars Nederland hopes that the measures will be finalized before the summer. The NVPC expects a catch-up of women who previously did not receive reimbursement for a reconstruction operation after the introduction.
According to the KWF, one in seven women get breast cancer. In 2024, approximately eighteen thousand people were diagnosed with breast cancer.