2023-08-02 17:07:23
Breast Reconstruction Rejections Spark Distrust Among Breast Cancer Patients and Surgeons
In January 2020, Geranne received the devastating news of her breast cancer diagnosis. She immediately sought treatment at the Alexander Monro Hospital, a renowned medical facility specializing in breast cancer diagnosis and treatment in Bilthoven.
“I underwent chemotherapy, immunotherapy, hormone therapy, and had my right breast amputated,” Geranne shared with RTL News. However, she knew from the beginning that she wanted breast reconstruction. “I wanted to regain my sense of self and not be reminded of my illness every day. It was important for me to feel complete, even in the most intimate settings,” she explained.
Geranne’s preference was to undergo breast reconstruction using her own body tissue. However, due to the COVID-19 pandemic, the waiting list for this procedure was estimated to be two years long. Reluctant to wait that long, Geranne opted for a prosthesis after consulting with her doctor.
While initially satisfied with the reconstruction, complications arose over time. She noticed a dent in her reconstructed chest, prompting her to seek help from her surgeon. While the surgeon was able to fix the issue, Geranne faced another setback when her insurer rejected her application for coverage after reviewing photos of her breast reconstruction.
“I received a cold letter stating that the dent was not deep enough. I wonder who is making these judgments about my body. Why can’t they just examine me in person?” Geranne expressed her frustration.
It turns out that Geranne is not the only breast cancer patient facing surgical rejections. The Dutch Society for Plastic Surgery (NVPC) informed NOS that they have observed a significant lack of trust among insurers when it comes to approving breast operations, including follow-up surgeries and post-corrections. Since the beginning of this year, breast reconstruction has been covered as a standard procedure. However, insurers often reject requests for additional operations.
Marjolein de Jong, the director and former oncological surgeon of the Alexander Monro Hospital, stated that they encounter these issues regularly. “Patients are treated disrespectfully, with judgments made solely based on a computer image. It’s embarrassing that someone’s body is evaluated purely based on a photo,” De Jong lamented.
Zorgverzekeraars Nederland (ZN), the trade association for health insurers, responded to these concerns, expressing their openness to discussions with NVPC. ZN stated, “We take the NVPC’s signals regarding potential disparities in treatment seriously and are willing to discuss the current process with them to identify areas of improvement.”
While a breast reconstruction is generally covered as a standard procedure, plastic surgeon Marjolein de Lange from the Alexander Monro Hospital acknowledged that it may not be sufficient in certain cases. “Over time, the breasts settle, and wounds heal. Sometimes, additional surgery is necessary,” de Lange explained.
For Geranne, her issues did not end with the dent in her reconstructed breast. She also experiences significant pain and deformities due to her prosthesis. “I have deformities in my chest. The prosthesis is placed under the pectoral muscle, causing constant tension. This restricts my arm movement and limits my ability to perform household chores. I used to be an avid golfer, but that is no longer possible,” Geranne revealed.
In response, Geranne followed her surgeon’s advice and once again applied for coverage for a breast reconstruction using her own tissue. Sadly, her request was denied yet again. “It is incredibly frustrating. I want to regain my confidence and move on with my life, but that seems impossible now. Essentially, it means that I have to get breast cancer again to qualify,” Geranne expressed her disappointment.
Director Marjolein de Jong argued that the decision to grant follow-up surgeries should be left to the doctors and patients involved. She understands that insurers wish to distinguish between purely aesthetic operations and reconstructions for breast cancer. However, de Jong believes the current process is overly complicated and time-consuming. She stated, “The doctor and patient should be trusted to decide whether surgery is necessary.”
De Jong also refuted the notion that women might abuse the system to obtain larger breasts. “These patients are grateful to be alive. A successful reconstruction significantly improves their quality of life. No woman seeks additional operations for pleasure after enduring such a challenging process,” she asserted.
Geranne now hopes that health insurers will revise their protocols. “I hope they take breast cancer patients more seriously and trust the expertise of plastic surgeons specializing in reconstructions. These professionals have more knowledge about this field than someone sitting in an office looking at pictures,” Geranne shared her desire for change.
The issue of breast reconstruction rejections and the subsequent distrust among breast cancer patients and surgeons has shed light on the need for a more patient-centered and empathetic approach to insurance claim assessments.]
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