news item | 12-19-2022 | 09:00
For women who have to have a mastectomy due to or to prevent breast cancer, care is provided to completely reconstruct the breast using their own fat cells. This is the conclusion reached by the National Institute of Health Care in “Standpunt AFT After Total Breast Removal.” The Zorginstituut attaches several conditions to the AFT compensation that healthcare providers must meet in order to be allowed to offer and perform the procedure.
AFT or Autologous Fat Transplantation with Expansion of External Tissue, as this surgical technique is medically called, is effective care according to the National Institutes of Health Care. In addition, fewer side effects and greater patient satisfaction are reported compared to standard breast reconstruction using silicone implants. Zorginstituut estimates that between 600 and 900 women who have had their breasts removed because of or for breast cancer prevention qualify for the procedure each year.
Not every woman will choose AFT
AFT with external tissue expansion is a surgical technique in which the skin in the breast area is first stretched using a special bra (expander) with a vacuum pump, which must be worn for at least 10 hours a day. When the skin is sufficiently tightened, a new breast is formed from fat cells from your own body during several surgical sessions (an average of 3 to 4 sessions). Because wearing an expander on a daily basis takes a lot of discipline and also requires multiple surgeries to build a new breast or breasts with fat cells, AFT will not be every eligible woman’s choice. Therefore, good patient information and joint decision-making is one of the conditions that the Zorginstituut sets for health insurance companies and caregivers when purchasing and providing them.
Conditional admission scheme
Since October 1, 2015, AFT with external tissue expansion has already been secured through a scheme of conditional admission to a limited group of women who have been involved in scientific research into its efficacy and cost-effectiveness. During the so-called releasedIn the study of 191 women, AFT was compared to standard breast reconstruction using silicone implants. According to the Zorginstituut, this study provided scientific evidence that AFT is a sufficiently proven effective treatment for women who have had a mastectomy for breast cancer or who have had it prophylactically. This means that AFT with external tissue expansion meets the state-of-the-art legal standard and treatment reimbursement will continue for the identified target group after conditional admission ends, even after January 1, 2023.
Proper care terms and guarantees
The Zorginstituut imposes payment conditions in order to ensure adequate care for patients. The professional group of plastic surgeons has now developed a guarantee document with patient representatives and health insurance companies. This contains agreements to provide appropriate and effective care and provide insight into the quality of that care. relating to the following agreements:
- Selection criteria ensuring that only women who have had breast enlargement due to breast cancer or for prevention are eligible for AFT with exogenous tissue expansion.
- How and when the professional group, patients’ association, and health insurers will develop joint guidelines for joint decision-making. The aim is to properly inform women about the advantages and disadvantages of AFT, so that they can make a well-informed choice of the most appropriate treatment with their practitioner.
- How and when to establish training and training requirements for plastic surgeons to allow them to perform this surgical technique.
- Since it is not yet sufficiently clear what effect AFT has on women’s quality of life and also whether care is sufficiently cost-effective, data recording is essential for monitoring and evaluation.
About the National Institute of Health Care
Everyone who lives or works in the Netherlands is obliged to have health insurance. Zorginstituut Nederland is a state organization whose main task is to compile the basic health insurance package. We make complex but necessary choices to ensure that everyone in the Netherlands receives quality care. Now and in the future.
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