Breast Reconstruction Surgery in the Netherlands, an Alternative Payment Method for Breast Reconstruction Surgery. Are Extra Fees Feasible in the Context of Reconstructive Surgery?


  •   Saeed Alqahtani

  •   Mohammed Ahmedhani Kilani

  •   Shahbaz Mansoor


Breast cancer is the most common cancer in women in the Netherlands, and breast reconstruction is becoming a common surgical procedure for women who have had a mastectomy. Reconstruction post breast cancer treatment is covered by conditional reimbursement until 01-04-2020 as long as it as an autologous fat transplant. Conditional reimbursements are special legal exceptions under constant consideration by the Ministry of Health and require evidence on treatment and cost effectiveness to be moved to basic healthcare package.

Surgeons at Maastricht UMC+ have developed sophisticated techniques for women that undergo a reconstruction surgery to recover sensitivity of the breasts. Improved sensitization would lead to a better quality of life and protect the skin against thermal and mechanical injuries. However, current health insurance coverage of breast reconstruction does not permit these additions. Furthermore, the reimbursement system in The Netherlands does not allow people to pay an extra fee for these additions.

Keywords: Breast reconstruction, Reimbursement system, Public Health Insurance, Netherlands


S Youlden DR, Cramb SM, Dunn NA, et al. The descriptive epidemiology of female breast cancer: an international comparison of screening, incidence, survival and mortality, Cancer Epidemiol, 2012, vol. 36 (pg. 237-48).

Beugels, J., Bod, L., van Kuijk, S. M. J., Qiu, S. S., Tuinder, S. M. H., Heuts, E. M., . . . van der Hulst, R. (2018). Complications following immediate compared to delayed deep inferior epigastric artery perforator flap breast reconstructions. Breast Cancer Res Treat. doi:10.1007/s10549-018-4695-0

Tuinder, S., Baetens, T., De Haan, M. W., Piatkowski de Grzymala, A., Booi, A. D., Van Der Hulst, R., & Lataster, A. (2014). Septocutaneous tensor fasciae latae perforator flap for breast reconstruction: radiological considerations and clinical cases. 2014 Sep;67(9):1248-56. doi: 10.1016/j.bjps.2014.05.008. Epub 2014 May 16. PMID: 24912743

Healy, C., & Allen, R. J., Sr. (2014). The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap. J Reconstr Microsurg, 30(2), 121-125. doi:10.1055/s-0033-1357272

Cornelissen, A. J. M., Beugels, J., Lataster, A., Heuts, E. M., Rozen, S. M., Spiegel, A. J., Tuinder, S. M. H. (2018). Comparing the sensation of common donor site regions for autologous breast reconstruction to that of a healthy breast. J Plast Reconstr Aesthet Surg, 71(3), 327-335. doi:10.1016/j.bjps.2017.09.011

Beugels, J., Cornelissen, A. J. M., Spiegel, A. J., Heuts, E. M., Piatkowski, A., van der Hulst, R., & Tuinder, S. M. H. (2017). Sensory recovery of the breast after innervated and non-innervated autologous breast reconstructions: A systematic review. J Plast Reconstr Aesthet Surg, 70(9), 1229-1241. doi:10.1016/j.bjps.2017.05.00

Cornelissen, A. J. M., Beugels, J., van Kuijk, S. M. J., Heuts, E. M., Rozen, S. M., Spiegel, A.J., . . .Tuinder, S. M. H. (2018). Sensation of the autologous reconstructed breast improves quality of life: a pilot study. Breast Cancer Res Treat, 167(3), 687-695. doi:10.1007/s10549-017-4547-3

Stevens LA, McGrath MH, Druss RG, Kister SJ, Gump FE, Forde KA. (1984). The psychological impact of immediate breast reconstruction for women with early breast cancer. Plast Reconstr Surg. 73 (4), pp. 619-28.

Edström E, Brandberg Y, Björklund T, Rylander R, Lagergren J, Jurell G, Wickman M, Sandelin K. (2005). Quality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: a prospective study. The Breast. 14 (3), pp. 201–208.

Cornelissen, Beugels, van Kuijk, Heuts, Rozen, Spiegel, van der Hulst, Tuinder. (2017). Sensation of the autologous reconstructed breast improves quality of life: a pilot study. Breast Cancer Research and Treatment. 167 (3), pp. 687–695.

Health Insurance Act (Zorgverzekeringswet) (Bulletin of Acts, Orders and Decrees 2005, 358), as amended by the Act of 29 October 2009 (Bulletin of Acts, Orders and Decrees 2009, 486).

Social Support Act (Wet maatschappelijke ondersteuning) (Bulletin of Acts, Orders and Decrees 2006, 351), as amended by the Act of 4 June 2010 (Bulletin of Acts, Orders and Decrees 2010, 269).

Health Care (Market Regulations) Act (Wet marktordening gezondheidszorg) (Bulletin of Acts, Orders and Decrees 2006, 415), as amended by the Act of 25 June 2009 (Bulletin of Acts, Orders and Decrees 2009, 265).

Bakker P, Jansen P (2013). Generalistische Basis GGZ. Verwijsmodel productbeschrijvingen [Generalistic Basic Mental Care, mode of referral and description of products]. Enschede. Bartholomée Y, Maarse H (2006). Health insurance reform in the Netherlands. Eurohealth,12(2):7–9.

Health Care Insurance Board (CVZ) (2009). Landen waarmee Nederland afspraken heeftgemaakt [Countries with which the Netherlands has made agreements]. Diemen: Health Care Insurance Board (, accessed 8 January 2009).

Health Systems in transition (2016), Vol 18, No.2. Netherlands Health system review. Accessed at:

Health Insurance in the Netherlands (2011). Accessed at: h-insurance-in-the-netherlands/health-insurance-in-the-netherlands.pdf

Public Health Insurance, Supplementary insurances and Dental insurances (2018). HollandZorg. Accessed at:

Decree of 28 June 2005, establishing an order in council as referred to in Articles 11, 20, 22, 32, 34 and 89 of the Healthcare Insurance Act (Health Insurance Decree). Accessed at:

Plast Reconstr Aesthet Surg, 67(9), 1248-1256. doi:10.1016/j.bjps.2014.05.008

Duine, T. J. College voor zorgverzekeringen. (2011). Standpunt multifocale en accommoderende lenzen na cataractoperatie.

Intraocular Lenses (IOLs): Including Premium, Toric and Aspheric Designs. (n.d.). Retrieved from

Multifocal IOLs vs Monofocal and Accommodating IOLs. (n.d.). Retrieved from

Staal, P. C., Blekkenhorst, B., Latta, J. M., Ligtenberg, G., van der Meer, F. M., van Saase, A.M. C. College voor zorgverzekeringen. (2009). Betekenis en beoordeling criterium 'plegen te bieden’.

Dutch Healthcare Authority (2015a). Bijlage 12 bij circulaire Care/Wlz/15/07c. Beleidsregel CA-BR-1607: Prestatiebeschrijvingen en tarieven zorgzwaartepakketten [Appendix 12 to policy letter Care/Wlz/15/07c. Regulation CA-BR-1607; product description and tariffs care intensity packages]. Utrecht: Nederlandse Zorgautoriteit.

DBC system. Accessed at:

Breidert, C., Hahsler, M., Reutterer, T. (2006). A review of methods for measuring willingness-to-pay. Innovative Marketing, 2(4)

Gamlen, C., Clancy, T. R., Moengen, D., & Rauen, J. (2012). Measuring return on investment in complex healthcare systems. J Nurs Adm, 42(7-8), 353-355. doi:10.1097/NNA.0b013e3182619165

Simoens S. Health Economic Assessment: A Methodological Primer. International Journal of Environmental Research and Public Health. 2009;6(12):2950-2966. doi:10.3390/ijerph6122950.

Regulation of the Minister of Health, Welfare and Sport of 1 September 2005, no. Z / VV-2611957, containing rules concerning the implementation of the Health Insurance Act

Meijer R & Rutgers H. Health-care costing in the Netherlands (2010). BMC Health Services Research, 10 (Suppl 2): A 20. doi: 10.1186/1472-6963-10-S2-A20

Conditional reimbursements of healthcare (2012). Accessed at:

Raine van de Brink (2014). Reimbursement of orphan drugs: the Pompe and Fabry case in the Netherlands. Orphanet Journal of Rare diseases, 9 (suppl 1): 017, doi: 10.1186/1750-1172-9-S1-O17


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How to Cite
Alqahtani, S., Kilani, M., & Mansoor, S. (2020). Breast Reconstruction Surgery in the Netherlands, an Alternative Payment Method for Breast Reconstruction Surgery. Are Extra Fees Feasible in the Context of Reconstructive Surgery?. European Journal of Medical and Health Sciences, 2(1).