Proper care agreements for total breast reconstruction with own fat cells | Information

News article | 19-12-2022 | 09:00

AFT, or autologous fat grafting with external tissue expansion, as this surgical technique is called in medical terms, is an effective treatment according to the National Institute of Health Care. In addition, fewer side effects and more patient satisfaction are recorded compared to standard breast reconstruction with silicone implants. The Zorginstituut estimates that each year between 600 and 900 women who have had their breasts removed due to breast cancer or as a preventive measure are eligible for the procedure.

Not all women 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 should be worn for at least 10 hours a day. When the skin has been stretched enough, a new breast is reconstituted with fat cells from your own body over several surgery sessions (on average 3 to 4). Because wearing the extender every day takes a lot of discipline and also requires multiple surgeries to build the new breast or breasts with fat cells, AFT will not be the choice of all women who qualify. Good patient information and shared decision-making are therefore one of the conditions that the Zorginstituut sets for health insurers and care providers when purchasing and offering.

Conditional admission scheme

Since October 1, 2015, AFT with external tissue expansion is already provided under the conditional admission scheme for a limited group of women who have participated in scientific research on its effectiveness and cost-effectiveness. During the so-called BREASTstudy in which 191 women participated, AFT was compared to standard breast reconstruction with silicone implants. According to the Zorginstituut, this study provided scientific evidence that AFT is a sufficiently proven effective treatment for women who have undergone breast removal due to breast cancer or who have had it done for prevention. Accordingly, AFT with external tissue expansion meets the legal state of science and practice criterion and the treatment will continue to be reimbursed for the defined target group after the end of conditional admission, even after the 1st January 2023.

Conditions and guarantees for adapted care

The Zorginstituut attaches conditions to the reimbursement in order to guarantee appropriate patient care. The professional group of plastic surgeons has now drawn up a guarantee document in collaboration with patient representatives and health insurers. This contains the agreements to provide appropriate and effective care and to outline the quality of that care. These are the following agreements:

• Selection criteria guaranteeing that only women who have undergone breast enlargement due to breast cancer or as a preventive measure are eligible for AFT with external tissue expansion.
• How and when the professional group, patient association and health insurers will jointly develop guidelines for shared decision-making. The objective is to properly inform women about the advantages and disadvantages of AFT, so that they can make a well-considered choice of the most suitable treatment with their practitioner.
• How and when and education and training requirements are developed for plastic surgeons to be licensed to perform this surgical technique.
• Because 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 necessary for monitoring and evaluation. .

About the National Institute of Health

Everyone who lives or works in the Netherlands is required to have health insurance. Zorginstituut Nederland is a government organization whose main task is to compile the basic health insurance package. We make complicated but necessary choices to ensure that everyone in the Netherlands can receive good care. Now and in the future.