In this blog, I reflect on a deep-rooted problem in the care of women undergoing breast reconstruction after breast cancer. Every year, some 17,000 women are diagnosed with breast cancer, of which about 6,000 undergo breast reconstruction, but only a small percentage receive the necessary medical tattoo, the nipple tattoo. This blog begins in the world of permanent make-up and medical tattooing, where, as an expert, I am confronted daily with the suffering caused by this lack of care. The news that hit me recently about Reconstruction after cancer being reimbursed by default except for breast cancer hit me. The blog on the International Women’s Day website on‘Power of the health insurer’ is also about the problem women face, a rejected breast reconstruction. It is time for action. Do you read along?
With breast reconstruction, not always the same attention is paid to completing the process of breast reconstruction with a nipple-hole tattoo. Nationwide, only 25% of women are offered breast reconstruction in their care pathway. That should include a nipple tattoo as standard. It isn’t. Bringing back that nipple with permanent colour happens even less often than those 25% who do undergo breast reconstruction. At the Antoni van Leeuwenhoek Hospital (AVL), this percentage is 77%. This also applies, for example, to the Alexander Monro specialist hospital, where the percentage is also higher.
According to the AVL, this disparity is due to the way care is explained to these women. But what happens to the women who do not receive this care? The consequences of mastectomy are harrowing, and this is something I see all too well in my practice Permanent Mooi Den Bosch. I provide the‘icing on the cake‘ to women who are familiar with this solution. I draw back the missing nipple with specialist permanent make-up.
A nipple tattoo is often an overlooked part of hospital care for women with breast reconstruction. Statistics on how often these tattoos are performed are not even kept. The medical tattooing profession has no DBC code or other code that makes it eligible for reimbursement. The hospital often assumes that plastic surgeons or other staff take on this task. And that is at the heart of the problem.
The sad consequence is that patients, the man or woman who has just come out of breast cancer are often left to fend for themselves. Do you search Google for medical tattoo, nipple hip tattoo or colouring scars? Of course, you will find a number of options from medical tattooists. Only they cannot bill with a DBC code. These DBCs represent all possible diagnoses, treatments and their costs. Healthcare providers record the diagnosis, treatment and costs in a so-called Diagnosis Treatment Combination (DBC).
So the medical tattooists found can do the nipple hip tattoo, but it is not reimbursed. There is no DBC code because insurers assume this care is performed in a hospital. Not so… as it turns out.
This causes a lot of stress to patients, which does not help recovery. The stress is not only with the patient, also in the implementation as in reimbursements from insurers.
Women have to fight for something that should be a natural part of their care. And I am referring to, as I wrote earlier, ‘icing on the cake‘. Especially after a lengthy process of being sick, having breast cancer and recovering, concluding with breast reconstruction. Although insurers reimburse psychological care for the loss of a breast, at that point the nipple tattoo is seen as cosmetic and no longer necessary.
My proposal is to require insurers to allow hospitals to choose breast reconstruction WITH nipple tattooing. It should no longer be optional, but a mandatory part of care.
That obligation on hospitals should also be backed up by a number of other things such as:
My proposal as would be an important step towards more inclusive and understanding care for women who have overcome breast cancer. The NOS news report on reimbursement for breast reconstruction has raised dust among healthcare providers and insurers. It is an advantage that this news has spread, as the conversation I started.
It is high time we committed to making a change. We must ensure that every woman (and man) who overcomes breast cancer gets the full care he or she deserves. That means breast reconstruction and certainly medical tattooing, or nipple-hole tattooing. That is very last step in the healing process and restoring their self-confidence, ‘the icing on the cake, .
