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

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.

Neuroprotection, Recovery of Function and Endogenous Neurogenesis in Traumatic Spinal Cord Injury Following Transplantation of Activated Adipose Tissue

Spinal cord injury (SCI) is a devastating disease, which leads to paralysis and is associated to substantially high costs for the individual and society. At present, no effective therapies are available. Here, the use of mechanically-activated lipoaspirate adipose tissue (MALS) in a murine experimental model of SCI is presented. Our results show that, following acute intraspinal MALS transplantation, there is an engraftment at injury site with the acute powerful inhibition of the posttraumatic inflammatory response, followed by a significant progressive improvement in recovery of function. This is accompanied by spinal cord tissue preservation at the lesion site with the promotion of endogenous neurogenesis as indicated by the significant increase of Nestin-positive cells in perilesional areas. Cells originated from MALS infiltrate profoundly the recipient cord, while the extra-dural fat transplant is gradually impoverished in stromal cells. Altogether, these novel results suggest the potential of MALS application in the promotion of recovery in SCI.