Overview of CPT Code 19306: Breast Reconstruction, Implant
CPT Code 19306 refers to the surgical procedure of breast reconstruction using implants, typically performed after mastectomy or lumpectomy due to breast cancer or other conditions.
When CPT Code 19306 is Used?
This procedure is indicated in various clinical scenarios.
- Post-mastectomy breast reconstruction for breast cancer patients.
- Reconstruction after lumpectomy when significant breast tissue is removed.
- Correction of congenital breast deformities.
- Reconstruction following traumatic breast injuries.
Symptoms Indicating This Procedure
Patients may report several symptoms that lead to the need for this procedure.
- Loss of breast tissue due to surgery or trauma.
- Desire for improved breast symmetry.
- Psychological distress related to breast loss.
- Physical discomfort from breast asymmetry.
Causes and Risk Factors
Several factors can lead to the need for breast reconstruction.
- Breast cancer requiring mastectomy.
- Genetic predisposition to breast cancer.
- Previous breast surgeries that resulted in deformity.
- Trauma or injury to the breast area.
Diagnostic Tests Before Procedure
Certain tests are performed to ensure the patient is a suitable candidate for the procedure.
- Mammography to assess breast tissue.
- MRI for detailed imaging of breast structures.
- Biopsy to confirm the absence of cancer in remaining tissue.
- Blood tests to evaluate overall health.
Procedure Description
The procedure involves several key steps.
- Anesthesia is administered to ensure patient comfort.
- Incisions are made in the breast area.
- The implant is placed either under the chest muscle or over it.
- Incisions are closed with sutures, and dressings are applied.
- Post-operative monitoring is conducted to ensure stability.
Preparation for the Procedure
Patients should follow specific guidelines before surgery.
- Consult with the surgeon about medical history and medications.
- Avoid blood thinners and certain supplements as advised.
- Arrange for transportation to and from the procedure.
- Follow fasting instructions prior to anesthesia.
Recovery and Aftercare
Recovery involves several important aspects.
- Initial recovery period lasts about 1-2 weeks.
- Wound care includes keeping the area clean and dry.
- Pain management with prescribed medications.
- Follow-up appointments to monitor healing and implant position.
Possible Complications
As with any surgery, there are potential risks.
- Infection at the surgical site.
- Implant rupture or leakage.
- Capsular contracture leading to hardening around the implant.
- Changes in nipple sensation.
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Post-Procedure Follow-Up
Regular follow-up is crucial for monitoring recovery.
- First follow-up within a week post-surgery.
- Subsequent visits at 1 month, 3 months, and 6 months.
- Annual check-ups to assess implant condition and breast health.
Alternative Treatments
There are non-surgical options available.
- Prosthetic breast forms for external use.
- Fat grafting to improve breast contour.
- Psychological counseling for emotional support.
Home Care Tips
Patients can take steps to aid their recovery at home.
- Wear a supportive bra as recommended.
- Avoid strenuous activities for several weeks.
- Keep the surgical area clean and dry.
- Monitor for signs of infection such as increased redness or swelling.
Patient Education & Prevention
Education is key to preventing complications.
- Understand the signs of complications and when to seek help.
- Discuss lifestyle changes that may reduce cancer risk.
- Stay informed about breast health and regular screenings.
Billing and Coding Information
CPT Code: 19306
Category: Surgery
Common Modifiers:
- 50 - Bilateral procedure
- RT - Right side
- LT - Left side
Average Cost and Insurance Coverage
Costs can vary based on several factors.
- Average cost ranges from $7,000 to $15,000.
- Insurance may cover the procedure if deemed medically necessary.
- Out-of-pocket costs depend on the insurance plan and deductible.
Related CPT Codes
- 19301 - Breast Reconstruction, Unilateral
- 19302 - Breast Reconstruction with Implant
- 19303 - Breast Reconstruction with Implant
- 19304 - Breast Reconstruction with Implant
- 19305 - Breast Reconstruction with Implant
References and Sources
Frequently Asked Questions (FAQs)
What is breast reconstruction?
Breast reconstruction is a surgical procedure to rebuild the shape of the breast after mastectomy.
How long does the recovery take?
Recovery typically takes 1-2 weeks, but full healing may take longer.
Will insurance cover the procedure?
Many insurance plans cover breast reconstruction if it is deemed medically necessary.
Are there risks involved?
Yes, like any surgery, there are risks such as infection and implant complications.
Can I have reconstruction at the same time as my mastectomy?
Yes, many patients opt for immediate reconstruction during their mastectomy.
