Overview of CPT Code 19307: Breast Reconstruction with Implant
CPT Code 19307 refers to the surgical procedure of breast reconstruction using an implant following mastectomy or breast tissue removal. This procedure aims to restore the breast's shape and appearance, enhancing the patient's body image and self-esteem.
When CPT Code 19307 is Used?
This procedure is indicated in various clinical scenarios, including:
- Post-mastectomy breast reconstruction for patients who have undergone total or partial mastectomy due to breast cancer.
- Reconstruction after lumpectomy when significant breast tissue is removed.
- Patients seeking to restore breast symmetry after unilateral mastectomy.
Symptoms Indicating This Procedure
Patients may report the following symptoms or concerns that lead to this procedure:
- Loss of breast shape or volume after mastectomy.
- Desire for improved body image and self-esteem.
- Physical discomfort or psychological distress related to breast loss.
Causes and Risk Factors
Several factors may lead to the need for breast reconstruction:
- Breast cancer diagnosis requiring mastectomy.
- Genetic predisposition to breast cancer (e.g., BRCA mutations).
- Previous breast surgeries that may have altered breast tissue.
Diagnostic Tests Before Procedure
Before undergoing breast reconstruction, several diagnostic tests may be performed:
- Mammography to assess breast tissue health.
- MRI or ultrasound for detailed imaging of breast tissue.
- Blood tests to evaluate overall health and surgical readiness.
Procedure Description
The breast reconstruction procedure typically involves the following steps:
- Anesthesia is administered to ensure patient comfort.
- An incision is made in the breast area to create a pocket for the implant.
- The implant is inserted into the pocket created.
- The incision is closed with sutures, and dressings are applied.
Preparation for the Procedure
Patients should follow these steps to prepare for breast reconstruction:
- Consult with the surgeon to discuss expectations and outcomes.
- Stop smoking and avoid blood-thinning medications as advised.
- Arrange for post-operative care and transportation home.
Recovery and Aftercare
Post-operative recovery typically includes:
- A recovery period of 4 to 6 weeks is expected.
- Wound care instructions to keep the incision clean and dry.
- Pain management with prescribed medications as needed.
Possible Complications
While generally safe, this procedure carries some risks:
- Infection at the surgical site.
- Implant complications such as rupture or displacement.
- Scarring or changes in breast sensation.
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Post-Procedure Follow-Up
Follow-up care is crucial for monitoring recovery:
- Initial follow-up within one week to check incision healing.
- Subsequent visits at 1, 3, and 6 months post-surgery.
- Long-term monitoring for implant integrity and breast health.
Alternative Treatments
Patients may consider these non-surgical options:
- Prosthetic breast forms for temporary restoration.
- Counseling and support groups for emotional support.
- Fat grafting techniques for minor volume restoration.
Home Care Tips
To aid recovery at home, patients should:
- Keep the surgical area clean and dry.
- Wear a supportive bra as recommended by the surgeon.
- Avoid strenuous activities and heavy lifting for several weeks.
Patient Education & Prevention
To prevent complications and recurrence:
- Regular follow-ups with healthcare providers.
- Awareness of breast health and self-examinations.
- Healthy lifestyle choices to support overall well-being.
Billing and Coding Information
CPT Code: 19307
Category: Surgery
Common Modifiers:
- 50
- RT
- LT
Average Cost and Insurance Coverage
The cost of breast reconstruction can vary:
- Average costs range from $7,000 to $15,000.
- Most insurance plans cover reconstruction after mastectomy.
- Out-of-pocket costs depend on the specific insurance policy.
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 restore the shape and appearance of the breast after mastectomy.
How long does recovery take?
Recovery typically takes 4 to 6 weeks, depending on individual healing.
Will my insurance cover this procedure?
Most insurance plans cover breast reconstruction after mastectomy.
Are there risks involved?
Yes, like any surgery, there are risks such as infection and implant complications.
