Overview of CPT Code 19311: Breast Reconstruction with Implant

Overview of CPT Code 19311: Breast Reconstruction with Implant

CPT Code 19311 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 physical and emotional well-being.

When CPT Code 19311 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.
• Reconstruction for congenital breast deformities or asymmetry.
• Reconstruction following trauma or injury to the breast.

Symptoms Indicating This Procedure

Patients may report the following symptoms or clinical findings that lead to the consideration of this procedure:

• Loss of breast shape or volume after mastectomy.
• Psychological distress related to breast loss.
• Desire for improved body image and self-esteem.
• Physical discomfort or asymmetry due to breast tissue removal.

Causes and Risk Factors

Several factors can lead to the need for breast reconstruction, including:

• Breast cancer diagnosis requiring mastectomy.
• Genetic predisposition to breast cancer (e.g., BRCA mutations).
• Previous breast surgeries that may have altered breast structure.
• Radiation therapy to the breast area that may affect tissue integrity.

Diagnostic Tests Before Procedure

Prior to the procedure, several diagnostic tests may be performed to ensure patient suitability:

• Mammography to assess breast tissue health.
• MRI or ultrasound for detailed imaging of breast tissue.
• Blood tests to evaluate overall health and surgical risk.
• Psychological evaluation to assess readiness for surgery.

Procedure Description

The breast reconstruction procedure typically involves the following steps:

• Anesthesia administration to ensure patient comfort.
• Incision made in a predetermined location to minimize scarring.
• Creation of a pocket for the implant beneath the chest muscle or breast tissue.
• Insertion of the breast implant into the pocket.
• Closure of incisions with sutures or adhesive strips.
• Post-operative monitoring for any immediate complications.

Preparation for the Procedure

Patients should follow these steps to prepare for their surgery:

• Consult with the surgeon to discuss expectations and outcomes.
• Stop smoking and avoid blood-thinning medications as advised.
• Arrange for transportation to and from the surgical facility.
• Follow pre-operative fasting instructions as directed.

Recovery and Aftercare

Post-operative recovery typically involves:

• Resting for several days following surgery.
• Wound care to keep the surgical site clean and dry.
• Wearing a supportive bra as recommended by the surgeon.
• Taking prescribed pain medications and antibiotics as needed.
• Attending follow-up appointments to monitor healing.

Possible Complications

While generally safe, this procedure carries some risks, including:

• Infection at the surgical site.
• Bleeding or hematoma formation.
• Implant rupture or leakage.
• Capsular contracture, leading to hardening around the implant.
• Changes in nipple sensation.

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Post-Procedure Follow-Up

Follow-up care is crucial for monitoring recovery:

• Initial follow-up appointment within one to two weeks post-surgery.
• Regular check-ups every few months for the first year.
• Annual mammograms as recommended for breast health monitoring.
• Ongoing assessments for any complications or concerns.

Alternative Treatments

Patients may consider these non-surgical options:

• Prosthetic breast forms for temporary solutions.
• Fat grafting techniques to enhance breast volume.
• Counseling and support groups for emotional support.
• Physical therapy for post-mastectomy rehabilitation.

Home Care Tips

To aid recovery at home, patients should consider the following:

• Keep the surgical area clean and dry.
• Avoid strenuous activities and heavy lifting for several weeks.
• Follow a balanced diet to promote healing.
• Stay hydrated and rest adequately.

Patient Education & Prevention

To prevent complications and recurrence, patients should:

• Attend regular breast health screenings.
• Discuss family history of breast cancer with healthcare providers.
• Maintain a healthy lifestyle with diet and exercise.
• Be aware of any changes in breast appearance or sensation.

Billing and Coding Information

CPT Code: 19311

Category: Surgery

Common Modifiers:

• 50 - Bilateral procedure
• RT - Right side
• LT - Left side

Average Cost and Insurance Coverage

The cost of breast reconstruction can vary widely:

• Average cost ranges from $7,000 to $15,000 depending on complexity.
• Insurance often covers reconstruction after mastectomy.
• Patients should verify coverage details with their insurance provider.

Related CPT Codes

• 19303 - Breast Reconstruction with Implant
• 19302 - Breast Reconstruction with Implant
• 19307 - Breast Reconstruction with Implant
• 19340 - Breast Reconstruction with Implant
• 19342 - Breast Reconstruction with Implant

References and Sources

• American Society of Plastic Surgeons
• National Cancer Institute
• Breastcancer.org
• Mayo Clinic - Breast Reconstruction