Overview of CPT Code 19316: Breast Reconstruction with Implant

Overview of CPT Code 19316: Breast Reconstruction with Implant

CPT Code 19316 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 19316 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 concerns that lead to the consideration of this procedure:

• Loss of breast shape or volume after mastectomy.
• Psychological distress related to body image post-surgery.
• Desire for symmetry in breast appearance.
• Physical discomfort or dissatisfaction with the current breast contour.

Causes and Risk Factors

Several factors may 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 resulted in deformity.
• Radiation therapy affecting 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 structures.
• Blood tests to evaluate overall health and surgical risk.

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, often following the natural contour.
• The implant is placed either directly under the breast tissue or beneath the chest muscle.
• 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.
• Follow any specific dietary restrictions prior to surgery.

Recovery and Aftercare

Post-operative recovery typically involves:

• A recovery period of 4 to 6 weeks, with gradual return to normal activities.
• Wound care instructions to keep the surgical site clean and dry.
• Pain management with prescribed medications as needed.
• Regular follow-up appointments to monitor healing.

Possible Complications

As with any surgical procedure, there are potential risks, including:

• Infection at the surgical site.
• Bleeding or hematoma formation.
• 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 essential for optimal recovery:

• Initial follow-up within 1 to 2 weeks post-surgery.
• Subsequent visits at 1 month, 3 months, and 6 months.
• Ongoing monitoring for any complications or concerns.

Alternative Treatments

Patients may consider these non-surgical options:

• Prosthetic breast forms for temporary reconstruction.
• Fat grafting techniques to improve breast contour.
• Counseling and support groups for emotional support.

Home Care Tips

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

• 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.
• Stay hydrated and maintain a balanced diet to promote healing.

Patient Education & Prevention

To prevent complications and recurrence, patients should:

• Attend regular follow-up appointments for monitoring.
• Be aware of signs of complications, such as unusual swelling or pain.
• Discuss any concerns with healthcare providers promptly.
• Consider genetic counseling if there is a family history of breast cancer.

Billing and Coding Information

CPT Code: 19316

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 costs range from $7,000 to $15,000 depending on complexity.
• Most insurance plans cover breast reconstruction after mastectomy.
• Patients should verify coverage details with their insurance provider.

Related CPT Codes

• 19318 - 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