Overview of CPT Code 19318: Breast Reconstruction with Implant

Overview of CPT Code 19318: Breast Reconstruction with Implant

CPT Code 19318 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 psychological well-being.

When CPT Code 19318 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.
• Desire for symmetry in breast appearance.
• Physical discomfort or issues related to breast asymmetry.

Causes and Risk Factors

Several factors may lead to the need for breast reconstruction:

• Breast cancer requiring mastectomy.
• Genetic predisposition to breast cancer (e.g., BRCA mutations).
• Previous breast surgeries that resulted in deformity.
• Congenital conditions affecting breast development.

Diagnostic Tests Before Procedure

Before undergoing breast reconstruction, several diagnostic tests may be performed:

• Mammography to assess breast tissue.
• MRI to evaluate breast anatomy and any underlying issues.
• Biopsy of any suspicious areas to rule out cancer.
• Blood tests to assess overall health and suitability for surgery.

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 breast fold.
• The surgeon creates a pocket for the implant beneath the chest muscle or breast tissue.
• The implant is inserted and positioned appropriately.
• 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 transportation to and from the surgery.
• Follow pre-operative fasting instructions provided by the healthcare team.

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 and implant position.

Possible Complications

While breast reconstruction is generally safe, potential complications include:

• Infection at the surgical site.
• Bleeding or hematoma formation.
• Capsular contracture around the implant.
• Changes in nipple sensation or breast sensitivity.

Secure, compliant, and built for trust

HIPAA-compliant and designed with privacy in mind, your patient’s data is protected. Focus on care while we safeguard your information.

Learn more

Post-Procedure Follow-Up

Follow-up care is essential for optimal recovery:

• Initial follow-up within one week to assess healing.
• Subsequent visits at 1 month, 3 months, and 6 months post-surgery.
• Long-term monitoring for any complications or changes in breast appearance.

Alternative Treatments

Patients may consider these alternatives to surgical reconstruction:

• Prosthetic breast forms for external use.
• Fat grafting techniques to improve breast contour.
• Psychological counseling to address body image concerns.

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 promote recovery:

• Understand the signs of infection and when to contact a doctor.
• Follow all post-operative care instructions carefully.
• Attend all scheduled follow-up appointments.
• Discuss any concerns about breast health with a healthcare provider.

Billing and Coding Information

CPT Code: 19318

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

• 19316 - Breast Reconstruction with Implant
• 19325 - Breast Reconstruction with Implant
• 19330 - Breast Reconstruction, Immediate or Delayed
• 19340 - Breast Reconstruction with Implant

References and Sources

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