Overview of CPT Code 19325: Breast Reconstruction with Implant

Overview of CPT Code 19325: Breast Reconstruction with Implant

CPT Code 19325 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 19325 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 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.
• MRI to evaluate breast anatomy and any remaining tissue.
• Blood tests to ensure 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 contours.
• 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 certain medications that can increase bleeding.
• 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.
• 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 monitoring recovery:

• Initial follow-up within 1 to 2 weeks post-surgery.
• Subsequent visits at 1 month, 3 months, and 6 months.
• Ongoing assessments for implant integrity and breast appearance.

Alternative Treatments

Patients may consider these non-surgical options:

• Prosthetic breast forms for temporary solutions.
• Counseling and support groups for emotional support.
• Physical therapy to address any post-surgical mobility issues.

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 heavy lifting and strenuous activities for several weeks.
• Stay hydrated and maintain a balanced diet to promote healing.

Patient Education & Prevention

To prevent complications and recurrence, patients should be aware of:

• Regular breast screenings and self-exams.
• Awareness of changes in breast appearance or sensation.
• Healthy lifestyle choices to reduce cancer risk.

Billing and Coding Information

CPT Code: 19325

Category: Surgery

Common Modifiers:

• 50
• RT
• LT

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
• 19318 - Breast Reconstruction with Implant
• 19330 - Breast Reconstruction, Immediate or Delayed
• 19340 - Breast Reconstruction with Implant
• 19350 - Breast Reconstruction with Tissue Expander

References and Sources

• American Society of Plastic Surgeons
• National Cancer Institute
• Breastcancer.org