Overview of CPT Code 19328: Breast Reconstruction with Implant

Overview of CPT Code 19328: Breast Reconstruction with Implant

CPT Code 19328 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 19328 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 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 the breast area, often following the natural breast fold.
• 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, followed by dressing application.

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 and implant position.

Possible Complications

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

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

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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 solutions.
• Fat grafting to improve breast contour.
• Psychological counseling for emotional support.

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.
• Stay hydrated and maintain a balanced diet for healing.

Patient Education & Prevention

To prevent complications and promote healing:

• 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: 19328

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.
• Out-of-pocket costs may apply depending on the insurance policy.

Related CPT Codes

• 19325 - Breast Reconstruction with Implant
• 19330 - Breast Reconstruction, Immediate or Delayed
• 19340 - Breast Reconstruction with Implant
• 19350 - Breast Reconstruction with Tissue Expander
• 19360 - Breast Reduction Surgery

References and Sources

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