Overview of CPT Code 19331: Breast Reconstruction with Implant

Overview of CPT Code 19331: Breast Reconstruction with Implant

CPT Code 19331 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 19331 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 resulted in deformity.
• Trauma or injury to the breast area.

Diagnostic Tests Before Procedure

Before undergoing breast reconstruction, several diagnostic tests may be performed to ensure patient suitability:

• Mammography to assess breast tissue.
• MRI or ultrasound for detailed imaging of breast structures.
• 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 breast tissue or chest muscle.
• Insertion of the breast implant into the pocket.
• Closure of incisions with sutures or adhesive strips.
• Post-operative monitoring for complications.

Preparation for the Procedure

Patients should follow these steps to prepare for breast reconstruction:

• Consult with the surgical team to discuss expectations and concerns.
• 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 the following:

• Initial recovery period of 1 to 2 weeks with limited physical activity.
• Regular follow-up appointments to monitor healing.
• Wound care instructions to prevent infection.
• Pain management with prescribed medications.

Possible Complications

While breast reconstruction is generally safe, potential complications include:

• Infection at the surgical site.
• Bleeding or hematoma formation.
• Implant rupture or leakage.
• Scarring or changes in breast sensation.

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Post-Procedure Follow-Up

Follow-up care is crucial for successful recovery:

• Initial follow-up within 1 to 2 weeks post-surgery.
• Subsequent visits at 1 month, 3 months, and 6 months.
• Long-term monitoring for implant integrity and breast health.

Alternative Treatments

Patients may consider these non-surgical options:

• Prosthetic breast forms for temporary solutions.
• Fat grafting techniques to improve breast contour.
• Psychological counseling 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.
• Avoid heavy lifting and strenuous activities.
• Stay hydrated and maintain a balanced diet.

Patient Education & Prevention

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

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

Billing and Coding Information

CPT Code: 19331

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.
• Out-of-pocket costs may apply based on individual insurance policies.

Related CPT Codes

• 19340 - Breast Reconstruction with Implant
• 19342 - Breast Reconstruction with Implant
• 19350 - Breast Reconstruction with Tissue Expander

References and Sources

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