Overview of CPT Code 19351: Breast Reconstruction with Implant
CPT Code 19351 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 19351 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.
- Breast reconstruction for patients with congenital breast deformities.
- 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 deformities.
- Trauma or injury to the breast area.
Diagnostic Tests Before Procedure
Prior to the procedure, several diagnostic tests may be performed to ensure patient suitability:
- Mammography to assess breast tissue.
- MRI for detailed imaging of breast anatomy.
- Blood tests to evaluate overall health and surgical risk.
- Physical examination to assess breast tissue and skin condition.
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 dressing applied to protect the surgical site.
Preparation for the Procedure
Patients should follow these steps to prepare for their surgery:
- Consult with the surgeon to discuss expectations and risks.
- Stop smoking and avoid blood-thinning medications as advised.
- Arrange for transportation to and from the surgery center.
- Follow pre-operative fasting instructions as directed.
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 keep the surgical site clean.
- Pain management with prescribed medications as needed.
Possible Complications
While generally safe, this procedure carries some risks, including:
- Infection at the surgical site.
- Bleeding or hematoma formation.
- Implant rupture or leakage.
- Capsular contracture, leading to hardening around the implant.
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Post-Procedure Follow-Up
Follow-up care is crucial for optimal recovery:
- First follow-up appointment within 1 week post-surgery.
- Subsequent visits at 1 month, 3 months, and 6 months.
- Regular monitoring for any signs of complications or concerns.
Alternative Treatments
Patients may consider these non-surgical options:
- Prosthetic breast forms for temporary reconstruction.
- Fat grafting to improve breast contour.
- Psychological counseling to address body image 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 strenuous activities and heavy lifting for several weeks.
- Monitor for any signs of infection or unusual symptoms.
Patient Education & Prevention
To prevent complications and recurrence, patients should be informed about:
- Regular breast self-exams and mammograms as advised.
- Healthy lifestyle choices, including diet and exercise.
- Awareness of changes in breast appearance or sensation.
Billing and Coding Information
CPT Code: 19351
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 cost ranges 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
- 19357 - Breast Reconstruction with Tissue Expander
- 19340 - Breast Reconstruction with Implant
- 19342 - Breast Reconstruction with Implant
- 19330 - Breast Reconstruction, Immediate or Delayed
- 19350 - Breast Reconstruction with Tissue Expander
References and Sources
Frequently Asked Questions (FAQs)
What is breast reconstruction?
Breast reconstruction is a surgical procedure to restore the shape and appearance of the breast after mastectomy.
How long does recovery take?
Recovery typically takes 4 to 6 weeks, but it varies by individual.
Will my insurance cover this procedure?
Most insurance plans cover breast reconstruction after mastectomy, but it's best to check with your provider.
Are there risks involved?
Yes, like any surgery, there are risks such as infection, bleeding, and complications with the implant.
Can I have reconstruction at the same time as my mastectomy?
Yes, many patients opt for immediate reconstruction during their mastectomy.
