Overview of CPT Code 19355: Breast Reconstruction with Implant

Overview of CPT Code 19355: Breast Reconstruction with Implant

CPT Code 19355 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 19355 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, 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:

• Mammography to assess breast tissue.
• MRI or ultrasound for detailed imaging of breast structures.
• Biopsy to confirm the absence of cancer in remaining breast tissue.
• Blood tests to evaluate overall health and surgical risk.

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 implant is placed either directly under the breast tissue or beneath the chest muscle.
• The incision is closed with sutures, and dressings are applied.
• Post-operative monitoring is conducted to ensure proper recovery.

Preparation for the Procedure

Patients should follow these steps to prepare for breast reconstruction:

• Consult with the surgical team 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 and dry.
• Pain management with prescribed medications as needed.

Possible Complications

While breast reconstruction is generally safe, potential complications include:

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

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Post-Procedure Follow-Up

Follow-up care is crucial for optimal recovery:

• Initial follow-up within 1 week to assess healing.
• Subsequent visits at 1 month, 3 months, and 6 months post-surgery.
• 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.
• Counseling and support groups 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 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 self-exams and mammograms as advised.
• Awareness of changes in breast appearance or sensation.
• Healthy lifestyle choices, including diet and exercise.
• Genetic counseling if there is a family history of breast cancer.

Billing and Coding Information

CPT Code: 19355

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

• 19357 - Breast Reconstruction with Tissue Expander
• 19340 - Breast Reconstruction with Implant
• 19361 - Breast Reconstruction with Implant
• 19350 - Breast Reconstruction with Tissue Expander
• 19355 - Breast Reconstruction with Implant

References and Sources

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