Overview of CPT Code 19364: Breast Reconstruction with Implant

Overview of CPT Code 19364: Breast Reconstruction with Implant

CPT Code 19364 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 19364 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 breast loss.
• Desire for improved body image and self-esteem.
• Physical discomfort or asymmetry in the chest area.

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 health.
• MRI or ultrasound for detailed imaging of breast tissue.
• Blood tests to evaluate overall health and surgical readiness.
• Psychological evaluation to assess emotional readiness 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 surgeon creates a pocket for the implant, which may involve using tissue expanders if necessary.
• The implant is inserted into the pocket and positioned appropriately.
• 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 blood-thinning medications as advised.
• Arrange for transportation to and from the surgery.
• Follow pre-operative instructions regarding fasting and medications.

Recovery and Aftercare

Post-operative recovery typically includes:

• 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.
• Follow-up appointments to monitor healing and implant placement.

Possible Complications

While breast reconstruction is generally safe, potential complications include:

• 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 essential for optimal recovery:

• Initial follow-up within 1 to 2 weeks post-surgery.
• Regular check-ups every few months for the first year.
• Long-term monitoring for any changes in breast appearance or health.

Alternative Treatments

Patients may consider these alternatives to surgical reconstruction:

• Prosthetic breast forms for external support.
• Fat grafting techniques to enhance breast volume.
• Psychological counseling to address body image concerns.

Home Care Tips

To aid recovery at home, patients should consider the following tips:

• 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 to support healing.

Patient Education & Prevention

To prevent complications and promote healing, patients should be informed about:

• The importance of following post-operative care instructions.
• Recognizing signs of infection or complications.
• Regular breast self-exams and follow-up screenings.
• Healthy lifestyle choices to reduce cancer recurrence risk.

Billing and Coding Information

CPT Code: 19364

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.
• Patients should verify coverage details with their insurance provider.

Related CPT Codes

• 19361 - Breast Reconstruction with Implant
• 19362 - Breast Reconstruction with Tissue Expander
• 19368 - Breast Reconstruction with Tissue Expander
• 19369 - Breast Reconstruction with Implant

References and Sources

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