Overview of CPT Code 19369: Breast Reconstruction with Implant

Overview of CPT Code 19369: Breast Reconstruction with Implant

CPT Code 19369 refers to the surgical procedure of breast reconstruction using an implant following mastectomy or breast tissue removal. This procedure aims to restore the shape and appearance of the breast, enhancing the patient's body image and self-esteem.

When CPT Code 19369 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 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

Prior to the procedure, several diagnostic tests may be performed to ensure patient suitability:

• Mammography to assess breast tissue.
• MRI to evaluate breast anatomy and any underlying issues.
• Blood tests to check overall health and surgical readiness.
• Physical examination to assess breast tissue and skin condition.

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 recovery.

Preparation for the Procedure

Patients should follow these steps to prepare for their surgery:

• 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 fasting instructions provided by the healthcare team.

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 generally safe, this procedure carries some risks, including:

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

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Post-Procedure Follow-Up

Follow-up care is crucial for monitoring recovery:

• Initial follow-up within 1 week 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.
• Psychological counseling to address body image issues.
• Physical therapy to improve overall well-being.

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.
• Stay hydrated and maintain a balanced diet to promote healing.

Patient Education & Prevention

To prevent complications and recurrence, patients should:

• Attend regular breast screenings and follow-up appointments.
• Be aware of changes in breast appearance or sensation.
• Discuss any concerns with healthcare providers promptly.
• Maintain a healthy lifestyle to reduce cancer risk.

Billing and Coding Information

CPT Code: 19369

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

Related CPT Codes

• 19368 - Breast Reconstruction with Tissue Expander
• 19367 - Breast Reconstruction with Implant
• 19370 - Breast Reconstruction with Tissue Expander
• 19361 - Breast Reconstruction with Implant
• 19364 - Breast Reconstruction with Implant

References and Sources

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