Overview of CPT Code 19380: Breast Reconstruction, Unilateral
CPT Code 19380 refers to the surgical procedure of breast reconstruction performed on one side of the body, typically following a mastectomy due to breast cancer or other medical conditions. This procedure aims to restore the shape and appearance of the breast.
When CPT Code 19380 is Used?
This code is applicable in various clinical scenarios, including but not limited to:
- Unilateral mastectomy due to breast cancer.
- Breast tissue loss due to trauma or congenital deformities.
- Reconstruction after lumpectomy when significant breast volume is lost.
Symptoms Indicating This Procedure
Patients may report the following symptoms that lead to the consideration of unilateral breast reconstruction:
- Asymmetry in breast size after mastectomy.
- Psychological distress related to body image.
- Physical discomfort due to uneven breast weight distribution.
Causes and Risk Factors
Several factors can lead to the need for unilateral breast reconstruction:
- Breast cancer requiring mastectomy.
- Genetic predisposition to breast cancer (e.g., BRCA mutations).
- Previous breast surgeries that resulted in deformities.
Diagnostic Tests Before Procedure
Prior to the procedure, several diagnostic tests may be conducted to ensure patient suitability:
- Mammography to assess remaining breast tissue.
- MRI to evaluate breast tissue and surrounding structures.
- Blood tests to check overall health and surgical readiness.
Procedure Description
The breast reconstruction procedure typically involves the following steps:
- Anesthesia administration to ensure patient comfort.
- Incision made in a predetermined location.
- Tissue expansion or flap technique used to create a new breast mound.
- Placement of implants if necessary.
- Closure of incisions with sutures.
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 thinners as advised.
- Arrange for post-operative care and transportation.
Recovery and Aftercare
Post-operative recovery typically involves the following:
- Initial recovery period of 4 to 6 weeks.
- Wound care instructions to prevent infection.
- Pain management with prescribed medications.
Possible Complications
As with any surgical procedure, there are potential risks involved:
- Infection at the surgical site.
- Scarring and changes in breast sensation.
- Implant complications such as rupture or displacement.
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Post-Procedure Follow-Up
Follow-up appointments are crucial for monitoring recovery:
- Initial follow-up within 1 to 2 weeks post-surgery.
- Subsequent visits every few months for the first year.
- Long-term monitoring for any complications or changes.
Alternative Treatments
Patients may consider these non-surgical options:
- Prosthetic breast forms for temporary solutions.
- Counseling and support groups for emotional support.
- Physical therapy to address any discomfort.
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 strenuous activities until cleared by the surgeon.
Patient Education & Prevention
Educating patients on breast health is vital:
- Regular breast self-exams and mammograms.
- Understanding family history and genetic risks.
- Healthy lifestyle choices to reduce cancer risk.
Billing and Coding Information
CPT Code: 19380
Category: Surgery
Common Modifiers:
- 50 (bilateral procedure)
- RT (right side)
- LT (left side)
Average Cost and Insurance Coverage
Costs can vary widely based on several factors:
- Average cost ranges from $10,000 to $30,000.
- Insurance may cover the procedure if deemed medically necessary.
- Out-of-pocket costs depend on the insurance plan.
Related CPT Codes
- 19301 - Breast Reconstruction, Unilateral
- 19302 - Breast Reconstruction with Implant
- 19303 - Breast Reconstruction with Implant
- 19316 - Breast Reconstruction with Implant
- 19318 - Breast Reconstruction with Implant
References and Sources
Frequently Asked Questions (FAQs)
What is unilateral breast reconstruction?
It is a surgical procedure to rebuild one breast after mastectomy.
How long does recovery take?
Recovery typically takes 4 to 6 weeks.
Will insurance cover the procedure?
Insurance often covers it if deemed medically necessary.
Are there risks involved?
Yes, potential risks include infection and scarring.
What should I expect during the procedure?
The procedure involves anesthesia, incision, and reconstruction.
