mccolloughpsc
Contributor
Would you add CPT code 19380 to codes 15771 & 15772 for patients left breast?
1. Encounter for breast reconstruction following mastectomy Z42.1
2. Acquired partial absence of left breast Z90.12
3. Personal history of malignant neoplasm of breast Z85.3
4. Breast asymmetry/ disproportion of reconstructed left breast N65.1
Procedures:
1. Left breast reconstruction with autologous fat grafting (108cc) 15771-51, 15772-51, 15772-51
2. Right breast mastopexy for symmetry 19316
Indication:
78 year-old lady with a history of left segmental mastectomy and left breast adjuvant radiation therapy for treatment of left breast cancer, now with significant deformity of the left breast, left breast post-radiation dermatofibrosis, and asymmetry between her breasts. I recommended left breast reconstruction with autologous fat grafting and right mastopexy for symmetry. The risks, benefits and alternatives to the proposed treatment were discussed in detail. She expressed understanding of my recommendation and agreement with the plan of care.
Description of Procedures:
The plan for left breast reconstruction with autologous fat grafting and right mastopexy for symmetry was reviewed.
5mm incisions were made with a #15 blade scalpel in the inner umbo and the mons. Klein’s tumescent solution was infiltrated throughout the anterior abdomen and flanks soft tissue for hemostatic effect (2000 mL total). A 3.5mm, Mercedes round-tip style cannula was then tunneled in the deep subcutaneous plane, just superficial to the fascia of the abdominal wall. This plane was maintained throughout. Liposuction was then performed, utilizing the LipoGrafter System for harvesting, filtering, and transferring of autologous adipose tissue. The incisions were closed with interrupted buried 4-0 monocryl for the deep dermis and simple interrupted 5-0 prolene sutures for the skin.
Attention was turned to the left breast. Inspection showed a significant depression deformity in the inferior lateral portion of the breast with surrounding post-radiation dermatofibrosis. 3mm incisions were made in the left breast IMF. Using the Coleman technique for structural fat grafting and a 16 gauge blunt tip microcannula, 0.1-0.25cc aliquots of fat were then grafted throughout the left chest, focusing on the inferior pole depression deformity and area of post-radiation dermatofibrosis. A total of 108cc of fat was grafted to the left chest. The incisions were closed with interrupted buried 4-0 monocryl for the deep dermis and simple interrupted 5-0 prolene sutures for the skin.
Attention was then turned to her right breast. A 38mm diameter cookie cutter was used to mark the new NAC perimeter. She was then placed in the upright seated position. The apex of the left breast at the breast meridian was transposed onto the left breast. Using the markings as a guide, her right breast was tailor-tacked in a vertical mastopexy. A 10cm wide superior dermoglandular pedicle was designed to carry the NAC. The excess skin within the mastopexy design was marked for excision.
She was then returned to the supine position and the staples were removed. The excess peri-areolar skin and the skin overlying the dermoglandular pedicle were deepithelialized using a #10 blade scalpel. Care was taken to preserve the superior dermoglandular pedicle to the NAC. The excess inferior pole and lateral skin was excised with a #10 blade scalpel. Outside the dermoglandular pedicle, the medial and lateral breast pillars were developed in the suprafascial plane. A wedge a parenchyma was excised between the medial and lateral pillars and along the IMF to better match the volume of the right breast. Hemostasis was obtained with the bovie electrocautery. The wound was irrigated copiously with betadine followed by Irrisept antibiotic solution.
The medial and lateral pillars were then approximated in layers. The superficial fascia was approximated with interrupted 2-0 vicryl sutures and the deep dermis with interrupted buried 3-0 monocryl sutures. The skin was closed with a running subcuticular 4-0 monocryl suture. The NAC was also inset in layers with interrupted buried 4-0 PDS sutures for the deep dermis followed by a running subcuticular 4-0 PDS for the skin. Prineo tape was then applied to the surface of the incisions.
1. Encounter for breast reconstruction following mastectomy Z42.1
2. Acquired partial absence of left breast Z90.12
3. Personal history of malignant neoplasm of breast Z85.3
4. Breast asymmetry/ disproportion of reconstructed left breast N65.1
Procedures:
1. Left breast reconstruction with autologous fat grafting (108cc) 15771-51, 15772-51, 15772-51
2. Right breast mastopexy for symmetry 19316
Indication:
78 year-old lady with a history of left segmental mastectomy and left breast adjuvant radiation therapy for treatment of left breast cancer, now with significant deformity of the left breast, left breast post-radiation dermatofibrosis, and asymmetry between her breasts. I recommended left breast reconstruction with autologous fat grafting and right mastopexy for symmetry. The risks, benefits and alternatives to the proposed treatment were discussed in detail. She expressed understanding of my recommendation and agreement with the plan of care.
Description of Procedures:
The plan for left breast reconstruction with autologous fat grafting and right mastopexy for symmetry was reviewed.
5mm incisions were made with a #15 blade scalpel in the inner umbo and the mons. Klein’s tumescent solution was infiltrated throughout the anterior abdomen and flanks soft tissue for hemostatic effect (2000 mL total). A 3.5mm, Mercedes round-tip style cannula was then tunneled in the deep subcutaneous plane, just superficial to the fascia of the abdominal wall. This plane was maintained throughout. Liposuction was then performed, utilizing the LipoGrafter System for harvesting, filtering, and transferring of autologous adipose tissue. The incisions were closed with interrupted buried 4-0 monocryl for the deep dermis and simple interrupted 5-0 prolene sutures for the skin.
Attention was turned to the left breast. Inspection showed a significant depression deformity in the inferior lateral portion of the breast with surrounding post-radiation dermatofibrosis. 3mm incisions were made in the left breast IMF. Using the Coleman technique for structural fat grafting and a 16 gauge blunt tip microcannula, 0.1-0.25cc aliquots of fat were then grafted throughout the left chest, focusing on the inferior pole depression deformity and area of post-radiation dermatofibrosis. A total of 108cc of fat was grafted to the left chest. The incisions were closed with interrupted buried 4-0 monocryl for the deep dermis and simple interrupted 5-0 prolene sutures for the skin.
Attention was then turned to her right breast. A 38mm diameter cookie cutter was used to mark the new NAC perimeter. She was then placed in the upright seated position. The apex of the left breast at the breast meridian was transposed onto the left breast. Using the markings as a guide, her right breast was tailor-tacked in a vertical mastopexy. A 10cm wide superior dermoglandular pedicle was designed to carry the NAC. The excess skin within the mastopexy design was marked for excision.
She was then returned to the supine position and the staples were removed. The excess peri-areolar skin and the skin overlying the dermoglandular pedicle were deepithelialized using a #10 blade scalpel. Care was taken to preserve the superior dermoglandular pedicle to the NAC. The excess inferior pole and lateral skin was excised with a #10 blade scalpel. Outside the dermoglandular pedicle, the medial and lateral breast pillars were developed in the suprafascial plane. A wedge a parenchyma was excised between the medial and lateral pillars and along the IMF to better match the volume of the right breast. Hemostasis was obtained with the bovie electrocautery. The wound was irrigated copiously with betadine followed by Irrisept antibiotic solution.
The medial and lateral pillars were then approximated in layers. The superficial fascia was approximated with interrupted 2-0 vicryl sutures and the deep dermis with interrupted buried 3-0 monocryl sutures. The skin was closed with a running subcuticular 4-0 monocryl suture. The NAC was also inset in layers with interrupted buried 4-0 PDS sutures for the deep dermis followed by a running subcuticular 4-0 PDS for the skin. Prineo tape was then applied to the surface of the incisions.