So far I have dx code 996.54 with cpt codes 19330-50, 19340-50
?? not sure what I should use for revision of rt areolar as 19350 is the use of grafts and this looks like they just excised and reshaped it???

PREOPERATIVE DIAGNOSIS: Status post bilateral saline breast
augmentation and right periareolar lift with partial deflation.

POSTOPERATIVE DIAGNOSIS: Status post bilateral saline breast
augmentation and right periareolar lift with partial deflation.

PROCEDURE:
1. Bilateral breast implant exchange to silicone gel.
2. Bilateral capsulotomy.
3. Revision of right nipple-areolar complex.


ANESTHESIA: General plus local.

COMPLICATIONS: None.

DRAINS: None.

SPECIMENS: None.

CULTURE: None.

DESCRIPTION OF PROCEDURE: The patient was marked preoperatively in
the upright position. Thigh-high TED stockings and preoperative
antibiotics were administered. General anesthesia was instituted.
The chest area was prepped and draped in a sterile fashion.

The procedure was begun on the left breast. The patient wanted to
approximate the size of the partially deflated implant on the left
side for her final result. The patient's previous left
infraperiareolar incision was utilized and no new scars were placed.
Upon entering the implant pocket, a smooth, round, partially deflated
saline implant was encountered. The pocket itself was clean and
glistening. There were areas of thickened capsule. A segmental
capsulotomy was performed. The implant was removed, and the volume
of fluid was removed and measured approximately between 350 and 375
mL of saline. An Inamed 371 mL silicone gel, smooth, round was then
selected and inserted. The wounds were closed in layers. Marcaine
had been infiltrated prior to closure. The wounds were closed in 2-0
and 3-0 PDS suture.

Attention was now turned to the right side. A crescent of
periareolar tissue was marked and excised from 9 o'clock, around the
top, to the 6 o'clock position to move the nipple-areolar complex
superiorly and medially, as well as to reduce the size of the areola.
These were all previous scars; no new scars were placed.

Upon entering the implant pocket, a clean smooth, round implant was
also encountered with clean water inside. A segmental capsulotomy
was performed. The wound was irrigated and Marcaine was infiltrated.
An Inamed 371 mL smooth, round silicone gel implant was placed. The
wounds were then closed using 2-0 and 3-0 PDS sutures. Steri-Strips
and an Elastoplast bandage were applied. The patient tolerated the
procedure well.

Postoperative instructions were reviewed with the patient
preoperatively. Followup will be in my office in 6 days or sooner if
necessary.