Introduction:
The removal of breast implants, also known as explantation, is a surgical procedure performed to remove previously inserted breast implants. This article aims to provide a detailed guide to the CPT (Current Procedural Terminology) codes associated with the removal of breast implants, from the perspective of a professional plastic surgeon. It will cover various aspects related to the procedure, including indications, techniques, potential complications, and cost estimates.
1. Indications for Breast Implant Removal:
Breast implant removal may be necessary for several reasons, including:
a) Implant complications such as capsular contracture, rupture, or infection.
b) Desire for size change or alteration in breast appearance.
c) Presence of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL).
d) Cosmetic reasons - patient's personal preference or dissatisfaction with the results of the procedure.
In cases where breast implant removal is medically necessary due to complications or BIA-ALCL, insurance coverage may be more likely.
2. CPT Code:
The CPT code used for breast implant removal is 19328 - "Removal of intact mammary implant(s), open approach."
It is important to note that the CPT code does not include the reinsertion, replacement, or revision of breast implants, which would require additional CPT codes.
3. Surgical Techniques:
There are two primary techniques for breast implant removal:
a) En bloc capsulectomy: This technique involves removing both the breast implant and the surrounding scar tissue (capsule) in one intact piece. It is often recommended for cases involving implant rupture or BIA-ALCL.
b) Implant removal with or without capsule removal: In situations where the capsule is thin, intact, and free from contracture, the surgeon may choose to remove the implant without removing the capsule. If the capsule is thick, calcified, or causing symptoms, total or partial capsule removal may be necessary.
The choice of technique depends on the individual patient's situation and should be discussed thoroughly during the preoperative consultations with the surgeon to ensure the most appropriate strategy is chosen.
4. Potential Complications:
As with any surgical procedure, breast implant removal carries potential risks and complications, including:
a) Bleeding and hematoma formation.
b) Infection.
c) Seroma - the accumulation of fluid around the surgical site.
d) Changes in breast shape and symmetry.
e) Scarring.
f) Numbness or changes in nipple sensation.
It is essential for patients to have a thorough understanding of these potential complications before undergoing the procedure.
5. Preoperative Evaluation:
Prior to breast implant removal, a comprehensive preoperative evaluation should be conducted, which may include:
a) Physical examination of the breast and surrounding tissues.
b) Imaging studies such as ultrasound or MRI to evaluate the integrity of the implants and the condition of the surrounding tissues.
c) Laboratory tests to assess the patient's overall health status.
d) Discussion of the patient's expectations, concerns, and desired outcomes.
e) Consent process, ensuring the patient fully understands the procedure and associated risks.
6. Anesthesia Options:
Breast implant removal can be performed under local anesthesia with sedation or general anesthesia, depending on the patient's preference and the surgeon's recommendation.
Under general anesthesia, patients are fully unconscious and not aware during the procedure. Local anesthesia with sedation allows patients to remain conscious while numbing the surgical area and providing relaxation through intravenous medications.
7. Recovery and Postoperative Care:
Following breast implant removal, patients should anticipate a period of recovery and adhere to specific postoperative care instructions, which may include:
a) Wearing a supportive surgical bra or compression garment to minimize swelling and promote healing.
b) Limiting physical activities and avoiding heavy lifting for several weeks.
c) Taking prescribed pain medications and antibiotics, if necessary.
d) Attending follow-up appointments to monitor healing progress and address any concerns.
8. Cost Estimation:
The cost of breast implant removal can vary depending on factors such as geographical location, surgeon's experience and reputation, facility fees, anesthesia fees, and specific patient needs. However, the average cost in the United States ranges between $4,000 and $8,000. It is crucial for patients to consult with their plastic surgeon and insurance provider to determine insurance coverage and obtain an accurate cost estimate for their specific case.
Conclusion:
Removal of breast implants is a decision that should be made after careful consideration and consultation with a professional plastic surgeon. Understanding the CPT code, surgical techniques, potential complications, and cost estimation associated with the procedure is essential for patients to make informed decisions. Always seek appropriate medical advice and ensure a comprehensive evaluation before proceeding with the removal of breast implants.
References:
1. American Society of Plastic Surgeons. "Breast Implant Removal." Accessed from: https://www.plasticsurgery.org/reconstructive-procedures/breast-implant-removal
2. American Society for Aesthetic Plastic Surgery. "Breast Implant Removal." Accessed from: https://www.smartbeautyguide.com/procedures/breast/breast-implant-removal/
