# Mastectomy Scar Revision for Symmetry



## Joyce Burchett (Nov 2, 2015)

Pt had a Right mastectomy & axillary lymph node dissection 1990. Now is known to be a BRCA mutation carrier. Now wishes prophylactic mastectomy on the left & she still has redundant skin & residual breast tissue of the right that rubs up against her bra & causes some amount of irritation. Lt lazy S incision to include skin overlying most of breast & nipple-areloar complex. We dissected down through subcutaneous fat. We raised superior flap first staying within subcutaneous plane until we ran out of breast tissue superiorly at the infraclavicula area, medially at the edge of sternum, & lateally at the midaxillary line. Created superior flap, then crated inferior flap stopping at inframammary fold. We mobilized breast off of chest wall starting medial & moving laterally, superior & moving inferiorly. We did not take pec fascia. Once breast was completely detached, we then placed marking stitches with short stitch marking superor & long lateral. We proceeded to irrigat wound, hemostasis achieved. Placed blake drain, anchored to skin & did quilting techinque to anchor superior flap to pectoral fascia to decrease dead space. Then approximated superior & inferior flap with vicryl, then the dermis then skin. On contralateral side excised an ellipse of skin overlying the residual mound. We made an ellipse measuring approximately 15 cm long. We made incision & dissected down through subcutaneous fat. We raised superior flap until beyond the excess wound. Then raised inferior flap until beyond inframammary fold. We then mobilized excess breast & skin tissue from chest wall. We did not take pec fascia. Once specimen was completely detached, we then placed marking stitches with short stitch superior, long lateral. Our defect measures 18 cm long x 10 cm wide. We irrigated wound & achieved hemostasis. Placed blake drain, & anchored to skin.  We then approximated the superior & inferior flap, then dermis, & then skin. Occlusive dressing placed around each drain, & wrapped patient's chest in Silverstein wrap. 
We coded Left Breast 19303.  Do we code Right side with complex repair CPT 13100, 13101, 13102?
Patient had no previous reconstruction on Right breast from previous total mastectomy & did not want any reconstruction on Left side, but did wish to revise the mastectomy scar so that she is competely flat on Right side as well as Left side after prophylactic mastectomy.  Any ideas on coding for Right side?


----------

