D.R.
Networker
pt had TE placed on separate day of mastectomy. Months later provider is now doing TE exchange to perm implant. Provider wants to submit 19380 RT / 19342 RT / 11970 RT / 15771/ 15772 x3. My opinion is we should only be submitting 11970 RT / 15771 / 15772 x3. Would appreciate thoughts please. tia!!
Procedure(s):
RIGHT BREAST EXPANDER EXCHANGE TO IMPLANT AND BIALTERAL BREAST FAT GRAFTING:
Attention was then turned to RT breast. Incision was made through the previous mastectomy site scar with a 15 blade scalpel. This carried down to the anterior portion of the implant capsule which was noted to have a nice thick well incorporated acellular dermal matrix layer. This capsule was incised and the old implant was removed. It was noted that the capsule and the breast tissue envelope was overall soft, and the acellular dermal matrix formed a nice well incorporated sling inferiorly along the inframammary fold. The inframammary fold was also in appropriate position therefore this is not modified with any capsulectomy. Medially there was a portion that was constricted and this was released via capsulotomy with Bovie electrocautery with improved contour medially. This is also performed laterally in order to provide some mobility and expand the lateral breast footprint to match the contralateral side. Sizer implants were then tested within the breast pocket and it was noted that a 605 cc breast implant provided the best volume, projection, base with, and contour when compared to the contralateral breast. Therefore, the breast pocket was washed with triple antibiotic solution and dilute Betadine solution. A new set of sterile gloves were placed, and the new implant was placed using sterile no touch technique with a Keller funnel. The implant was a Mentor memory gel extra breast implant smooth moderate plus profile, 605 cc, reference number SMPX–605, lot #9567276, serial #9567276–037. The incision was then closed in layered fashion with a 3-0 Prolene suture closing the capsular layer in running fashion. The deep dermis was then reapproximated with buried interrupted 3-0 Monocryl sutures. The epidermis was then reapproximated with a running subcuticular 4-0 Monocryl suture.
Attention was then turned to the bilateral breasts. The right breast was noted to have significant hollowing in the superior and medial fold, as well as a sharp acute angle as the breast mound transitioned into the anterior axilla when compared to the contralateral breast. Therefore approximately 150 cc of fat was grafted to the right breast circumferentially, with the majority of the fat focused on the superior lateral, superior, and medial aspects of the breast to improve the overall contour. This had good effect. Attention was then turned to the left breast where superiorly there remained a chemotherapy port. This breast also had a deficiency of superior and superior medial pole fullness. Therefore approximately 50 cc of fat was grafted to this region with good effect. The right breast incision was dressed with Dermabond. The fat grafting cannulation sites were dressed with dry sterile dressings.
Procedure(s):
RIGHT BREAST EXPANDER EXCHANGE TO IMPLANT AND BIALTERAL BREAST FAT GRAFTING:
Attention was then turned to RT breast. Incision was made through the previous mastectomy site scar with a 15 blade scalpel. This carried down to the anterior portion of the implant capsule which was noted to have a nice thick well incorporated acellular dermal matrix layer. This capsule was incised and the old implant was removed. It was noted that the capsule and the breast tissue envelope was overall soft, and the acellular dermal matrix formed a nice well incorporated sling inferiorly along the inframammary fold. The inframammary fold was also in appropriate position therefore this is not modified with any capsulectomy. Medially there was a portion that was constricted and this was released via capsulotomy with Bovie electrocautery with improved contour medially. This is also performed laterally in order to provide some mobility and expand the lateral breast footprint to match the contralateral side. Sizer implants were then tested within the breast pocket and it was noted that a 605 cc breast implant provided the best volume, projection, base with, and contour when compared to the contralateral breast. Therefore, the breast pocket was washed with triple antibiotic solution and dilute Betadine solution. A new set of sterile gloves were placed, and the new implant was placed using sterile no touch technique with a Keller funnel. The implant was a Mentor memory gel extra breast implant smooth moderate plus profile, 605 cc, reference number SMPX–605, lot #9567276, serial #9567276–037. The incision was then closed in layered fashion with a 3-0 Prolene suture closing the capsular layer in running fashion. The deep dermis was then reapproximated with buried interrupted 3-0 Monocryl sutures. The epidermis was then reapproximated with a running subcuticular 4-0 Monocryl suture.
Attention was then turned to the bilateral breasts. The right breast was noted to have significant hollowing in the superior and medial fold, as well as a sharp acute angle as the breast mound transitioned into the anterior axilla when compared to the contralateral breast. Therefore approximately 150 cc of fat was grafted to the right breast circumferentially, with the majority of the fat focused on the superior lateral, superior, and medial aspects of the breast to improve the overall contour. This had good effect. Attention was then turned to the left breast where superiorly there remained a chemotherapy port. This breast also had a deficiency of superior and superior medial pole fullness. Therefore approximately 50 cc of fat was grafted to this region with good effect. The right breast incision was dressed with Dermabond. The fat grafting cannulation sites were dressed with dry sterile dressings.