BFAITHFUL
Expert
dr. did a breast reconstruction of R & L breast with insertion of permament breast prosthesis. Im thinking CPT 19342-50?
DX: Bilateral breast cancer
Procedure: mentioned above
patient had cancer in both right and left breast under the both nipple areola. this required the patient therefore to have both right and left nipples removed. this subcutaneous mastectomy occurred on October 30, 2009 and the patient subsequently had the removal of her nipples bilaterally. she had infiltrated ductal wall differentiated carcinoma were noted in the right breast and nodular in situ noted in the left upper medial quadrant left breast.. the date of the amputation of the nipples bilaterally was subsequently performed also as a outpatient. the date was November 13, 2009. patient at this point has had complete healing of the anterior chest walls bilaterally and is presented to her permanent implants inserted.
incisions were made in the previous subcutaneous mastctomy scar with a 15 blade scalpel. the incision was then deepened down to the edge of the chest wall and the medial edge of the pectoralis muscle was identified. this was done bilaterally and the patient first had the right nipple areaola which was handed down to the chest wall. the site of the previous amputation then reaised completely. the patient have a subpectoral pocket developed. minimal bleeding was obtained because of bipolar cautery with fiberoptic exam. the left breast had identical technique utilized with the skin incision deepened down to the chest wall. at the chest wall, the pectoralis muscle was identified. the pectoralis muscle was then released and release off the chest wall and then all the pervious scarred subcutaneous tissue and skin flaps were elevated. when this was completed the patient then had irrigation of both pockets and then reexamination.
patient then had the area irrigated and the temporary use of intraoperative expander to facilitate the expansion. the tissue expander was style #133 FV . this was utilized to expand the entire skin and breast and lobe and went down to clearly appreciate that a 550c implant would correct the problem of the previous contracture and the breast amputation. the expander was deflated. the pocket was irrigated with saline. a number of serial laps were placed and the opposite breast was also intraoperatively expanded utilizing the same expander. Once the patient had the same pocket noted then it was removed. patient then had silicone filled breast implants brought into the operating room with the right and left breast had ref.#20. the patient had excellent symmetry when she was lying as well seated up right. the patient had 7mm jackson pratt drain inserted through the old incision bilaterally and placed to constant suction.
DX: Bilateral breast cancer
Procedure: mentioned above
patient had cancer in both right and left breast under the both nipple areola. this required the patient therefore to have both right and left nipples removed. this subcutaneous mastectomy occurred on October 30, 2009 and the patient subsequently had the removal of her nipples bilaterally. she had infiltrated ductal wall differentiated carcinoma were noted in the right breast and nodular in situ noted in the left upper medial quadrant left breast.. the date of the amputation of the nipples bilaterally was subsequently performed also as a outpatient. the date was November 13, 2009. patient at this point has had complete healing of the anterior chest walls bilaterally and is presented to her permanent implants inserted.
incisions were made in the previous subcutaneous mastctomy scar with a 15 blade scalpel. the incision was then deepened down to the edge of the chest wall and the medial edge of the pectoralis muscle was identified. this was done bilaterally and the patient first had the right nipple areaola which was handed down to the chest wall. the site of the previous amputation then reaised completely. the patient have a subpectoral pocket developed. minimal bleeding was obtained because of bipolar cautery with fiberoptic exam. the left breast had identical technique utilized with the skin incision deepened down to the chest wall. at the chest wall, the pectoralis muscle was identified. the pectoralis muscle was then released and release off the chest wall and then all the pervious scarred subcutaneous tissue and skin flaps were elevated. when this was completed the patient then had irrigation of both pockets and then reexamination.
patient then had the area irrigated and the temporary use of intraoperative expander to facilitate the expansion. the tissue expander was style #133 FV . this was utilized to expand the entire skin and breast and lobe and went down to clearly appreciate that a 550c implant would correct the problem of the previous contracture and the breast amputation. the expander was deflated. the pocket was irrigated with saline. a number of serial laps were placed and the opposite breast was also intraoperatively expanded utilizing the same expander. Once the patient had the same pocket noted then it was removed. patient then had silicone filled breast implants brought into the operating room with the right and left breast had ref.#20. the patient had excellent symmetry when she was lying as well seated up right. the patient had 7mm jackson pratt drain inserted through the old incision bilaterally and placed to constant suction.
