Hi,
My physician did a mastectomy, the plastic surgeon did breast tissue expanders. It unfortunately became infected. The plastic surgeon did remove the tissue expander. At the time he removed them, he noticed a small nodule. It was slightly inferior to the main incision. It was part of the inferior breast flap. He did excise this piece of skin and it did come back as invasive carcinoma with metastais from the breast.
Thus, my physician went back in to re excise this.
Here is the operative report: The external portion of the suture material was removed. I could identify the site of the previous biopsy which had diagnosed the area of skin metastasis. This was slightly beneath the main incision scar along its midportion was a part of the inferior breast flap. I made a fusiform type incision to include the area of metastasis within the widest portio of the fusiform incision. This was made to encompass a great portio of the patient's previous scar. Hemostasis was maintained with electrocautery. I proceeded to excise the full thickness of the breast flaps with this procedure. There were some adhesions to the patient's pectoralis major muscle and to the prosthetic AlloDerm graft. These were taken down with sharp dissectionutilizing the scalpel. Ultimately once the entire segment of skin to excised was free I proceeded to mark it with Vicryl suture material for orientation and also mark the site of the preveious biopsy of the metastasis with Vicryl sutre material. This information was provided along with the specimen to the pathology department. The specimen was submitted fixed in formalin. This site was then irrigated and made meticulously hemostatic. A round Blake fluted suction drain was then placed beneath the breast flap and was made to exit throught a separate stab incision. The drain was anchored to the skin with a heavy silk suture material and ultimately was placed to a bulby type suction reservoir. The incision was then closed in 2 layers utilizing interrupted intradermal sutures of 3-0 Vicryl on the deep dermis and then the skin was closed iwth interrupted vertical mattreess sutures of 4-0 nylon. Following closure the site was cleansed and then was ultimately dressed with sterile gauze and Tegaderm type dressing material.
I don't know where to begin with this. Should I be under the skin section of CPT (116xxx and then Complex repair. But again I don't have size, unless I go off pathology. I don't have that back yet.
The only thing I do know with this is DX. of 198.2 and 174.9
Any help would be greatly appreciated.
Marci, CPC
My physician did a mastectomy, the plastic surgeon did breast tissue expanders. It unfortunately became infected. The plastic surgeon did remove the tissue expander. At the time he removed them, he noticed a small nodule. It was slightly inferior to the main incision. It was part of the inferior breast flap. He did excise this piece of skin and it did come back as invasive carcinoma with metastais from the breast.
Thus, my physician went back in to re excise this.
Here is the operative report: The external portion of the suture material was removed. I could identify the site of the previous biopsy which had diagnosed the area of skin metastasis. This was slightly beneath the main incision scar along its midportion was a part of the inferior breast flap. I made a fusiform type incision to include the area of metastasis within the widest portio of the fusiform incision. This was made to encompass a great portio of the patient's previous scar. Hemostasis was maintained with electrocautery. I proceeded to excise the full thickness of the breast flaps with this procedure. There were some adhesions to the patient's pectoralis major muscle and to the prosthetic AlloDerm graft. These were taken down with sharp dissectionutilizing the scalpel. Ultimately once the entire segment of skin to excised was free I proceeded to mark it with Vicryl suture material for orientation and also mark the site of the preveious biopsy of the metastasis with Vicryl sutre material. This information was provided along with the specimen to the pathology department. The specimen was submitted fixed in formalin. This site was then irrigated and made meticulously hemostatic. A round Blake fluted suction drain was then placed beneath the breast flap and was made to exit throught a separate stab incision. The drain was anchored to the skin with a heavy silk suture material and ultimately was placed to a bulby type suction reservoir. The incision was then closed in 2 layers utilizing interrupted intradermal sutures of 3-0 Vicryl on the deep dermis and then the skin was closed iwth interrupted vertical mattreess sutures of 4-0 nylon. Following closure the site was cleansed and then was ultimately dressed with sterile gauze and Tegaderm type dressing material.
I don't know where to begin with this. Should I be under the skin section of CPT (116xxx and then Complex repair. But again I don't have size, unless I go off pathology. I don't have that back yet.
The only thing I do know with this is DX. of 198.2 and 174.9
Any help would be greatly appreciated.
Marci, CPC