Please help with CPT codes for Breast Recon. Surgery? Op note:
Px(s) done:Bilateral immediate breast reconstruction with tissue expanders and Veritas tissue matrix after bilateral mastectomies.
PROCEDURE: The mastectomies were performed with the periareolar approach. The scar from the previous biopsy which had been performed with an inferomedial radial incision from the areola, was excised in addition to the areolar tissue. After completion of mastectomy, attention was turned to reconstruction.
Large veins were noted on the undersurface of the mastectomy flaps. Several ends of the veins were ligated with titanium clips. Incision was made between slips of the lateral aspect of the pectoralis major muscle. Dissection was carried in a preserratus plane laterally. Inferiorly, the pectoralis major muscle was released to the level of the inframammary fold. Medially the muscle was released to the level of the prepectoral fascia. On the left side, the tissues were deficient over the lower pole of the breast. For this reason, Veritas tissue matrix was used to span the distance from the inframammary fold to the pectoralis major muscle. This was inset with 2-0 PDS suture. The perforator vessels from the internal mammary system were ligated with titanium clips. Additional hemostasis was performed using bipolar electrocautery.
Prior to initiation of reconstruction the chest was swabbed with Betadine and new drapes were applied. After preparation of the pockets for the expanders, attention was turned to preparation of the expanders. All air was removed in 100 mL of saline were instilled. The expander was placed within the pocket. Care was taken to achieve adequate medial and inferior placement. The pockets were closed with 2-0 PDS sutures. 15 Blake drains were placed percutaneously. The mastectomy flaps were again inspected and found to be fully viable. Both incisions were closed in inferior medially to superior laterally oriented oblique manner. This was performed with 3-0 Monocryl deep dermal sutures and running 4-0 Monocryl subcuticular suture. Dermabond adhesive completed the closure. The patient was placed in a well padded surgical bra. She was extubated in the operating room and transported to recovery room in stable condition.