CPT® Code 19304

Deleted

1. Indications

Subcutaneous mastectomy is indicated for various conditions that may necessitate the removal of breast tissue while preserving the overlying skin and muscle. The following are common indications for this procedure:

• Breast Cancer Patients diagnosed with breast cancer may undergo subcutaneous mastectomy as part of their treatment plan, particularly when the cancer is localized and there is a need to remove the breast tissue while maintaining skin integrity.
• Genetic Predisposition Individuals with a family history of breast cancer or those who test positive for genetic mutations (such as BRCA1 or BRCA2) may opt for this procedure as a preventive measure to reduce their risk of developing breast cancer.
• Benign Breast Conditions Patients with benign breast conditions that cause significant discomfort or concern may also be candidates for subcutaneous mastectomy, allowing for the removal of problematic tissue without extensive alteration to the breast structure.

2. Procedure

The subcutaneous mastectomy procedure involves several key steps that ensure the effective removal of breast tissue while preserving the underlying structures. The following outlines the procedural steps:

• Step 1: Incision The procedure begins with the surgeon making an incision along the inframammary crease, which is the natural fold beneath the breast. This incision is strategically placed to minimize visible scarring and to provide optimal access to the breast tissue.
• Step 2: Dissection Following the incision, the surgeon carefully dissects the breast tissue from the underlying muscle fascia and skin. This step requires precision to ensure that the muscle remains intact while the breast tissue is removed. The dissection is performed meticulously to avoid damage to surrounding structures.
• Step 3: Pathological Examination Before the complete removal of the breast tissue, the surgeon may examine the skin for any pathological conditions that could necessitate further intervention. This examination is crucial for ensuring that any underlying issues are addressed during the procedure.
• Step 4: Tissue Removal Once the dissection is complete and any necessary examinations are performed, the breast tissue is excised. This step is critical for achieving the desired outcome of the surgery while maintaining the integrity of the skin and muscle.
• Step 5: Nipple and Areola Repositioning After the breast tissue has been removed, the nipple and areola are sutured back into their original position. This step is essential for preserving the aesthetic appearance of the breast post-surgery.
• Step 6: Drainage and Prosthesis Placement To manage any potential fluid accumulation post-surgery, a suction catheter or drainage tube is inserted. Additionally, if indicated, a prosthesis may be placed under the skin to provide support and enhance the cosmetic outcome before the surgical site is closed.
• Step 7: Closure Finally, the incision is closed using sutures, and the surgical site is dressed appropriately to promote healing and minimize the risk of infection.

3. Post-Procedure

After the subcutaneous mastectomy, patients are typically monitored for any immediate complications, such as bleeding or infection. The insertion of a suction catheter or drainage tube helps manage fluid accumulation, which is crucial for a smooth recovery. Patients may experience some discomfort and swelling in the surgical area, which can be managed with prescribed pain relief medications. Follow-up appointments are essential to monitor the healing process and to remove any drainage tubes if used. Patients are advised on post-operative care, including activity restrictions to allow for proper healing. The expected recovery time may vary, but many patients can return to normal activities within a few weeks, depending on their individual healing process and any additional treatments that may be required.