CPT® Code 19396

1. Indications

The preparation of a moulage for a custom breast implant, as described by CPT® Code 19396, is indicated for several specific conditions and circumstances that necessitate tailored breast reconstruction. These indications include:

• Agenesis - A condition where breast tissue is absent, leading to significant asymmetry.
• Severe Hypoplasia - Insufficient breast tissue development, resulting in underdeveloped breasts.
• Poland Syndrome - A congenital condition characterized by the absence of one breast and associated chest wall deformities.
• Scoliosis - A spinal deformity that can affect the symmetry of the chest wall and breast appearance.
• Pectus Excavatum - A condition where the breastbone is sunken into the chest, potentially impacting breast shape and symmetry.
• Breast Tissue Loss - Loss of breast tissue due to trauma or mastectomy, necessitating reconstruction to restore breast shape.

2. Procedure

The procedure for preparing a moulage for a custom breast implant involves several detailed steps to ensure an accurate representation of the patient's anatomy. These steps include:

• Step 1: Preparation of the Chest - A thin plastic film is securely taped to the patient's chest. This film acts as a base for the moulage and is essential for capturing the contours of the chest wall.
• Step 2: Marking Anatomical Landmarks - The surgeon marks the plastic film to indicate the superior, inferior, right, and left borders of the breast area, along with any additional information deemed important for the custom implant design.
• Step 3: Making the Composite Impression - A composite impression is created using materials such as wax, plaster of Paris, rubber, agar, or alginate. This impression captures the precise shape and dimensions of the breast area, ensuring that the custom implant will fit accurately.
• Step 4: Removal and Sending to Laboratory - Once the composite material has set, the plastic film with the impression is carefully removed from the chest. This moulage is then sent to a specialized medical manufacturing lab for further processing.
• Step 5: Creation of the Silicone Implant - At the laboratory, a sterile silicone implant is crafted based on the moulage. This custom implant is designed to meet the specific needs of the patient and is returned to the surgeon for implantation.

3. Post-Procedure

After the moulage preparation procedure, there are several considerations for post-procedure care. The patient may be advised to monitor the area for any signs of irritation or discomfort from the materials used during the impression process. It is essential to ensure that the moulage is sent promptly to the manufacturing lab to facilitate the timely creation of the custom silicone implant. The surgeon will provide instructions regarding follow-up appointments to discuss the next steps in the breast reconstruction process, including the timing of the actual implant surgery. Additionally, the patient may be counseled on what to expect during the recovery period following the eventual implantation of the custom breast implant.