19303

Mastectomy, modified radical, including axillary lymphadenectomy

A modified radical mastectomy is a surgical procedure for breast cancer that involves the removal of the entire breast (all breast tissue, overlying skin, and nipple-areola complex) along with the axillary lymph nodes (lymphadenectomy). Unlike a radical mastectomy, the underlying pectoral muscles are preserved.

Clinical Indications

  • Invasive breast cancer (ductal carcinoma, lobular carcinoma)
  • Locally advanced breast cancer not amenable to breast-conserving surgery
  • Recurrent breast cancer after prior breast-conserving therapy or mastectomy
  • Inflammatory breast cancer (often post-neoadjuvant therapy)
  • Paget's disease of the breast with underlying invasive carcinoma
  • Prophylactic surgery in high-risk individuals (e.g., BRCA mutation carriers) where breast-conserving surgery is not an option or desired

Procedure Steps

  1. Patient positioning and sterile preparation and draping of the chest and axilla.
  2. Incision planning, typically an elliptical incision to encompass the nipple-areola complex, biopsy scar, and a margin of skin.
  3. Dissection of skin flaps, elevating the skin and subcutaneous fat from the pectoralis major muscle superiorly, inferiorly, medially, and laterally.
  4. Mobilization and removal of the entire breast tissue, down to the pectoralis major fascia.
  5. Identification and dissection of axillary lymph nodes (levels I and II, and sometimes III) while preserving key nerves and vessels.
  6. Hemostasis and irrigation of the surgical site.
  7. Placement of surgical drains (e.g., Jackson-Pratt drains) to prevent seroma formation.
  8. Closure of the skin flaps with sutures or staples.
  9. Application of sterile dressings.

Coding Guidelines

  • CPT code 19303 includes the removal of the breast and axillary lymph nodes. Do not report separately for axillary lymphadenectomy (38745) if performed as part of 19303.
  • If sentinel lymph node biopsy (38525, 38500) is performed in conjunction with a modified radical mastectomy, it is typically considered bundled unless distinct work is documented. Consult payer guidelines.
  • If immediate breast reconstruction (e.g., tissue expander, implant placement, flap reconstruction) is performed during the same operative session, those reconstruction codes (e.g., 19340, 19361, 19367) should be reported separately.
  • Biopsy procedures (e.g., needle biopsy) performed prior to the mastectomy are reported separately.
  • The code 19303 refers to a unilateral procedure. If bilateral, append modifier 50.
  • Pathological examination of the removed tissue is a separate service performed by a pathologist and reported with appropriate pathology codes (e.g., 88307).

Associated ICD-10 Codes