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Background:  Breast augmentation today is done in a wide range of ages in women. From ages 17 to 72, I have placed breast implants over the past three decades. All of these females have been more than healthy enough to undergo the surgery but, occasionally, they do have some medical conditions that have can have some bearing on their aesthetic outcome.

One such medical condition is that of medical devices implanted in and around the breast. Most commonly these are either chemotherapy ports or pacemakers. While chemotherapy ports can be encountered at any age, pacemakers are more typical in older patients who are more prone to heart conditions that affect its electrical conduction. Such pacemakers are located in the upper pole of the left breast right under the skin. While located on the breast mound its wire feeds into the vessels above it and not through the breast tissue.

Case Study:  This 60 year old female was involved in an auto accident several years previously which resulted in the placement of a pacemaker in the upper pole of the left breast due to a traumatic heart injury. It was an on demand pacemaker to treat a low heart rate should that occur…although it had not since the accident. She presented for large breast implants to enlarge sagging breasts which had been previously lifted. The pacemaker had a prominent rectangular profile right under the skin.

Under general anesthesia and through inframammary incisions, 630cc high profile saline breast implants were placed. They were inflated to 750ccs.  The profile of the pacemaker became slightly more prominent but not significantly so.

This case illustrates that the profile of an indwelling pacemaker can become more prominent as the breast is enlarged. This is usually not of a concern to the patient as they have long accepted the medical need for it. More relevantly on demand pacemakers require that a company field representative come on the day of surgery to externally deactivate the pacemaker for surgery…as well as reactivate it after the surgery.

Case Highlights:

1) Breast augmentation can be successfully done in patients who have pacemakers.

2) The presence of a pacemaker in the upper pole of the breast does not limit the placement of submuscular implants or their size.

3) A placement of a submuscular breast implant will make the pacemaker protrude a bit more than when the breast was less full.

Dr. Barry Eppley

Indianapolis, Indiana

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