Abstract
Breast implants whether used for cosmetic or reconstructive purposes can be placed
in pockets either above or below the pectoralis major muscle, depending on clinical
circumstances such as subcutaneous tissue volume, history of radiation, and patient
preference. Likewise, cardiac implantable electronic devices (CIEDs) can be placed
above or below the pectoralis major muscle. When a patient has both devices, knowledge
of the pocket location is important for procedural planning and for durability of
device placement and performance. Here, we report a patient who previously failed
subcutaneous CIED placement due to incision manipulation with prior threatened device
exposure requiring plane change to subpectoral pocket. Her course was complicated
by submuscular migration of the CIED into her breast implant periprosthetic pocket.
With subcutaneous plane change being inadvisable due to patient noncompliance, soft
tissue support of subpectoral CIED placement with an acellular biologic matrix (ABM)
was performed. Similar to soft tissue support used for breast implants, submuscular
CIED neo-pocket creation with ABM was performed with durable CIED device positioning
confirmed at 9 months postprocedure.
Keywords breast implant - acellular dermal matrix - cardiac device
