Where would the place saline breast implants in a patient with a Pacemaker/ICD? Submuscular or subglandular?

I typically would place the implants in the sub muscular plane since the AICD is in the sub glandular plane. I have operated on many patients with pacemakers and defibrillators.  This is the common solution.

I have had a few patents with ICDs and have placed the ICD itself below the muscle to better hide it.  With the addition of and implant, I would be concerned with placing both ICD and implant in the same pocket.  Movement of the implant could affect ICD leads, and conversely, ICD could damage implant. Likely best compromise is implant sub muscular,and ICD sub glandular The above information is never meant to be a substitute for an examination and discussion with a board certified plastic surgeon.

In my 36 years in practice I have only had this issue 2 times and in both I placed the implants submuscular. Best tp have a full cardiac clearance also ...