Where would you place saline implants in a patient with an AICD/pacemaker in left breast tissue? (Photos)

Where would you place saline implants in a patient with an AICD/pacemaker in left breast tissue? I'm 5'10" 119lbs. 25 years young, 34A. I want to have natural looking breasts... I just don't want to see the outline of my device! :( my cardiologist suggested a pocket revision of my AICD. Where would you place the ICD? then what technique (submuscular, Subfascial or subglandular) would be best for the implant to cover my device? Thank you!

Doctor Answers 13

Under muscle.

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I have done this before and placed a small breast implant under the muscle. I recommend you do not go too big. Best, Dr. ALDO.

Scottsdale Plastic Surgeon
4.9 out of 5 stars 215 reviews

Breast augmentation in a patient with a pacemaker.

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I generally put saline implants under the muscle pacemaker or not. In your particular case the presence of the pacemaker reinforces the decision to place the implant in a sub muscular position.

Implant post pacer

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From your photos it looks like palcing it under the breast may provide best coverage but it also depends on how big you want to be.that would be a big determining factor as well.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 69 reviews

Where would you place saline implants in a patient with an AICD/pacemaker in left breast tissue?

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Pacer subcutaneous implants submuscular is the choice I would recommend for you. Best to attain in peson PS opinions. 

Implant location

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Your pacemaker is high up on your chest and should be above the location of the implant. This is very beneficial in minimizing its visibility. I would certainly suggest a sub-muscular implant to minimize its appearance as well as to give a better and more natural end result. If the implant height is chosen correctly, the pacemaker should become less obvious. Also, avoid an excessively large implant as this will emphasize it more - i would suggest a moderate projecting Inspira or moderate plus profile Mentor to best camouflage the pacemaker. I would probably suggest leaving the pacemaker in its current location for now as I think a well done great augmentation will likely be all that is needed to minimize its appearance. I recently did this exact operation and the results were very nice with no appreciable pacemaker lump. Good luck on achieving your goals. 

AICD/Pacemaker and Breast Augmentation

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Your pacemaker/AICD is in a subcutaneous pocket and will always be somewhat palpable and visible.  If it can be placed a bit deeper in your tissues, i.e., next to your muscle, it may be less discernable.  It can also be placed in the submuscular space to make it even less discernable.  If this is the case, the breast implant can be placed in the subglandular space and this would completely cover the pacemaker/AICD.  The only difficulty here is that subglandular placements are associated with more capsular contracture.  This risk can be diminished with a textured device or with a saline implant.  You would need to consult with your cardiologist  and plastic surgeon to work together on this.  

Pacemaker and plastic surgery

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Hi... Thank you for the question.. And photos....  For your surgery I recommend a cardiologist evaluation the day of your surgery... And a under muscle technique...

Luis A. Mejia, MD
Dominican Republic Plastic Surgeon
4.6 out of 5 stars 83 reviews

Saline implant placement

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ICDs are general placed over the muscle by cardiologists, but when problems arise (discomfort, high visibility, worry for inadequate tissue coverage), I have seen the device moved to a submuscular position.  I would suggest you place your implants in the submuscular position as well, but likely the device should be moved prior to the augmentation so that your breast implants are not injured during the position change of the ICD.  Even if you leave the ICD in the same position, I would recommend submuscular placement of the implants (partial submuscular/dual plane) especially when using saline implants.  Given how thin you are, you may wish to strongly consider using silicone gel implants over or preferably under the muscle to avoid problems with visibility of the implant and rippling.  Make sure your cardiologist signs off on your breast augmentation surgery prior to proceeding and best of luck with your surgery!

Jeffrey A. Sweat, MD
Sacramento Plastic Surgeon
4.9 out of 5 stars 51 reviews

Planning implant surgery with a pacemaker

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Thank you for your question about breast augmentation with a pacemaker.

  • You are slim so a saline implant is more likely to show.
  • It must go under the muscle to better conceal it.
  • I assume you want saline so the size can be adjust at surgery - which makes sense since one breast is naturally larger.
  • A gel implant - although more expensive - is likely to look better above the muscle but still may show.
  • Where does your cardiologist want to put the pacemaker? 
  • Once it is in its new position, your plastic surgoen can take measurements to see what shape implant is likely to best conceal the lower rim of the pacemaker.

Always consult a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes


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Please look at case 26 on my website reference below.
Definitely your implant needs muscular cover. I would recommend cohesive gel rather than saline. In this case I recommended tall height anatomical if the lady wished to try and reduce the irregularity from the pacemaker. She chose a round implant as she was concerned about rotation and the possibility of another op should it rotate (risks 1%). 
Your surgeon needs to be aware of the type of pacemaker and best to have an ECG and a cardiology review prior to the op.

Gary L. Ross, MBChB, FRCS
Manchester Plastic Surgeon
5.0 out of 5 stars 177 reviews

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