Optimizing Aesthetic Results in Breast Surgery and Cardiac Implantable Electronic Device (CIED) Placement Using...

Area of Science:

• Cardiology
• Biomaterials Science
• Plastic Surgery

Background:

• Younger patients require cardiac implantable electronic devices (CIEDs), prioritizing quality of life and aesthetics.
• Current guidelines lack standardized recommendations for CIED generator pocket positioning, especially with breast implants.
• Aesthetic concerns are paramount, particularly regarding CIED placement in relation to the female breast.

Purpose of the Study:

• To report the first use of bovine pericardium mesh (acellular biological matrix - ABM) for repositioning a migrated CIED in a patient with breast implants.
• To evaluate the efficacy of ABM in securing the device and improving aesthetic outcomes.
• To address the lack of standardized recommendations for CIED placement in patients with breast implants.

Main Methods:

• A migrated, protruding subcutaneous CIED was repositioned using an acellular biological matrix (ABM) made of bovine pericardium mesh.
• The ABM was used to anchor the device securely against the prepectoral fascia.
• Postoperative ultrasonography was employed to confirm device compartmentalization and periprosthetic space integrity.

Main Results:

• Successful repositioning of the CIED with stable, durable device positioning maintained at 12-month follow-up.
• Excellent breast symmetry and a smooth aesthetic transition were achieved.
• Ultrasonography confirmed successful isolation of the periprosthetic space, matrix, and device.

Conclusions:

• Reinforcement and repositioning of subcutaneous CIEDs using ABM is a viable option for patients with breast implants.
• This technique offers advantages such as minimized tissue disruption, stable positioning, and improved aesthetic results.
• ABM provides a method for achieving outcomes comparable to deeper device placement while maintaining device security and aesthetic integrity.