The patient consented for the procedure, and she was admitted electively to the catheter lab. She was prepped and draped allowing access above and below the breast implant. The procedure was performed with local anaesthetic and conscious sedation. An elliptical incision was made around her scar caudal to her breast prosthesis. The prosthesis was mobilised, the old generator was removed and the new generator was connected to her old leads (Figure 1). The device was then placed in an antimicrobial pouch (Tyrx, Medtronic, USA) to reduce the risk of infection and the generator was sutured to the underlying fascia at the cranial aspect of her prosthesis aiming to obtain a good ICD shock vector because her shock lead tip was previously sited close to her generator (Figure 2). A new smaller breast prosthesis was implanted above the ICD generator. The wound was closed in layers with Monocryl 3-0 and Glue. The ICD was reactivated, and all checks were satisfactory. The patient was pleased with the aesthetic results and the wound healed well in the 6-week device check in the clinic.
Discussion :