She was followed up in the device clinic and early 2024 the device reached recommended replacement time when she was listed for generator change. She was keen to continue to have an ICD in situ despite not having any appropriate treatments from the device. Once again, a joint case between a breast surgeon and cardiologist was arranged to allow generator change minimising the risk of implant complications. Due to the marginal increase in size between an Autogen MINI generator (Boston Scientific, USA; 26.5cc, 9.9mm) and a Resonate extended longevity ICD (Boston Scientific, USA; 29.5cc, 9.9 mm), the decision was made to implant the extended longevity ICD to allow longer interval between the need for another generator change. This would therefore require a smaller breast prosthesis to ensure breast size symmetry.