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 :