An Unexpected Finding During a Breast Excisional Biopsy: A Case Report

Background: Pacemaker leads within the breast are rare. Although it is infrequent, there are some reports of implanted cardiac devices or wires migrating into breast tissue or through the chest wall. To the best of our knowledge, there are no current reports of pacemaker leads within the breast tissue of a patient with concurrent breast cancer. This case aims to detail the surgical management of this rare phenomenon. Case Presentation: A pacemaker-dependent, female patient presented to the operating room for a left breast excisional biopsy. Intraoperatively, two epicardial leads were unexpectedly found within the center of the patient’s breast tissue. Since the two leads were found to be transecting the left breast mass, the mass was removed in pieces. Postoperative pathology revealed a 2.2 cm invasive papillary carcinoma. Due to concern for unclear margin status, the patient elected for a left modified radical mastectomy and sentinel lymph node biopsy following the implantation of a new pacemaker lateralized to the right side of the chest. Following this operation, final pathology was negative for residual cancer. Sentinel lymph node biopsy was negative. Conclusion: This case describes an interdisciplinary approach to the relocation of a permanent pacemaker and clinical treatment of a patient’s breast cancer. If encountered, the presence of a pacemaker lead within the breast of a patient with breast cancer will likely require an individualized management strategy. Therefore, collaboration between cardiologists and surgeons is vital to successful clinical management of this phenomenon.