Submammary Pacemakers and ICDs in Women: Long-Term Follow-up and Patient Satisfaction

BACKGROUND: Device placement in women has unique considerations not addressed with standard implant techniques. These may include irritation and discomfort from purse and/or bra straps, changes in body image, and cosmetic issues with visible scars. Submammary device placement (SMI) addresses these problems and may be associated with greater patient comfort, cosmesis, and device acceptance. METHODS AND RESULTS: Over a 9-year period, 51 women, mean age 47 years (range 13-70 years), underwent submammary device implantation at our institution. These included seven cardiac resynchronization therapy devices, 26 implantable cardioverter defibrillators, and 18 pacemakers. Devices had been implanted for a mean of 57 months (range 2-118 months) when, in 2009, patient satisfaction was assessed via a telephone survey. Questions related to the initial decision, the preprocedure education, implant experience, recovery, complications, and long-term satisfaction. Seventy-three percent of women listed cosmesis as their main reason for SMI, 76% had a mammogram since implant, and 89% reported no issues with mammography. Ninety-seven percent felt that SMI was the right choice and 95% stated they would do SMI again. Ninety-five percent also said they would recommend the procedure to others. CONCLUSION: Complications were rare (three lead dislodgements and one pneumothorax). SMI has high patient acceptance and long-term satisfaction with few complications. This procedure should be considered in women requiring device implantation.