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Submammary Device Implantation in Women: A Step-by-Step Approach


  • M. Giudici reports participation on a research grant supported by Boston Scientific. L. Vazquez reports speaker honoraria from Medtronic, Boston Scientific and St. Jude Medical. C. Meierbachtol is an employee of Boston Scientific. Other authors: No disclosures.

  • Section Editor: Samuel J. Asirvatham, M.D.

Michael C. Giudici, M.D., University of Iowa Hospitals, 4426BJCP Iowa City, IA 52242, USA. Fax: 319-384-6427; E-mail:


Submammary Device Implantation in Women. Introduction: The frequency of device implantation is increasing in younger patients as our ability to diagnose long-QT syndrome, hypertrophic cardiomyopathy, Brugada Syndrome, and other life-threatening disorders earlier has improved. Similarly, use of cardiac resynchronization therapy and ICD therapies has increased in cardiomyopathy patients.

Methods and Results: Device implantation in young women has unique considerations. Standard pectoral implants lead to excessive scar formation due to skin tension and interfere with purse straps, bra straps, and seat belts. There are also privacy and body image concerns as the subclavian region is exposed with many contemporary fashions.

Results: Over an 11-year period, we implanted pacemakers, implantable converter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices (defibrillators or pacemakers) in 60 women, aged 13–70 years, using a 2-incision submammary approach. Follow-up surveys were performed using the Florida Patient Acceptance Survey (FPAS). Women with submammary device placement reported significantly greater device acceptance (M = 92.41, SD = 6.46) than women with standard implant technique (M = 70.29, SD = 17.85); t (54) =–6.08, P < 0.001, on the FPAS. Across subscales on the FPAS, women with submammary device placement also reported significantly less body image concern (P < 0.001), less device-related emotional distress (P < 0.001), and greater confidence in returning to life appropriately (P = 0.01) than women with standard device placement.

Conclusion: We present here our technique for submammary device implantation. (J Cardiovasc Electrophysiol, Vol. 24, pp. 476-479, April 2013)

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