Submammary placement of neurostimulator devices: broadening the spectrum of cosmetic techniques

Abstract

AbstractDeep brain neurostimulators (DBS) have enabled thousands of individuals to overcome movement disorders, thus offering them a new chance for social integration while enhancing their self-esteem. A classic DBS consists of a central implantable pulse generator (IPG) and its respective wires and leads that extend to the scalp to reach the brain. The classic positioning of the generator is currently subcutaneous, usually just below the clavicle or in the abdominal wall. As DBS systems are of a substantial size, this subcutaneous placement leads to unsightly and visible devices, particularly in thin patients. We report two cases of female patients who benefited from our technique to hide the IPG under the breast parenchyma. IPGs were placed through an inframammary incision in a subglandular pocket, similar to the technique used for implant-based breast augmentation. In the first case, the devices were implanted in a subglandular pocket and replaced 5 years later due to battery life limitation. In the second case, the devices were replaced from a subclavicular position to a submammary one. No major or minor complications were observed. Both patients reported an excellent level of satisfaction with the aesthetic and functional outcome. Despite the significant quality of life improvement of patients with DBS, the ideal implantation of the generator should also take into consideration the comfort and cosmetic aspects. Our approach has the potential to markedly improve the aesthetic outcome of such an intervention.Level of evidence: Level V, therapeutic study.