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

Ilias G Petrou,Shahan Momjian,Ali Modarressi

doi:10.1007/s00238-020-01665-5

Ilias G Petrou, Shahan Momjian + Show 1 more

Open Access

https://doi.org/10.1007/s00238-020-01665-5

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Abstract

Deep 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.

Highlights

Deep brain stimulation (DBS) has become a commonplace procedure over the past decades for the management of Parkinson’s disease [1], primary dystonia [2] or tremor [3], improving tremendously the patients’ quality of life
The important success of this procedure has led to the further investigation of diseases that could be treated by DBS, such as treatment-resistant obsessive-compulsive disorder [4], epilepsy [5, 6] or even obesity [7]
We present our technique of implanting the generator in a subglandular pocket, such as the one used in implant-based breast augmentation (Fig. 1)

Summary

Introduction

Deep brain stimulation (DBS) has become a commonplace procedure over the past decades for the management of Parkinson’s disease [1], primary dystonia [2] or tremor [3], improving tremendously the patients’ quality of life. In thin patients, even the smallest nonrechargeable devices may cause cosmetic and functional inconvenience To overcome this problem, other positions have been described as the axillary or the submammary ones [9, 16]. Patient 2 was a 67-year-old woman (BMI, 19.1 kg/m2) who had two unilateral non-rechargeable IPGs in a subclavicular position for Parkinson’s disease since 2013. As the patient was unhappy with the aesthetic appearance and presented skin irritation because the devices were just below her brassiere straps, we proposed a bilateral submammary position. The surgical approach was similar to that of a subglandular implant-based breast augmentation via the inframammary fold. No major or minor complications were observed Both patients reported excellent levels of satisfaction with the aesthetic outcome and intervention experience

Discussion

Compliance with ethical standards