Any Experience of This Procedure?

I've been offered a slightly different form of procedure where a vertical incision is made in the crease of the shoulder just below the collarbone. This is said to minimize visible scarring. There is a risk in that if the nearest vein is not viable, then it's more complicated to get the one by the collarbone (sorry, complete layman's terms). Has anyone else had this done & what was their experience? I am very tempted, more from a vanity perspective than anything else. I didn't really get the opportunity to ask questions about impact on recovery time, but should have the chance to do this before making a decision on surgery day.

6 Comments

PM Location

by donb - 2010-09-09 08:09:00

Good morning Morwenna! I am not an expert on our medical innards but I have had 4 implants over the last 18 years. My 1st was just under my left collarbone and each replacement had to be lower as the pouch surounding your PM naturally sags. Guess I always blamed that to my activity as I developed a lot of scar tissue & also each of 3 replacements were also of differant physical size. The 1st being quite large followed by a very small replacement. My 3rd was again quite large as it was positioned quite low and not comfortable.

I had built up quite a lot of scar tissue around this PM within the 1st year with lots of itching and some pain. Well it started to erode soon after and had to be removed.
Also one of my leads of the 2 had a bad insulation fracture which my cardiologist noted when he installed the 3rd PM.

Now, after a couple of months without a PM as I was showing only 1st degree electrical block, but my sleep timeHR would again drop down in the 30s' along with intermittant Atrial-Fib. So now I'm sporting my 4th new PM with 2 new leads starting all over in my right chest and again a nice good fit just under my collarbone. I was also fortunate to have a very experienced cardiologist who had years of experience as a plastic surgeon prior.
I must tell you not to get upset with my ordeal as I have had the best of life throughout the past 18 years since my 1st PM at age 60. (should have had it sooner). Also I would not have been on this site as I needed answers and got lots of support from this group. So, I'm sure you will get opinions as to your upcoming surgery. Just tell your surgeon you want a good home for your new buddy!!
Good luck!! It will be a piece of cake. donb

Sorry!!

by donb - 2010-09-09 08:09:20

I didn't answer your question, I got carried away. I believe some of our newbies have had vertical incision but with basically same PM location immediately under collarbone. Sounds like a good way of doing it !! donb

al;ternate locations

by Tracey_E - 2010-09-09 10:09:52

I'm trying to picture exactly where that would be. You wouldn't want it too close to the shoulder because it might get in the way of moving your arm. We've had a few women here done that way, mostly very thin and very active, and they hit it with their arm sometimes when they move. I

Mine is behind the breast, put in from the side about where the underwire of my bra hits. I needed a new lead this last time and they put the lead in from higher on my chest but he did it so that the scar doesn't show with most clothing. It's not vertical, more of a 45 degree angle, down enough from the collar bone and far enough in from my shoulder that it's covered with a tank top. Does that make sense? So, it's a bit more in and at an angle from where you're describing. I think, lol. Anyway, they didn't run the lead directly in the subclavian (where they'd go if done just under the collarbone) but rather in a secondary vein but it still ends up in the subclavian. The doc did a venogram first to make sure there was room to do it that way.

I highly recommend trying to bury it a bit, however you go about it. If it's a little deeper than the usual placement, the recovery is a little longer and a little harder but it's not that bad. I've had 4 replacements now. Even with my deep submammary placement, I've never taken more than tylenol after the first few days. By the end of the first week I'm mostly back to normal activities, by 6 weeks I'm doing my full workout at the gym with push ups. (push ups are always the last thing for me to be able to do again without it hurting) Not only does it look better which makes it easier to forget it's there, but it feels better having it buried. I don't have any problems working out or with seat belts and bra straps rubbing. It's nice that your dr is thinking ahead, many don't give us options or worry about how it will look.

seen a video

by turboz24 - 2010-09-09 11:09:04

I've seen a video with the placement you are talking about. They "slice" you right where your deltoid (shoulder muscle) and pectoral (chest muscle) meet. They access the Cephalic vein that runs right below that implant area. The implant procedure I saw, they used that approach to place the implant under the pec major.
Are they placing it under the muscle?

Fat?

by turboz24 - 2010-09-10 04:09:13

I don't know about other guys, but I 0 fat where my implant is. The scar is pretty large, since it the implant put pressure on it and pulled it. I had internal stiches as well as glue.

Scar

by cruz - 2010-09-10 10:09:29

I have the traditional "scar" if you could even call it that. I'm female and had the procedure done in Feb of this year. The scar is barely visible. They used internal stitches and the surgical glue. It's difficult to get the device as deeply buried on a female because we don't have as much fat (sorry guys) in that area. The "lump" was very visible in the very beginning. The EP told me it would go down in size and it has. When I flex my arm (like putting my arm behind my back), you can see the lump, but not the scar. Even just after the surgical tape wore off, the scar was only a very tiny thin red line. It is now not even that. If it's the scar alone that's the issue, I think it's a non-issue. I have worn clothing that shows the area where the scar is at and no one would even notice it. The shoulder area is where the most pain came from for me. I'm not familiar with the method for the vertical slice. Maybe as Turboz is asking, they are using this method to implant under the muscle. For me, it would be a question of which method puts more recovery on the shoulder rather than the scar.

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