Plastic Surgery to reduce scaring

We have just learned that our 13 year old daughter will need to have her pacemaker replaced. She has only had it about 3 years, but it is one of those Medtronic Sigma devices that are subject to the latest recall. She has already had several major heart surgeries, and we are devastated that she will have to go through yet another procedure, and much sooner than we anticipated. She already has a number of scars from her earlier procedures, including the original pacemaker placement, which was done when she was four (she's had one replacement already). The original placement was in her abdomen, but now they want to move it to her chest. Since the new scar will be highly visible, I am wondering if anyone has every asked for a plastic surgeon to participate in their pacemaker surgery. I would like to try and do what I can as a mother to minimize the trauma that my child will be going through in dealing with yet another surgery and scar. In the past I have raised this idea with her cardiologists, but have gotten pretty dismissive answers. Any thoughts?

10 Comments

other options

by Tracey_E - 2009-05-21 01:05:16

If your surgeon is willing to consider alternate placements, you really don't need a plastic surgeon, imo. Most doctors don't have many young pm patients. It's not that they can't make it look good, it's just that it doesn't come up that often. Plastic surgeons are good for reconstruction and making the scar look better. Because the pm will leave a lump if not buried, the idea's to get the scar/lump where you can't see it more than to make the scar look good. Does that makes sense?

Even if they can't bury it like mine is, ask about putting it lower and deeper, a few women members here have done that. It's an easier surgery than mine but much less conspicuous than the usual shallow placement just under the collarbone.

Good luck! I'm glad you have a great team, that makes a world of difference. I never had an appreciation for what my parents went through with me until I was a mom myself. My hat's off to you.

plastic surgery

by susanryan - 2009-05-21 01:05:17

Thanks Tracey and Don. We don't have the option to wait on this surgery, but I think you are right that we should wait to do any scar revisions until she is grow. I understand that scarring is often worse in adolescence. And Tracey, I do understand what you are saying about the bulge vs. the scar itself. The bulge is a big concern of mine, as like most teenagers, she likes to go around in tank tops as much as possible. Plus she is a very good athlete, playing tennis, running track, doing backpacking/hiking trips, so I am concerned about the impact of the chest placement on her lifestyle too. We will talk to her doctor both about placement and the scarring. We'll see what happens. Thanks for your comments and support.

Surgeon

by donb - 2009-05-21 04:05:18

Hi Tracie E,
To answer your question about lead placement, in my case there was'nt much choice as my left area was a wreck. I believe they will use the same site area if they can, but for a skinny small person with three prior generators with lots of inner scar tissue they had to go to the right side. I had two months without a PM when I could have had the old leads removed but also had to deal with the risk factor of 17 Years of ingrown leads with laser removal. Had I had that done & recovered I still would have had to have a right side replacement. As it turned out I went into AF, change of Meds and a new right chest PM intall. Now waiting to see when my plastic surgeon can get with my Cardiologist to clean up my left side. Don

plastic surgery

by susanryan - 2009-05-21 09:05:38

Thank you very much. My thought is that we could try to have a plastic surgeon in on the surgery to help close her up. I'm not a medical professional, so have no idea if this is reasonable or every done. When I have raised this in the past, the responses I have gotten from the Cardiologists have been things like "we don't do that", "none of my patients care about their scars", "insurance doesn't cover that." We would be happy to pay privately if we could help in her in any way. Obviously her safety is the most important thing, but I have to think about her self esteem and overall wellbeing too. Thanks again for answering, and the very best of luck to you too. Susan

Plastic Surgery

by donb - 2009-05-21 09:05:44

Just want to comment about plastic surgery chest restoration. I have an appointment within the hour to see a plastic surgeon as I have some major scar tissue which is forcing my old leads on my left chest to almost come through. My Cardiologist made the appointment as he wants to address the old lead issue. I forgot to mention I have my fourth PM with new leads in my right chest. I'll ask this plastic surgeon about your daughter's issue and get his feel as his experience with PM scarring restoration. Don

surgeon

by Tracey_E - 2009-05-21 10:05:58

If her doctor is dismissing your concerns, get another opinion. If he won't even discuss appearances with you, it's obviously not a priority with him and he won't take extra care. Some surgeons get the job done, some are more careful about how it looks.

My first pm was done by a plastic surgeon teamed with a cardiac surgeon, done at my cardiologist's suggestion due to my age and build (20's, small boned, underweight). It doesn't just look better, it feels better also. I never have problems with seat belts and bra straps rubbing or carrying a backpack. We were prepared to pay him ourselves, but insurance didn't question it and it was covered.The cardiac surgeon was there to do the leads, etc, the plastic surgeon decided on the placement and did the incisions and stitching.

Mine is nearly invisible, it only shows if I wear a halter or string bikini. I don't know if my placement would work on someone so young, but mine is behind the breast and placed from the side. I have a tiny scar (less than an inch) where they put the leads in on my chest, barely visible if I wear a low cut top. The main scar is on my side, about where an underwire hits, and they tunneled in and buried the pm behind the breast. I can barely feel the edges if I poke around looking for it.

Recovery from burying it this way is longer than a regular placement. I was never in enough pain to take more than tylenol, but it was a good three months before I could stretch in any direction and do a full workout without any twinges. I feel it was totally worth it in the end- no lump, no scar, no discomfort. You would not necessarily need a plastic surgeon to do it the way mine was done. At that time (15 yrs ago) anything other than under the collarbone was virtually unheard of for adults but it's more common now, and now they have those tapes and glues that replace stitches so scars look better anyway. You just need a surgeon willing to think outside the box, to do a little homework instead of automatically doing it they way they always do it.

Don, when you get a second set of leads, do they automatically go on the other side or can they still go on the left? I'm facing lead replacement next time, discussing remove the old ones or put new ones on top of the old.

plastic surgery

by susanryan - 2009-05-21 11:05:08

Thank you very much for your comments. We do have tremendous confidence in our daughter's cardiologists, who have always gone way out of their way to do everything possible for our child. Most, if not all of the comments I quoted were from a doctor she saw at the time that she had her last major surgery, which was nine years ago. And I don't think she meant any harm, she was just completely focused on the cardiac issues, which in my daughter's case are far from trivial; she is lucky to be alive, much less be the active, fabulous kid that she is.

But the current team is wonderful, particularly her EP and regular cardiologist, and although they did not think a plastic surgeon was necessary the last time around, perhaps that was because they were just placing it in the same spot as the old one, which is in her abdomen. So I am hopeful that perhaps this time they will be receptive to the need to consider the aesthetic aspects of the case as well as the cardiac issue. One major problem is that we don't have much time to line people up -- because of the recall of the device, her EP would like to do the surgery as soon as possible, and I don't know how easy it will be to line up a plastic surgeon on a week's notice.

But like you, my daughter is thin and small boned, and I dread to think what the placement is going to look like if they go the standard route.

Thanks again for your comments and help.

Plastic Surgery

by donb - 2009-05-21 12:05:48

Hi, This is Don, just got back seeing The Plastic Surgeon. He said age is a big factor for a growing child as scarring is involved. The reason for delaying the surgery until maturity age is the outcome is always better. If the repair is done at a younger age, especially in the breast area, the chances are the scar will show up much more as it grows. So He says wait until she develops fully and it'll be the best way to go.
I can vouch myself as I had appendectomy done at age 12 and being a scar person you should see mine.
My pacemaker scar always brings the same comment, (OH MY GOD) but men don't usually care only when it HURTS Don

placement on a tiny person

by mgweaver - 2009-05-22 07:05:23

Hi! I had my ICD implanted when I was 25 and weighed (and still do weigh) about 105 pounds. I have a small chest and my ICD is definitely noticeable. I too wear alot of tank tops during the summer. But honestly I don't even notice it anymore. The only time I have had an issue is when I had to wear a strapless dress for a wedding. That's about it. I actually looked into getting breast implants in hopes that it would cover mine up a little but that's not happening either. I seem to have something to discuss with my cardiologist everytime I go for a checkup though. Either implants or why a corner or my ICD gets in the way when I am trying to shave my armpits. Haha. He just laughs it off because I am one of his only young patients with an ICD. Tell your daughter to wear that scar proudly. It makes for a fun story sometimes too. :)

~Marisa

Devastation

by Faith - 2009-10-12 10:10:03

I'm 39 and got a pacemaker implanted when I was 34. Nobody told me how it would look - the doctor actually said it would just be a little scar and don't worry, somebody will love you. But it's not just a little scar and because I've always been very thin on top you can see the whole outline of the pacemaker plus there's a scar but the scar is the least of my problems.

For years I've been convinced there should be another way to deal with pacemakers. I wasn't old when I got it. I was a relatively young single woman and I have been deeply affected by this disfiguration which I continually try to hide or if I don't have to see people look at it and feel like a freak.

I simply don't think it's anybody's business that I have a pacemaker and I don't think it should be clearly visible. Nor should I have to wear tops up to my neck for the rest of my life.

Is there anybody who knows of anything that can be done after the pacemaker has been in for some time.

Any help anyone can offer would be most appreciated.

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