Pacemaker Placement?


I am 31 years old female with a complete av heart block. Next month, I will be getting a pacemaker with two lead wires implemented, but I'm having trouble with deciding on where I want the pacemaker. I honestly don't want it under the skin above the pectoral muscle. My doctor suggests to place it under the pectoral muscle. I'm worried it's going to bother me when I carry bag packs, or doing upper body workouts. The doctor also doesn't think that having a pacemaker under the breast is the best option for the long run. I would like it under the breast. Just FYI, I'm very active and love to travel/hike.

Is placing the pacemaker under the pectoral muscle the best placement? Or should I try to get the pacemaker under the breast?

I would love to hear your opinions! If you could go back, would you change where your pacemaker is located?


Sub-pectoral implant

by ar_vin - 2020-02-14 02:11:12

I'm similarly very active and weighed options for PM placement prior to my procedure. 

Since I hike/backpack/run/climb often with a backpack my concern was the PM getting in the way of the pack straps. My EP and I discussed options and he suggested a sub-pectoral placement which is what I chose.

I was a bit sore for the first week or so after the procedure but healed very quickly and most of the pain and soreness were much reduced in two weeks. During the entire time after the implant I stayed active by walking 4-8 miles each day for the first two weeks. After three weeks I was walking up steep roads near our local hiking trails to keep myself in shape.

When I tried on a pack three months after the implant there was almost no soreness.

More than an year after the implant I do everything that I was doing prior to my implant at the same intensity on the same mountains and trails. I don't even know I have a PM most of the time.

Sorry i can't help you with under the breast placement as I have no experience with that - I'm sure others will weigh in.

Welcome to the club you didn't ever want to belong to! 



I've had both

by Tracey_E - 2020-02-14 11:35:33

I am you, but fast forward 25 years! I also love to travel, hike, work out. My first 4 were under the breast, when I got my latest they moved it to pectoral. Pro's and con's to both.

I got my first in 1994 at age 27. At that time no one was doing alternate placements but I was young and underweight so my cardiologist brought in a plastic surgeon and I think they were making it up as they went along. Ok, I know they were making it up as they went along! They went in from the side, right about where the side seam of a bra hits. Men, gotta love 'em, they were trying to make it inconspicuous but a woman would have known not to make a scar there! It eventually got numb but wearing a bra was interesting the first few months. 

Under the breast took a lot longer to heal. It's more invasive and it was weeks before I could wear a bra, months before I could sleep on my left side. Once it healed, I didn't even know it was there and I loved it. By the third, the scar tissue had built up enough that it was getting achy sometimes, especially before my period. It was kinda funny, that's how I knew I was about to start, not by the calendar but because I could feel my pacer lol. 

When I got my 4th, I needed a new lead and the scar tissue was getting worse so they brought in a plastic surgeon to clean up the pocket. I had room in the vein for another lead but because it was buried so deep, they put the new one in a different vein which meant a new incision and they tunneled it to the pacer itself. I was pretty sore after that one between redoing the pocket and running the lead but again, once it healed and I didn't even know it was there. 

When I got my 5th, I had a new surgeon. He wanted to move it because it was so deep it was hard to get to.  I said no, I like it there. He said, ok, but instead of going in where the previous ones from the side he wanted to go in from the scar where they'd put the lead in last time. BTW, that scar is right along the edge of a tank top so closer to my armpit than middle of chest but still easily covered. I said ok, just don't move it. The jerk moved it under the pectoral. It was ok there but it has since shifted so the side sticks out a bit and it moves if I have my arm up or sleep on my left side and it bugs me. Not enough to have another surgery to move it, but enough to make me cuss that surgeon pretty regularly and at least discuss moving it with my new doctor. If it had stayed put, it would probably be fine.  

I love to hike and have no trouble with a heavy pack, either now or with the previous placements. I do Crossfit so Olympic lifting, pull ups, push ups. Sometimes if we do a lot that uses chest muscles it'll get a little achy for a few days but nothing more than mildly annoying. 

In case it's in your future, I had two babies while it was submammary and nursed them with no issues. 

Year before last, there was a growth in the old pocket that showed up on a mammo. Biopsy was clean, it was just something funky in the scar tissue. (there was a name for it but I couldn't tell you what it is) Everything was fine but it was scary at the time and wouldn't have happened if the pacer hadn't been in the breast for so many years. 

I get why the surgeons prefer pectoral or subcutaneous to submammary. It's more work, longer healing, more infection risk, scar tissue builds around it making it hard to get out, it's more trouble if a lead needs replaced. I personally found it more comfortable but subpec isn't bad and I'll take that over just under the skin where it leaves a lump any day.

Depending on your build, they may be able to do it a bit lower and deeper without putting it under the pectoral. IMO that's your best option. It's out of the way but not in the muscle. That's my plan for the next one, or if I decide I can't wait out the battery and decide to have this one moved sooner. 

Hope that's more helpful than confusing! I found the surgery easier than expected and after I felt better than I ever imagined. I'd been tired and easily dizzy my whole life, from the minute I woke up with that first pacer I felt so much better. I didn't realize just how bad I'd felt until I had something to compare it to. There have been a few little bumps in the road but I am healthy and active 25 years later, there's nothing I want to do that I cannot. No one looks at me and sees a heart patient. Wherever you decide to place it, wishing you an easy surgery and fast recovery. Feel free to message me if you want to chat.

You got a choice?

by cagedliberty - 2020-02-14 21:08:17

I just got a pacemaker implanted a few weeks ago and I wish I had been given information about options. 
My pacemaker is located above my pectoral muscle and its boxy shape is very apparent. The scar is also bang center of a bra strap so I have been avoiding tops that have straps for now.


I don't have any advice as I am not familiar with your options but I wish you the best of luck and speedy healing!

Choice and assertion of rights

by ar_vin - 2020-02-15 01:22:32

"You got a choice?"

You always got a choice! It's your body, your life and your money (at least in private insurance systems). You must assert your choices and be involved in decision making for all medical decisions except in dire situations when one is unable to participate. 

- Always ask questions till you're satisfied with the answers you get

- Always take the time and make the effort to educate yourself on your options; it IS an effort! But hey it is your life!

- Never get pushed around by self-important "professionals" who refuse to engage with you and answer your questions. You could seek out another equally if not more qualified physician who will happily work with you

- If at all possible, buy time and avoid hasty decisions. In most cases a delay of a few weeks is unlikely to make any difference to your eventual outcomes

- Do seek out an EP who will welcome your questions and not stonewall you


I speak from personal experience: when I was initially diagnozed with "sick sinus syndrome", I was hospitalized (for very little reason in retrospect): the technical jargon for this is "observation". It is a way for the medical system to extract massive amounts of money for nothing - in my case it amounted to around $150,000 for a two day hospital stay. An entirely criminal shakedown. I have excellent insurance so it was covered but regardless it's a massive waste.

A friend who runs a health insurance billing services company explained to me that "observation" is probably well over 50% of unaccounted for wasteful spending in the US. Before I was released from the hospital (and had not been billed yet) my friend predicted what the codes on my bill would say and he was spot on.

A literal gun was held to my head by the EP in charge of my care who insisted I was in dire need to a PM implant the very next morning. I kept pushing for answers and did not consent to any procedure until I obtained a second opinion.

Unfortunately this is the sorry state of the US health care system as we know it.

I eventually got the PM implant almost an year later (having consulted a second EP, a highly competent and personable physician who spent a great deal of time explaining my options and the how the decision might impact my health.

To be clear: the first EP is highly regarded and is indeed very competent at his job; unfortunately he is a total jerk and lacks basic communication skills! In my couple of encounters with him, he would be looking into his phone or taking calls while I was in his office sitting across from him and trying to ask him questions. And he NEVER responded to a single email!

My eventual PM implant cost my insurance company around $50,000 to put things in perspective.

So please assert your rights!





Thank you!

by Dvera - 2020-03-07 13:15:47

Thank you so much everyone!! I didn't expect to receive such informative responses! I truly appreciate all of you for taking the time to respond!

Tracy, your message really moved me and I will be reaching out to you personally! I am blown away by how you take charge of your placement. How do you find such cooperative doctors? I also want to keep in touch in regards to how your new placement goes so I can use what you did if I need it in the future or if subpectoral doesn't work.  Also, to answer your question, I am short, 5'1", and fit.

To cagedliberty, you are not alone! I really like ar_vin's advice for future placement or when you have to replace the battery! I think you could have a subpectoral placement in the future since it's right next to where you probably have it now. If you are really interested in changing the placement, maybe you can ask in the forum and see if anyone has changed the placement before a battery replacement or during? Again, keep in mind that I don't know everything and I am getting my pacemaker next week...
Every doctor I have met, they all reccommended me to get the pacemaker just under the skin! No one ever told me that there were other options. I kept putting off the surgery (like 8 years!) because I had no symptoms (ex: shortness of breath or chest pains) and I was hoping for future advancement of pacemaker placements. I only found my options through research and reading medical journals. Then, I was lucky to find this group. The past few years, I have learned to not take the doctor's decision as the only option, but to do my research and get different opinions from other doctors. It's such a hassle! I finally found a doctor that was willing to do subpectoral placement and had experience with such placement.

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