Optimizing Aesthetic Results in Breast Surgery and Cardiac Implantable Electronic Device (CIED) Placement Using Acellular Biological Matrices

The increasing number of younger patients requiring cardiac implantable electronic devices (CIEDs) necessitates not only survival but also a preserved quality of life. Aesthetic considerations for CIED placement-particularly in the context of the female breast-are increasingly important, yet current guidelines lack standardized recommendations for ideal generator pocket positioning, especially in the presence of breast implants. We report the first use of bovine pericardium mesh to reposition a migrated, protruding subcutaneous CIED in a patient with prior breast implant reconstruction, who presented with breast contour distortion. Generator pocket repositioning was performed using an acellular biological matrix (ABM) to anchor the device securely against the prepectoral fascia, effectively preventing future dislodgement. The patient achieved excellent breast symmetry and a smooth transition between the anterior chest wall and the superolateral mammary pole. Postoperative ultrasonography confirmed successful compartmentalization of the periprosthetic space, matrix, and device. Durable device positioning was maintained at 12-month follow-up. This case demonstrates that reinforcement and repositioning of subcutaneous CIEDs using ABM in patients with breast implants offers multiple advantages including minimized tissue disruption; stable positioning along the chest wall; isolation of the periprosthetic space; and aesthetic outcomes comparable to those achieved with deeper device placement.