Pacemaker Placement and Breast Exams

Q:  I have been feeling very tired for years and I have also passed out a few times. After some tests, I was found to have a slow heart rate (in the 30s) and a fast one at times (in the 160s). I was sent to an electrophysiologist, who said I would need a pacemaker. I am a young mom and I understand that this would be a great help to keep my heart rate stable.

I am however concerned with the place where this doctor wants to put it. He said that it would be best if placed under the breast. He said that it should not go under the collar bone because it would stick out too much.

I have done some reading on this and I am worried because of the surgery involved. I can't find a lot to read out there but what I did find does not sound good. I have had a few breast biopsies done, I go for a yearly mammogram, and I might need another biopsy. So, I am worried that if the pacemaker is placed under the breast, it might hide suspicious lumps that may show up.

Do you know of any other options that I may have for placement of this much needed pacemaker? I was to have this done last week but had put it off for a while. I just moved here and I would like to get another opinion. I would appreciate any information you might have on this.

A:  For your heart arrhythmia, a permanent pacemaker is the treatment of choice. They are placed under local anesthesia and usually function for 10 to 15 years before requiring replacement.

G. Hossein Almassi, MD, Professor of Surgery (Cardiothoracic) at the Medical College of Wisconsin, prefers to place pacemakers just under the skin about two finger-breadths below the left clavicle (collar bone). He chooses the left side because most people are right-handed and would be moving the left side less vigorously.

Today's pacemakers are so small, about the diameter of a half-dollar and half-an-inch thick, that they should not be detected under clothing. To avoid even a slight bulge, the pacer can be placed under the pectoral muscle, but still above the breast tissue. Dr. Almassi stressed that he would not implant the pacemaker under the breast tissue for the very reasons you mentioned (interference with breast exam and mammography).

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.