Pocke Revision under/thru muscle

Hello,
I am so glad I found this group… My question is...

Has anyone had there PM put in under the muscle? I had a PM put in in Sept 2009 and have had a lot of pain with it. I finally got a referral to a new specialist and he wants to do a pocket revision on Monday. He said he is going to cut my muscle and place the PM in that way. He said I am to thin for it to be so close to the surface. My old pacer was put in as an emergency procedure, I went in for a Tilt Table test and my heart stopped for 2 minutes and I was placed in ICU.

I am worried about the muscle being cut and loosing strength, not to mention the muscle will have to be cut every time I have to have the batteries changed… how is the recovery time???

I have so many more question, but I start with this one first...

Thank You
GiGi

14 Comments

burying it

by Tracey_E - 2010-04-27 06:04:02

Mine is behind the breast, so it's under both muscle and breast tissue. It's put in from the side, not the upper chest which is usual. There are a handful of us here with our pm's buried.

Something to ask your surgeon- other members have had it placed between the pectoral muscles rather than putting it in the muscle and had good results. Hopefully Inga will see this, she explains it really well.

Angelie, another member, had hers done just as you described. Her dr used the same incision where it was originally placed, just buried it a lot deeper so it would be under the muscle. She was sore the first few weeks but bounced back quickly after that and is feeling great now.

Any alternate placement that requires more digging is going to leave us more sore at first. I had my last replacement at the end of January. I needed a new lead this time that they had to tunnel it through, and as long as they were digging with the lead I had a plastic surgeon clean up the scar tissue from the last surgeries. So, it was by far my most invasive surgery to date. I only took tylenol after the first few days, I was mostly back to regular activities but babying my left side by a week. By 4-6 weeks I felt mostly back to normal, it just tugged if I pulled the wrong way, sometimes it ached at the end of the day if I overdid it. Now, I'm back to weights and my full routine at the gym, no pain whatsoever.

Replacements- super easy! I've had 4 now. They go in the same place and the scar tissue forms a pocket around it, think opening a zipper. If the first surgery is a 10, replacements are a 4 or 5 the first week, then a 2.

correction

by golden_snitch - 2010-04-27 07:04:19

Last surgery was in summer 2009.

subpectoral placement

by golden_snitch - 2010-04-27 07:04:24

Hey there,

as Tracey already said I had my pacer placed sub-pectorally but not from the side like she had. Last time I had it done was in summer 2008. The surgeon made the incision below my left collar bone, and cut through the pectoralis major muscle. He then sewed the pacer onto the pectoralis minor so that it stays in place, closed the incision he made in the muscle and then the normal one (skin). I was pretty sore afterwards, it was not comparable to the subcuteaneous placement (my first pacer was done that way). All three times I had a subpectoral placement, I needed painkillers for about two weeks afterwards.

What has helped me a lot afterwards was physical therapy. Since I was hurting so much, I didn't dare to move my arm much which is not good for the shoulder joint (risk that it stiffens). Physical therapy helped to gain movement back, and it also helped with the hardening of the chest muscles, neck and shoulders.

I had all subpectoral placements under general anaesthesia. First time due to the fact that I also had a lead extraction, and really didn't want to stay awake because I had heard that it was difficult to do a local anaesthesia when they actually need to cut into the muscle. Second and third time the surgeon himself wanted me to get a general because he thought that a local might not be enough. I don't know what will happen when I need a replacement in about eight years. For me, it would be ok to have a general again. I was awake for my first pacer surgery which was a normal procedure with a subcutaeneous pocket, and I didn't really like that. I prefer sleeping through it.

Hope this helps a bit.
Best wishes
Inga

Me too mee too!

by Dwight - 2010-04-27 09:04:06

I have been having the same problems as you state and told mine could be replaced deeper as a solution. I just can't deal with it right now. If it gets no better after another 3 months I may change my mind. Please keep me informed of your decision and your results.
Thanks,
Dwight

May 4 for implant of pacemaker

by linda4heart - 2010-04-28 09:04:57

Guys, could you please respond but I am very nervous about having my crt-d boston scientific implanted in the pectoral muscle. I am thinking the shape will not be any better here. Please respond if you now anything about this. I am 62 and in good shape but have stairs in the house and not sure how all this will work. I have one week to return to work. Please let me know what you think. My doc. thinks this is the way to go but he implanted it and it is almost in my armpit. I am thin so this does not help. Thanks for any help

I am looking at the same procedure

by linda4heart - 2010-04-28 10:04:18

I too am going to have to have my PM put into the pectoral muscle as it was originally placed under the skin back in October and now it is poking up so bad that I think it may break through anyday. I have been reading daily to see about postings concerning the recovery for this. My doctor says it will hurt like heck for the first week. I am 62 years old and in very good shape but am wondering if my recovery will extend past a week. I will be following all of your postings and will let you know how I do when I finally get this scheduled.

linda

by Tracey_E - 2010-04-29 05:04:32

A week would be pushing it to return to work, imo, because a CRT-D is considerably larger than a PM. I'm guessing you'll still be on painkillers at the end of a week. I'm not a dr, that's just a guess, but since it's so much larger I think your recovery time is going to be longer and pain level will be higher than those of us with a pm buried this way. I was limited in how much I could move my left arm and twist my torso for a good two weeks. You won't be able to do more than very minimal lifting for 6-8 weeks. It takes muscle that long to heal, so during that time anything that uses your chest muscles will pull. I felt good and was back on my feet in under a week, but I needed help to do things like stretch to put dishes away, lift a pot while cooking, fold a load of laundry.

A side note... take a button up top to the hospital and plan to wear things you don't have to pull over your head for about two weeks.

Pacer being moved under muscle

by Angelie - 2010-04-29 11:04:31

I had this done this year on 2/15/10, after a lengthy bout of IV antibiotics from my pacer trying to work its way through my thin skin.
My single chamber was okay under my skin, but I suffered nothing but protruding problems after my dual chamber upgrade.
The pain after surgery was not anything I could prepare myself for. I was always awake for my other pacer surgeries, but was under concious sedation for my sub-pec placement. I knew the sub-pec procedure would be a bit more involved and did not care to feel all the pushing a pulling as through previous pacer procedures. (I've had 4 pacer surgeries in under 2 years)
Although sub-pec hurt quite a bit more compared with the "cakewalk" of under the skin placement, the pain wasn't anything that a prescription pain reliever couldn't resolve. After my very first under the skin placement, I returned to my secretarial work duties 2 days after my implant. I was out a week after my sub-pec placement, and wore my sling because the pressure of my arm hanging down hurt my pacer site.
The first week was unbearable and scary. I thought it was horrible that the pain was that much different, and it scared me how I could NOT lift my arm even if I had tried. My arm seemed as if it were stuck after attempting to move it just two inches from my body. So the first week was hell.
Second week, (just one week post-op) I was without the sling and the difference a week makes was AMAZING. They just moved my pacer and not my leads, so I didn't have lead placement restrictions. One week post-op I was able to lift my arm to shoulder level. I was proud, and my anxieties about future movement lessened significantly.
Two weeks post-op, I was feeling back to myself. Minor pain, not even taking over the counter meds and long stopped taking the heavy prescription pain killers. Back at work, still had lifting restrictions but trying to gently to move my arm as much as I could. At two weeks post-op, I was able to slowly and gently raise my arm above shoulder level, and I was relieved.
Now at just over 2 months post-op, I can do anything as I did before, and just a few weeks ago swung on the monkey bars with some little kids at my church.
Being very thin, with I guess thin muscle on my chest wall. I've always been the type were you could feel all of my ribs through my chest muscles. Being this thin has also led to my pacer still being a bit noticable, but IT IS under the muscle and in a much safer more protected place.
If anyone has any questions with this please feel free to send me a private message. I'll try to help ease your anxiety as much as I can.

Angelie

Not a problem

by sln - 2010-05-01 12:05:19

Since I'm thin and thin-skinned, and fairly active, the EP put my PM under the muscle to begin with. That was about a year and a half ago and I don't have any problems with it. It also isn't particularly noticeable except for the scar, and under clothing not at all (even fairly clingy clothing). I haven't had any issues with doing activities like kayaking, skiing, etc., and appreciate that the PM is more protected than if it were just under the skin. Although it probably was more sore to begin with, I'm glad that it is subpectoral. I can feel it a little if I move certain ways but it doesn't hurt. I don't do weight lifting, though, except for very light weights, and don't know whether that would affect whether someone would want the PM under the muscle.

I also had conscious sedation for the procedure and wasn't unhappy about not remembering it...

More on this topic? 2012

by Peg541 - 2012-01-20 10:01:31

Hi is anyone from this topic still active here? I am 62 and getting my first pacemaker on Jan 31st and need the same advice.

I am pretty close to goal weight with thin shoulders. Not vain at all. Never wear close fitting clothes or swim (occasionally) I think under the skin should be fine for me.

But want more advice since the EP is giving me the choice. Maybe once he looks at my chest he'll feel differently.

I am not looking for a 6 week recovery. I was thinking more like one week. But if it's best to do it under the muscle I will.

Any more opinions here?

Thanks for any answers.
Peg

Under skin or muscle?

by PissyChrissy - 2014-12-16 12:12:21

Thanks for all your comments in recent years! I see nothing new on this subject since 2012.
I scheduled my first PM replacement for Feb 20/2015. I need to decide whether to keep it under the skin or have it put in the muscle to conceal it better. I'm not thin, just average, but the pacer is still noticeable. I had one family photo done where it cast a perfect circle shadow on my left chest!
I'm not that vain but my husband doesnt enjoy the feeling of it. If he accidently touches it, he gets that shivery response.
Trying to decide if the pain is worth it?!

First PM sub pectoral

by Kathy07 - 2014-12-17 06:12:13

I am 34 years old and a crossfit 6 days a week and work full time in nursing.
I had my first PM implanted on the 8th December 2014. I was not prepared for the pain that I woke up with after a general anaesthetic.
My Pectoral muscle was cut to make a pocket for the pacemaker to fit into neatly. I have an athletic physique and almost no excess tissue in the chest area so this was my only option.
I found that prescription medications have helped and regular timed analgesic has decreased or kept the pain to a minimum. Mostly it's the discomfort that I have been concerned about and a burner/stinger sensation I get in my left forearm when I abduct my arm this only started 4 days post op and is still making its presence felt.
It's early days yet with a few small post op hiccups but I'm sure they will subside. My insertion site looks great and having it in the muscle makes it less visible.
So my focus is recovery and getting back to the sport I love.
I have found this site very helpful, some great comments which helped me prior to surgery. If anyone has any further comments about burners/stingers/nerve issues in the arm I'd be grateful for any insight.

Cheers
New ticker :)

In the muscle...

by gigi_c - 2014-12-17 11:12:06

Well it's been 4 years since I had my pacer put into the muscle due to horrible pain with it just below the surface... Best decision ever made... The pain disappeared like magic... The recovery pain was not bad just uncomfortable, annoying. Keeping your arm down is the biggest obstacle... I was worried about strength being lost with the muscle being cut. I have not had any problems with that... Do to my heart issues I don't exercise much so I can not comment on weight lifting or high use of that muscle... I did pool aerobics for awhile with no issues... As for being vain, I don't think this applies to us... We did not choose this it chose us. Putting it in the muscle helped a lot with the visual. It is more of a slight mound instead of a tinker toy look under the skin... I lucked out with having it redone my scar looks like a cross, I think is it awesome since it saves my life... Good luck with your journey... With any surgery there is pain but it is doable and the pain is such a small part of our journey.

under the muscle

by vattens1 - 2015-01-22 10:01:32

I just had mine repositioned under the muscle as it was beginning to sick out of skin you could see outline very well. I only had it put in last june. Felt a big of pulling as had it done under local but not painful. Sore afterwards mainly muscle pain but i only took over the counter pain killers for 2 days. Seems to be much more settled where it is. Get a couple of twinges but that is to be expected

You know you're wired when...

You play MP3 files on your pacer.

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