title: Submammary Placement With Mastopexy for Implantable Pulse Generator Site Pain in Thin Women.
abstract: OBJECTIVE
  Implantable pulse generators for neurostimulation and other indications are becoming more widespread. Pain at the generator site, erosion through the subcutaneous issues, and migration of the generator are frequent post-operative complications that result in high rates of re-operation. We report a case where a submammary combined approach with plastic surgery for improved soft tissue coverage resulted in better esthetic and functional outcomes in a thin woman.
  
  
  METHODS
  A 40-year-old thin woman presented for revision of spinal cord stimulator due to pain at the bilateral infraclavicular generator sites secondary to lack of soft tissue coverage. She underwent revision of the implantable generator site with placement of the generator in the submammary location and concurrent mastopexy with plastic surgery.
  
  
  RESULTS
  At two-year follow-up she continues to be pain-free after surgery and is very satisfied by the cosmetic outcome.
  
  
  CONCLUSIONS
  Submammary placement of implantable pulse generators in thin women combined with mastopexy may result in improved soft tissue coverage, decreased pain at the generator site, and a low rate of complications.
authors.affiliation: Division of Neurosurgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hong
authors.affiliation: Division of Plastic Surgery and Neurosurgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Emily B
authors.initials: EB
authors.lastname: Ridgway
mesh_terms: D000328:Adult; D019928:Breast Implantation / Q000009:adverse effects; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology / Q000628:therapy*; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D013116:Spinal Cord / Q000502:physiology*; D016896:Treatment Outcome
keywords: Complications; generator site pain; implantable pulse generator; spinal cord stimulation