Breast Reduction in a Patient With Prepectoral Deep Brain Stimulator

Summary:

Deep brain stimulation (DBS) is an increasingly common neurosurgical intervention for drug-resistant epilepsy, Parkinson disease, essential tremor, and other neuropsychiatric diseases. The pulse generator is commonly placed infraclavicularly, but prepectoral pockets have been reported due to improved cosmesis with less prominent devices and scars. Reduction mammoplasty surgery has not been reported in patients with prepectoral DBS devices. We present the case of a 56-year-old woman with symptomatic macromastia and subglandular DBS device who underwent pocket exchange to the subfascial plane during routine generator exchange. She subsequently underwent bilateral breast reduction in the setting of a subfascial DBS. Successful reduction mammoplasty was performed without complication. DBS device perioperative management, intraoperative electrocautery, and careful dissection to preserve device pocket are discussed. Breast reduction for symptomatic macromastia can safely be performed in patients with deep brain stimulators with proper preoperative planning and coordination with neurosurgical colleagues.