Abstract A surgical approach is described for a more cosmetically acceptable placement of the automatic implantable cardioverter-defibrillator in young women. The transvenous sensing lead and the vena caval spring electrode are placed through a small subclavicular incision. The left ventricular patch electrode is placed through an anterior minithoracotomy in the crease under the left breast. A small transverse incision in the left lower quadrant is used to place the generator under the external oblique fascia in the low abdominal wall. Minimal cosmetic impairment from incisions and hardware results.