Sometimes, if there is substantial weight loss, the overlying tissue can become thinner and it may look like the wires are about to pop out. The weight change can also give the appearance that the device has shifted. In general, this will not affect the function of the device. If the device checks are normal and the chest X-ray shows good lead positioning in the heart, there is no need to worry.
Rarely, the overlying tissue can become so thin that there is a risk of the skin breaking down. There are times that the pacemaker is repositioned in the operating room to prevent skin breakdown. It is important to have your cardiologist keep an eye on the health of the overlying tissue.