A new pilot study suggests botulinum toxin A could help reduce pain and expedite expansions by relaxing the pectoralis major muscle in post-mastectomy tissue expander-based breast reconstruction.
“Immediate or delayed reconstruction cases can be plagued with pain from the direct pressure that the expander exerts onto the muscle. The toxin in this case helps by relaxing the muscle and making the reconstructive period more tolerable, especially during the expansion phase,” the study’s lead author Allen Gabriel, M.D., associate clinical professor of plastic surgery, at Loma Linda University Medical Center, Loma Linda, Calif., tells Cosmetic Surgery Times.
Researchers studied 30 patients undergoing mastectomies with immediate expander or acellular dermal matrix reconstruction. Fifteen patients received 40 units of botulinum toxin A (Botox, Allergan; neurotoxin group) injected into each pectoralis major muscle through four serial injections. The remaining 15 patients received four serial injections of 0.9% sodium chloride (NaCl; placebo group).
Researchers followed the patients for more than a year, recording patient demographics, visual analog score, laterality, office visits, amount of expansion and number of times to full expansion, as well as the amount of required narcotics.
They found the two groups were similar in terms of age, laterality, expander size and complications. But patients receiving the neurotoxin had less pain compared with those in the placebo group. There was also a significant increase in the volume of expansion each visit in the botulinum toxin A group. And while patients in the two groups has similar narcotic usage in the three days after surgery, narcotic use dropped significantly in the neurotoxin group from days 7 to 45, compared to the placebo group.
“For some patients, the toxin can be injected into the pectoralis major with the use of ultrasound before or after surgery. In our study, the toxin was injected into the pectoralis major muscle during surgery by direct visualization,” Dr. Gabriel explains. “The principle of muscle relaxation can be utilized in any implant based surgical cases, where the pectoralis major is elevated. This applies to both reconstructive and cosmetic breast surgery cases.”
The researchers reported no neurotoxin-associated complications. The study was first published online March 30, 2015 in the Aesthetic Surgery Journal.
Gabriel A, Champaneria MC, Maxwell GP. The efficacy of botulinum toxin a in post-mastectomy breast reconstruction: a pilot study. Aesthet Surg J. 2015 May;35(4):402-9.