A recent study presented at the International Society of Aesthetic Plastic Surgery’s  20th Biennial Congress in San Francisco, California noted that Botulinum toxin A, commonly known as Botox, may significantly reduce the postoperative pain from silicone breast implant reconstruction procedures following mastectomy surgery.

Breast reconstruction usually involves the placement of a temporary expander implant between layers of the pectoralis major chest muscle during a mastectomy surgery.  Following the mastectomy the expander is filled serially with saline to create a pocket.  The permanent breast implant is placed at a separate procedure. The chest muscle will sometimes contract and spasm in response to the expansion, which in some cases can cause pain or discomfort.

The authors of the study theorized that injections of Botox could offer relief by temporarily causing the chest muscles to remain relaxed. That way, fewer muscle spasms would occur and less pain would arise.

The small, randomized clinical trial used statistical significance to demonstrate that women who received Botox injections were more comfortable after breast reconstruction surgery than those who received a placebo.

No notable differences in the use of narcotics, muscle relaxants, or anti-inflammatory drugs were observed for the 2 trial groups in the first 3 days after breast reconstructive surgery. However, during days 7 to 45 of recovery, the Botox group used significantly fewer doses of narcotics and muscle relaxants.

Additionally, the authors found a statistically significant increase in the volume of expansion per office visit, leading to full expansion more quickly in the Botox trial group.

No adverse reactions were reported among the trial group who used Botox following their breast reconstruction surgery.

In 2004, a similar study reported Botox placed in the pectoral muscles between mastectomy and tissue expander placement reported less postoperative pain and used fewer narcotics in the first 24 hours after surgery, and in the final expansion period.

The studies are small, and further studies will help shed light on the off-label use of this well known drug.  Hopefully further studies will show that this common drug can be used by plastic surgeons to decrease the pain after mastectomy and breast reconstruction, as well as possibly hasten the recovery process.  Studies of off-label use of Botox in the aesthetic or cosmetic breast surgery are underway.

Jeffrey J. Roth, M.D., F.A.C.S.

Las Vegas Plastic Surgery

(702) 450-0777

www.jjrothmd.com

References:

James Brice

Gabriel A, Maxwell G.P. The efficacy of botulinum toxin in post mastectomy expansion.  International Society of Aesthetic Plastic Surgery (ISAPS) 20th Biennial Congress: Abstract 45. Presented August 17, 2010.  San Francisco, CA.

Botulinum toxin infiltration for pain control after mastectomy and expander reconstruction.  Layeeque R, Hochberg J, Siegel E, Kunkel K, Kepple J, Henry-Tillman RS, Dunlap M, Seibert J, Klimberg VS.  Ann Surg. 2004 Oct;240(4):608-13; discussion 613-4.

Botulinum toxin type A infiltration for pain control after breast augmentation.  Zhibo X, Miaobo Z.  Plast Reconstr Surg. 2009 Nov;124(5):263e-4e.

Breast cancer remains a significant disease, effecting 1 in 8 American women. More than 57,000 breast reconstruction procedures were performed in 2007. Seventy-five percent of women who have mastectomies have surgical reconstruction of one or both breasts.

Immediate vs. Delayed Reconstruction:

Reconstruction can be immediate, (at time of the mastectomy), or delayed until after the mastectomy wound has healed. Advantages of immediate reconstruction are that the patient wakes up with a breast mound. Delayed reconstruction occurs frequently, as women complete adjuvant treatments, (i.e.; radiation, chemotherapy), or women who have had mastectomies years ago find out about new options they may not have had when they were going through the process.

Expander/Implant vs. Autogolus, (One’s own tissue).

One way to make a new breast is placing an expander in the breast pocket at the time of the mastectomy. This allows the Plastic Surgeon to fill the expander until the skin and soft tissue size is right. Typically one takes out the expander and places an implant.
Using one’s own tissue is another option. This is where tissue can be rotated from one area of the body to another to make a breast mound. There is now an expanding interest in free tissue transfer. This is where the tissue to be used is dissected from one area of the body and then “plugged in” to another area, (artery to artery, vein to vein, etc).

Nipple Reconstruction:

This is usually one of the last stages. A popular way is to make a little flap from surrounding tissue to make a nipple. The new nipple and areola can later be colored in professionally to match the other side.

How to find a Reconstructive Surgeon:

Your breast surgeon may have a plastic surgeon that he often works with. You can ask him for a recommendation. Also, it may be a good idea to get more than one opinion.
Look to see if your reconstructive surgeon is Board Certified by the American Board of Plastic Surgery. All of the members of The American Society of Plastic Surgeons are Board Certified and have been trained in breast reconstruction. They have a convenient surgeon finder feature. www.plasticsurgery.org