Botox Injections Reduce Pain in Immediate Post- Mastectomy Breast Reconstruction Using Expanders
Botulinum toxin A injections (including Botox, Dysport and Xeomin) have been the #1 nonsurgical procedure nationwide since 2000. In 2014, more than three million botulinum toxin procedures were performed. The injectable is known for temporarily reducing muscle mobility for either aesthetic or functional purposes and is a popular go-to choice for anyone seeking to address early signs of aging.
That stunning statistic proves that Botox and other similar injectables have certainly been embraced by those looking to slow down the aging process. Its use has expanded from freezing frown lines to addressing many other medical conditions including migraines and excessive perspiration.
Well there's another benefit. A recent study published in the Aesthetic Surgery Journal (ASJ) showed botulinum toxin A may offer post-mastectomy breast reconstruction patients relief by temporarily paralyzing the muscles and decreasing the pain associated with tissue expanders, the temporary implants filled with saline so the expansion goal is reached much sooner.
One of the frequently reported issues facing patients undergoing post-mastectomy breast reconstruction is muscle spasms and contractions during the first stages of tissue expansion. In some cases, post-mastectomy breast reconstruction surgeries may involve the use of tissue expanders that are inserted beneath the pectoral muscles and slowly expanded over the course of several weeks until they reach the desired point of expansion and have created a pocket for the placement of a permanent breast implant.
The ASJ study involved thirty patients, randomly assigned to one of two treatment groups. The neurotoxin group received botulinum toxin A into each chest muscle through four serial injections, while the placebo group received 4 serial injections of sodium chloride. All patients were observed over a year. There was a significant difference between the two groups: patients who received botulinum toxin A felt less pain and need for pain medication in the first 7-45 days post-surgery compared to the placebo group. As a result, they were able to increase in the volume of expansion per visit and reach their expansion goal faster.
I spoke with the study's lead author, Dr. Allen Gabriel, to get more insight on his ground-breaking research and what this could mean for women seeking to recreate bust lines after undergoing a mastectomy.
Mary Cunningham: When did you first start using botulinum toxin A in this "expander procedure"?
Dr. Gabriel: I first started using Botox in breast reconstruction in 2007.
MC: What specifically does Botox help with?
Dr. Gabriel: Botox helps with temporarily relaxing the pectoralis major muscle, which leads to decreased pain and tightness following a sub pectoral/dual plane expander reconstruction. Because the patients do not feel the amount of pain they would have if they didn’t receive Botox, this also allows larger volumes of expansions and therefore less trips to the doctor to get fully expanded to the final volume.
MC: Are there any complications that could arise from incorporating Botox while the tissue is being stretched?
Dr. Gabriel: In the last 8 years we have not had any complications related to Botox.
MC: Are there any instances that you know of when a patient has gone through the expander procedure for one breast without the injectable, and then undergone the same on the other breast later, with Botox?
If so, have they been able to notice a difference in their experience using Botox?
Dr. Gabriel: We have had patients who had a mastectomy and reconstruction to one breast without the use of Botox and years later underwent a second mastectomy and reconstruction with Botox to the other breast, and they couldn't believe the difference. In our pilot study it was also evident who received Botox and who didn't even though it was blinded. We were able to conclude the study after a relatively low number of patients because once the patients knew the benefit, and we could tell the difference the Botox injections were making, we wanted to make sure everyone going forward received Botox and not the placebo.
MC: Do you know if other hospitals have started to use BOTOX in this manner? How wide spread is this?
Dr. Gabriel: Unfortunately, it is not widespread yet but my friends and some colleagues have started using it when women undergo breast reconstruction after a mastectomy. There is not enough awareness around this. If we can use social media and get the word out to the breast cancer patients then hopefully more patients will start benefiting from this.
MC: Are there any other non-traditional uses for Botox that you are incorporating into your patient care?
Dr. Gabriel: I have also used Botox in helping patients with smoking cessation by relaxing their upper lip so they can't purse their lips to smoke. This has worked well for my select group of patients.
MC: That is certainly interesting and innovative! We're so thankful to have your mind working on solutions for our health, comfort and wellness. Thank you for your time and feedback, Dr. Gabriel.
Knowing that the addition of Botox can help breast reconstruction patients in so many ways, we could hope more surgeons begin incorporating the injectable to the benefit of many women recovering from breast cancer.
Botulinum toxin A has not been approved by the US Food and Drug Administration (FDA) for paralysis of the pectoralis major muscle in breast reconstruction surgery or for relaxing the upper lip to help with smoking cessation, so these fall under off-label use.