As a member of the Aesthetic Society, I now am avidly reading two journals each month. This last one from the May June 2015 Aesthetic Surgery Journal had an article from my mentor who taught my breast fellowship, Dr. Pat Maxwell. The article is “The Efficacy of Botulinum Toxin A in Post Mastectomy Breast Reconstruction: A Pilot Study.”
Why use Botox in breast cancer reconstruction? No, this is not plastic surgeons gone wild. When we do breast cancer reconstruction with a tissue expander and breast implant, we place the breast tissue expander under the pectoral muscle. We need to do this to get tissue coverage over the implant. The muscle does not like this. This may manifest in many ways, the two most important to us are PAIN and TIGHTNESS. Once you have a tissue expander, you come into the office every 2 – 3 weeks and we expand the breast using saline. We are limited in the expansion by pressure on the muscle and skin tension.
In this study, they decided to use Botox to weaken the pectoral muscle. Their question, “Does Botox have a role in breast cancer reconstruction?”
Study:
30 patients had mastectomies with immediate tissue expander reconstruction. The neurotoxin (Botox) group got 40 units of Botox placed in the pectoralis major muscle with 4 injections. The other group received placebo. The patients were followed over 1 year. They followed office visits, visual analog score (to assess clinical pain), amount of expansion, number of times to full expansion, and amount of narcotics required.
Results:
- There were no significant differences between the 2 groups for age, laterality, expander size, or complications
- There WAS a significant decrease in pain the Botox group
- There WAS a significant increase in the volume of expansion per visit in the Botox group
- There was NO difference in narcotics in the first 3 days, but there was less narcotic use in days 7-45 in the Botox group.
So?
Looks like Botox might be part of the protocol in the future for breast cancer reconstruction with tissue expanders. Less pain, easier expansion (less office visits). I found the expansion data interesting: it was 2.2 fills with 98cc of fill each time in the Botox group, versus 6 fills with 54cc each time in the non-Botox group. (I also wonder if it would help with bone deformation. Sometimes during expansion we can see the ribcage deform due to the tension of the muscle. This is mainly in radiation patients, but would botox have an effect there?)
Interesting study. Studies similar to this have been done in the past on the pectoralis major and latissimus dorsi, but at a higher dose (75-100units).