April 22, 2015
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Use of Botox in post-mastectomy breast reconstruction may reduce pain, expedite tissue expansion

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Off-label use of Botox in post-mastectomy breast reconstruction can help decrease postoperative pain as well as the time necessary to complete the expansion phase of breast reconstruction, according to researchers’ findings.

Thirty patients undergoing mastectomy were randomly assigned to a neurotoxin group (15 patients) or a placebo group (15 patients). The neurotoxin group received 40 units of Botox (onabotulinumtoxinA, Allergan) into each pectoralis major muscle throughout the course of four injections. The placebo group received four injections of 0.9% sodium chloride.

Allen Gabriel, MD

Gabriel Allen

One year of follow-up data were collected, included patient demographics, visual analog scale (VAS) scores, laterality, office visits, amount of expansion, number of times to full expansion and amount of narcotics used. Mean follow-up was 23.4 months.

The researchers found no significant difference between initial fill and expander sizes between the groups. Additionally, complication rates for seroma, infection, skin necrosis, expander loss and hematoma did not vary.

Although there was no significant difference observed for narcotic use within the first 3 days following surgery, the researchers observed the use of oxycodone and valium was significantly less in the neurotoxin group from day 7 to day 45, but not for the use of oral NSAIDS. The neurotoxin group was also observed to have a greater volume of expansion per visit compared with the placebo group.

The neurotoxin group’s mean number of fills was 2.2 and the mean volume per fill was 98 cc to reach final expansion vs. 5.8 fills of 54 cc in the placebo group.

Overall, use of onabotulinumtoxinA shortened the time necessary to complete the expansion phase of breast reconstruction, while providing less pain to the patient after day 7, according to the researchers. - by Abigail Sutton

Disclosures: Gabriel reports he is a consultant for Allergan and Acelity. Please see the full study for a list of all other authors’ relevant financial disclosures.