Most people know that Botox®—the most popular minimally invasive cosmetic procedure—is most commonly used to erase facial wrinkles. Derived from the bacterium Clostridium botulinum, Botox is a neurotoxin; it works by impeding nerve impulses that cause muscle contractions. Injections into the forehead or the “crows feet” area beyond the eye eliminates wrinkles for a few months, while Botox injected into the underarm temporarily eliminates excessive perspiration. It is also used to curtail overactive bladders.
What most people do not know is that Botox is also a very effective painkiller that some physicians now use to relieve the pain of migraine headaches and other types of chronically painful conditions. New research shows that it may also ease the discomfort many women experience with tissue expanders, and shorten the overall expansion timeline.
For many women, the pressure exerted by tissue expanders on the pectoralis chest muscle can be quite uncomfortable, and even painful. Botox relaxes the muscle, reducing discomfort and generally creating a more tolerable experience as a woman proceeds through the stages of expanding the pocket behind the muscle to make room for a breast implant.
A small study at Loma Linda University involved 30 patients who had mastectomies with immediate reconstruction with tissue expanders or acellular dermal matrix. Half of the patients received 40 units of Botox serially injected directly into their pectoralis muscles; the remaining participants—the control group—received four serial injections of sodium chloride (saline).
Compared to women who received the placebo (the saline), women who received the neurotoxin benefited in three ways:
· They reported less pain and muscle spasms.
· They completed the expansion process sooner because they were able to tolerate more saline during office “fill” visits: a mean of 98 cc per fill compared to 54 cc in the placebo group.
· They required fewer opioids and valium after the first post-op week (subsequent use of oral NSAIDs was about the same in both groups).
The two groups were of similar age, with no significiant differences between initial fills and expander sizes. No complications or side effects from the neurotoxin were reported, and complication rates for seroma, infection, skin necrosis, expander loss and hematoma did not vary.
This study echoes the results of various other small studies over the past few years, but the use of Botox is by no means standard with tissue expansion for breast reconstruction. Although Botox is FDA-approved for various applications, its use in breast reconstruction is “off label,” meaning it might be helpful but that is not specifically its approved use. (That’s why its use in breast reconstruction may not be covered by insurance.)
A larger-scale clinical study is currently underway at the Mayo Clinic; its results may have a more profound influence on whether Botox becomes more common during tissue expansion, and whether or not insurance will cover it.
Source: Gabriel A, et al. “The efficacy of botulinum toxin a in post-mastectomy breast reconstruction: a pilot study.” Aesthetic Surgery Journal (2015) 35(4): p. 402-9.