title: Neurectomy for breast reconstruction-related spasms of the pectoralis major muscle.
abstract: Tissue expander-based breast reconstruction is the most commonly utilized technique in the U.S. This modality, however, may be associated with significant pain related to pectoralis myospasms. Spasms of the pectoralis major likely result from trauma to the pectoral nerves during muscle elevation. In a subset of patients, Botox(®) therapy may be inadequate for long-term relief. We describe a patient with intractable pectoralis myospasms after breast reconstruction. Upon failing Botox(®) therapy, medial and lateral pectoral neurectomies were performed. Nine months after the procedure, the patient noted dramatic improvement in both symptoms and cosmesis with no musculoskeletal sequelae. We recommend medial and lateral pectoral neurectomy as an alternative in patients with intractable pectoral myospasms after tissue expander reconstruction.
authors.affiliation: Department of Surgery, Division of Plastic Surgery, Lehigh Valley Health Network, Allentown, PA, USA. Electronic address: Joshua_m.adkinson@lvhn.org.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Adkinson
authors.affiliation: Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: Nathan F
authors.initials: NF
authors.lastname: Miller
authors.affiliation: Department of Surgery, Division of Plastic Surgery, Lehigh Valley Health Network, Allentown, PA, USA.
authors.forename: Robert X
authors.initials: RX
authors.lastname: Murphy
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects*; D010369:Pectoralis Muscles / Q000294:innervation* / Q000503:physiopathology; D010525:Peripheral Nerves / Q000601:surgery*; D013035:Spasm / Q000209:etiology* / Q000601:surgery*
keywords: Botox; Breast; Chronic pain; Muscle spasm; Neurectomy; Reconstruction