title: The efficacy of botulinum toxin A in post-mastectomy breast reconstruction: a pilot study.
abstract: BACKGROUND
  Botulinum toxin A has been successfully used in a variety of areas to temporarily obliterate muscle mobility for either functional or aesthetic gain. Tissue expander-based breast reconstruction has been plagued with pain and discomfort.
  
  
  OBJECTIVE
  The purpose of this pilot study was to evaluate the role of a neurotoxin (Botulinum toxin A) in expander-based breast reconstruction.
  
  
  METHODS
  Thirty patients underwent mastectomies with immediate expander or acellular dermal matrix reconstruction. The neurotoxin group (n = 15) received 40 units of neurotoxin (Botulinum toxin A, Allergan, Inc, Irvine, CA) into each pectoralis major muscle through 4 serial injections and the placebo group (n = 15) received 4 serial injections of 0.9% NaCl. All patients were followed over 1 year, and patient demographics, VAS (visual analog score), laterality, office visits, amount of expansion and number of times to full expansion, and amount of narcotics required were recorded. Statistical significance was considered as p < .05.
  
  
  RESULTS
  There were no significant differences between the two groups in terms of age, laterality, expander size, or complications (p = .46-.66). There was a significant difference between the two groups in the VAS score, demonstrating decreased pain in the neurotoxin group (p < .05). In addition, there was a significant increase in the volume of expansion per visit in the neurotoxin group as compared to the placebo group (p < .05). There was no significant difference in narcotic use in the first 3 days after surgery; however, there was a significant decrease in use of narcotics from 7 to 45 days in the neurotoxin group (p < .05). There were no complications associated with the use of the neurotoxin.
  
  
  CONCLUSIONS
  The infiltration of the pectoralis major muscle with neurotoxin in immediate, expander-based reconstruction may be beneficial in reducing pain and expediting expansions.
authors.affiliation: Drs Gabriel and Maxwell are Associate Clinical Professors in the Department of Plastic Surgery at the Loma Linda University Medical Center, Loma Linda, CA. Dr Champaneria is a plastic surgeon in private practice in Vancouver, WA.
authors.forename: Allen
authors.initials: A
authors.lastname: Gabriel
authors.affiliation: Drs Gabriel and Maxwell are Associate Clinical Professors in the Department of Plastic Surgery at the Loma Linda University Medical Center, Loma Linda, CA. Dr Champaneria is a plastic surgeon in private practice in Vancouver, WA.
authors.forename: Manish C
authors.initials: MC
authors.lastname: Champaneria
authors.affiliation: Drs Gabriel and Maxwell are Associate Clinical Professors in the Department of Plastic Surgery at the Loma Linda University Medical Center, Loma Linda, CA. Dr Champaneria is a plastic surgeon in private practice in Vancouver, WA.
authors.forename: G Patrick
authors.initials: GP
authors.lastname: Maxwell
mesh_terms: D062088:Acellular Dermis; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D010865:Pilot Projects; D011446:Prospective Studies; D015626:Tissue Expansion / Q000379:methods
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A