Botulinum toxin infiltration for pain control after mastectomy and expander reconstruction

Rakhshanda Layeeque, Julio Hochberg, Eric Siegel, Kelly Kunkel, Julie Kepple, Ronda S. Henry-Tillman, Melinda Dunlap, John Seibert, Vicki Klimberg, Luis O. Vasconez, Rakhshanda Layeeque, David W. Easter, Keith A. Kelly

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61 Scopus citations

Abstract

Introduction: We hypothesized botulinum toxin (BT) infiltration of the chest wall musculature after mastectomy would create a prolonged inhibition of muscle spasm and postoperative pain, facilitating tissue expander reconstruction. Methods: An Institutional Review Board (IRB)-approved prospective study was conducted of all patients undergoing mastectomy with tissue expander placement during a 2-year period. Study patients versus controls had 100 units of diluted BT injected into the pectoralis major, serratus anterior, and rectus abdominis insertion. Pain was scored using a visual analog scale of 0 to 10. Wilcoxon rank sum test was used for continuous variables and the χ2 test for nominal level data to test for significance. Results: Forty-eight patients were entered into the study; 22 (46%) with and 26 (54%) without BT infiltration. Groups were comparable in terms of age (55 ± 11 years versus 52 ± 10 years; P = 0.46), bilateral procedure (59% versus 61%; P = 0.86), tumor size (2 ± 2 cm versus 2 ± 3 cm; P = 0.4), expander size and volume (429 ± 119 mL versus 510 ± 138 mL; P = 0.5). The BT group did significantly better with pain postoperatively (score of 3 ± 1 versus 7 ± 2; P < 0.0001), during initial (score of 2 ± 2 versus 6 ± 3; P = 1.6 × 10-6), and final expansion (1 ± 1 versus 3 ± 2; P = 0.009). Volume of expansion per session was greater thus expansion sessions required less in the BT group (5 ± 1 versus 7 ± 3; P = 0.025). There was a significant increase in narcotic use in control patients in the first 24 hours (17 ± 10 mg versus 3 ± 3 mg; P < 0.0001), initial as well as final expansion periods (P = 0.0123 and 0.0367, respectively). One expander in the BT group versus 5 in the control group required removal (P = 0.13). There were no BT-related complications. Conclusion: Muscular infiltration of botulinum toxin for mistake-tuum and tissue expander placement significantly reduced postoperative pain and discomfort without complications.

Original languageEnglish (US)
Pages (from-to)608-614
Number of pages7
JournalAnnals of Surgery
Volume240
Issue number4
DOIs
StatePublished - Oct 2004
Externally publishedYes

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ASJC Scopus subject areas

  • Surgery

Cite this

Layeeque, R., Hochberg, J., Siegel, E., Kunkel, K., Kepple, J., Henry-Tillman, R. S., Dunlap, M., Seibert, J., Klimberg, V., Vasconez, L. O., Layeeque, R., Easter, D. W., & Kelly, K. A. (2004). Botulinum toxin infiltration for pain control after mastectomy and expander reconstruction. Annals of Surgery, 240(4), 608-614. https://doi.org/10.1097/01.sla.0000141156.56314.1f