Main Article Content
Post-mastectomy pain syndrome, Post-breast-surgery pain syndrome, Breast cancer, Botulinum toxin
Background: The spasm and/or contracture of the pectoralis major contribute to the post-breast surgery pain. The purpose of our study was to evaluate changes in the post-breast surgical pain syndrome after the infiltration of botulinum-toxin type-A (BTX-A), according to the type of surgery and the reconstitution of the botulinum-toxin.
Methods: This retrospective study was conducted at the Rehabilitation Department with two cohorts: BTX-A reconstituted with saline solution (SS group) or with levobupivacaine (LV group). Data about pectoralis major contracture and pain (global, at night, at rest and during activity) before the infiltration and six weeks after that were collected from the medical records and compared between SS and LV groups, and between conservative breast surgery and mastectomy cases.
Results: in the study, 48 women aged 53.3 (±11.10) years were included, with 26 (54.2%) in SS group and 22 (45.8%) in LV group. There were no differences between both groups except transitory paresis (3.8% vs 22.7%; P=0.022). In all patients, baseline circumstances vs after 6 weeks were compared, and we found significant differences in contracture (1,77 (±0.57) vs 0.97 (±0.79)), VAS global (5.45 (±1.92) vs 3.46 (±2.48)), VAS night (3.17 (±3.13) vs 1.61 (±2.29)), VAS rest (2.14 (±2.56) vs 1.21 (±1.98)) and VAS activity (4.31 (±2.55) vs 2.78 (±2.58)). We found higher improvements in the breast conservative surgery.
Conclusion: A significant lower pain and contracture after BTX-A injection in the pectoralis major was observed, but its reconstitution in levobupivacaine may not be an effective method to increase the analgesic effect. There were higher improvements in the breast conservative surgery than in the mastectomy.
2. de Carlos Iriarte E, Hedo AC, González MM, Caravaca GR, Ruiz-Soldevilla J, Pérez BS. Infiltración con toxina botulínica para el control del dolor en cáncer de mama. Rehabilitación. 2012;46(2):112-9.
3. Dessy L, Maruccia M, Mazzocchi M, Scuderi N. Treatment of post mastectomy pain syndrome after mastopexy with botulinum toxin. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2014;67(6):873-4.
4. Tait RC, Zoberi K, Ferguson M, Levenhagen K, Luebbert RA, Rowland K, et al. Persistent post-mastectomy pain: Risk factors and current approaches to treatment. The Journal of Pain. 2018;19(12):1367-83.
5. Gabriel A, Champaneria MC, Maxwell GP. The efficacy of botulinum toxin A in post-mastectomy breast reconstruction: a pilot study. Aesthetic surgery journal. 2015;35(4):402-9.
6. Layeeque R, Hochberg J, Siegel E, Kunkel K, Kepple J, Henry-Tillman RS, et al. Botulinum toxin infiltration for pain control after mastectomy and expander reconstruction. Annals of surgery. 2004;240(4):608.
7. Winocour S, Murad MH, Bidgoli-Moghaddam M, Jacobson SR, Bite U, Saint-Cyr M, et al. A systematic review of the use of Botulinum toxin type A with subpectoral breast implants. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2014;67(1):34-41.
8. Lo KK, Aycock JK. A blinded randomized controlled trial to evaluate the use of botulinum toxin for pain control in breast reconstruction with tissue expanders. Annals of plastic surgery. 2015;74(3):281-3.
9. O'Donnell CJ. Pectoral muscle spasms after mastectomy successfully treated with botulinum toxin injections. PM & R: the journal of injury, function, and rehabilitation. 2011;3(8):781-2.
10. Senior MA. Botox and the management of pectoral spasm after subpectoral implant insertion. Plastic and reconstructive surgery. 2000;106(1):224-5.
11. Güleç A. Dilution of botulinum toxin A in lidocaine vs. in normal saline for the treatment of primary axillary hyperhidrosis: a double?blind, randomized, comparative preliminary study. Journal of the European Academy of Dermatology and Venereology. 2012;26(3):314-8.
12. Yen MT, Wall VK. Bupivacaine-induced myotoxicity and its effect on botulinum toxin paresis. Annals of plastic surgery. 2008;60(1):6-9.
13. Park J, Park HJ. Botulinum toxin for the treatment of neuropathic pain. Toxins. 2017;9(9):260.
14. Kim A, Jung J, Pak A. Botulinum toxin type A reconstituted in lidocaine with epinephrine for facial rejuvenation: results of a participant satisfaction survey. Cutis. 2013:13-8.