Botulinum toxin may help minimize post-operative pain in women who undergo breast reconstruction after a mastectomy, according to Dr. Allen Gabriel, who presented his study at the recent International Society of Aesthetic Plastic Surgery Congress.
The doctor conducted a 30-patient clinical trial for this off-label application of Botox, demonstrating that botulinum toxin type A can address post-operative pain.
Breast reconstruction (using silicone breast implants) typically involves the positioning of a temporary expander implant between layers of the chest muscle, which is filled with water to create a pocket where a permanent implant will reside. Pain can result from muscle contractions and spasms in response to the expansion.
Dr. Gabriel, along with his collaborator Dr. G. Patrick Maxwell, theorized that Botox injections could offer relief by temporarily paralyzing the muscle so that fewer spasms occur, resulting in less pain.
The clinical trial assigned 30 breast cancer patients—who all planned a mastectomy with silicone implant breast reconstruction—into two groups: one group had Botox injected into the chest muscle and the other received injections of saline solution as a placebo.
After surgery, the women who received the Botox injections were reportedly more comfortable than those who received placebo. The doctors measured patient responses three times during and after the procedure, noting that during days 7 to 45 of the recovery period, those that received Botox injections used significantly fewer doses of narcotics and muscle relaxants.
Read more about this study on Medscape
Right now on the website of Plastic and Reconstructive Surgery Journal, you can access a free article about the nutritional status of post-bariatric patients — specifically those who have undergone bariatric surgery (gastric bypass or lap band) and then seek body-contouring procedures from a plastic surgeon.
As they lose a significant percentage of their body weight, these patients become prone to nutrient deficiencies. In this study of 100 bariatric surgery patients (98 gastric bypass and 2 lap band), nearly 18 percent of the subjects showed protein intake levels that were lower than the recommended intake. Additionally, 39.7 percent showed low iron intake and 11 percent had low intake of vitamin b12.
The Importance of Protein for the Post-Bariatric Patient
Protein intake is important for the post-bariatric patient, for general health reasons as well as surgical reasons. Protein aids the healing process during recovery from body contouring and its deficiency has been linked to problems such as “decreased wound tensile strength and increased rates of skin and fascial wound breakdown.”
The authors found certain predictors of low protein intake in their subjects. Those with increasing age and those who underwent a greater change in BMI after bariatric surgery were more likely to have a low daily protein intake. Because food intolerance is relatively common in post-bariatric patients, a higher daily protein allowance may be recommended, the authors suggest.
Women considering breast reconstruction will now receive more information about their treatments and how it can be financed, thanks to a new law recently signed by NY Gov. David Paterson. The law is designed to ensure that disadvantaged women receive the information they need about breast reconstruction, including info on health insurance coverage and surgical techniques that can reconstruct the breasts and restore a normal appearance.
An unfortunate reality is that many patients don’t undergo breast reconstruction because they’re not aware that the procedure has universal health insurance. Doctors pushed for the new law so that a discussion of breast reconstruction options would be required, thus increasing the number of patients undergoing the surgery.
There seems to be a stark contrast in resources between breast reconstruction patients of different backgrounds. Evidently, some are making decisions about treatment with a relative lack of information, while others are independently seeking out advanced microsurgical procedures. According to a recent study in Plastic and Reconstructive Surgery, a growing number of breast cancer patients are using the Internet to find a reconstructive surgeon on their own, and many are choosing advanced microsurgical breast reconstruction procedures.