Local Surgeon Makes International News on Botox Benefits
Southwest Medical Group plastic surgeon Allen Gabriel, MD, continues to be on the leading edge of new plastic surgery techniques with the off-label use of Botulinum toxin A (Botox) to significantly reduce postoperative pain for women receiving immediate breast reconstruction with expanders following mastectomy. In fact, an article outlining the details of Dr. Gabriel’s study on the treatment was among the annual top ten list of most read articles by plastic surgeons worldwide as featured in Medscape from WebMD in December.
Allen Gabriel, MD, chief of plastic surgery at Southwest Washington Medical Center in Vancouver, Washington, has demonstrated in a clinical trial that Botox effectively addresses the sources of severe pain associated with the procedure. He presented his findings at the International Society of Aesthetic Plastic Surgery 20th Biennial Congress earlier this year.
Implant based breast reconstruction often involves the positioning of a temporary expander implant under layers of the pectoralis major chest muscle. The muscle often contracts and spasms in response to the expansion, causing pain. He and collaborator G. Patrick Maxwell, MD, who practices at Loma Linda, theorized injections of Botox could offer relief by temporarily paralyzing the muscle, causing it to remain flaccid. Women who received the botulinum injections were far more comfortable after surgery than those who received a placebo, Dr. Gabriel explained.
“The use of [botulinum] is changing the reputation of expanders as a painful part of breast reconstruction” says Dr. Gabriel. “Before we started using [botulinum], patients leaned toward autologous reconstruction because of anxiety about expander pain. Now, patients are more inclined to choose expanders.”
Thirty consecutive breast cancer patients scheduled for mastectomy with immediate implant based breast reconstruction were randomly assigned to 1 of 2 groups: 40 units of botulinum injected into each pectoralis major; or the same routine procedure using saline solution as a placebo. Procedures were performed at Southwest Washington Medical Center.
The women who received the botulinum injections were far more comfortable after surgery than those who received placebo, Dr. Gabriel explained. Patient responses were measured at 3 time points during and after the procedure with a 10-point visual analog scoring (VAS) test, where a score of 1 signified an absence of pain and 10 was associated with unbearable pain. According to Dr. Gabriel, the mean VAS score at the 3 time points for the botulinum group was about 4, and was significantly lower than the mean VAS score of 7 seen in the placebo group.
The researchers had planned to recruit more patients, but the randomized portion of the trial was halted when potential subjects began requesting palliative pain treatment and expressed fear about being selected for the placebo group.
Southwest Washington Medical Group
Southwest Washington Medical Group is affiliated with Southwest Washington Medical Center, the region’s health care leader and steward for nearly 150 years. Southwest is a community-focused, not-for-profit, 450-bed, medical institution located in Vancouver, Washington, Repeatedly recognized nationally as a 100 Top Hospital, Southwest provides a full range of outpatient and inpatient diagnostic, medical, and surgical services to Clark County residents. Southwest is also one of Clark County’s largest employers. Southwest’s 3,400 employees and active medical staff members help support tertiary level services such as cancer, heart, emergency, trauma, family birth and primary care.
Medscape from WebMD
Medscape from WebMD is a part of WebMD Health Professional Network that includes theHeart.org and eMedicine.com. Medscape from WebMD offers specialists, primary care physicians, and other health professionals the Web's most robust and integrated medical information and educational tools. Medscape from WebMD features original, professional medical content, including review articles, journal commentary, expert columns, patient education articles, book reviews, and more. The result is a medical Web site rich in content, broad in appeal, and high in quality. Medscape from WebMD is organized by medical specialty, with each supported specialty having its own customized Web site. Specialty content is evaluated, created, and presented under the guidance of a WebMD program director and a medical professional advisory board.