La tossina botulinica nella ricostruzione mammaria

Introduction: The breast reconstruction by expanders and prosthesis is actually the most common approach, due to the easy realization and the low invasivity of the operation. The technique needs several steps: the expanders positioning, its gradual expansion and the potential substitution with the permanent prosthesis. The expander process can be more o less long , in relation to the surgeon approach and the patients body reaction. The expansion is infact contrasted by the skin thensin and the major pectoralis muscle contraction. This is the real limit to a quikly expansion, creating pain and expanders dislocation (5-7). Aim of the study: The aim of our study is to evaluate the advantage in botulism toxin use to obtain flaccid paralysisof major pectoralis muscle in women underwent breast reconstruction by expanders and prosthesis. Matherials and Methods: We selected 20 patientscandidate for a breast reconstruction with expanders and prosthesis, and then we divided the into two groups: group A composed by patients underwent muscolar injectionof botulism toxin douring the operation of expander positioning; group B composed by patients treated as standard protocols (controls). Patients were 35-50 years old, and they were been treated previouslywith a Modified Radical Mastectomy for monolateral breast cancer. Alla the expanders were 500CC, texturized and with integrated valve. The surgical techique was always the same. Results were evaluated in terms of pain, expansion speed, and arm mobility. Results: Expansion time resulted significatively decreased in patients from group treated with botulism toxin; the filling volume was was bigger in group A each time and all the patients form the group A permitted an overexpansion of the exapnder. A questionnaire about pain suggested that patients from group A reported lower value compared to patients of group B from the 7th days after operation and the almost absence of drug assumption for pain control. Conclusions: The use of botulism toxin permits a faster expansion process and more tollerated by patients, moreover the absence of the contraction of the pectoralis muscle over the implant reduces the possibility of implant dislocation. A faster expansion process permits to arrive earlier to the next step of breast reconstruction, reducing the ill experience.