Zikiryakhodzhaev Aziz D, Alekseeva Galina S, Reshetov Igor V, Starkova Marianna V, Saribekyan Eric K, Usov Fedor N, Vlasova Maria Yu
Department of Oncology and Reconstuctive Plastic Surgery of Breast and Skin, P.A. Hertsen Moscow Oncology Research Center, Moscow, Russian Federation.
Federal State Autonomous Educational Institution for Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russian Federation.
Plast Reconstr Surg Glob Open. 2021 Jan 25;9(1):e3372. doi: 10.1097/GOX.0000000000003372. eCollection 2021 Jan.
Capsular contracture is one of the most common complications after breast reconstruction. Surgical treatment is the main option for capsular contracture correction and includes capsulotomy, capsulectomy, and removal/replacement of the affected implant. However, the surgical trauma from reoperation, along with reduced quality of life, in patients with clinically significant capsular contracture has prompted a search for alternative treatment options. The use of the botulinum toxin type A in the treatment of neurological diseases and of keloid scars in aesthetic practice nudged the idea of using the same toxin for the correction of capsular contractures in breast cancer patients. Botulinum toxin type A injection is an easy procedure requiring no anesthesia or inpatient care. The treatment has few side effects. In addition, the injection does not cause sensory loss or dysesthesia. We described a clinical case of the capsular contracture correction using incobotulinumtoxin A. Capsular contracture IV developed 4 months post surgery after long-term lymphorrhea. Radiation therapy was not performed. According to the internal protocol, the patient was advised to undergo incobotulinumtoxin A treatment instead of surgery. Within 1 week after the second injection, all symptoms decreased-specifically, the general shape of the reconstructed breast. Also, the pain syndrome disappeared.
包膜挛缩是乳房重建术后最常见的并发症之一。手术治疗是纠正包膜挛缩的主要选择，包括包膜切开术、包膜切除术以及取出/更换受影响的植入物。然而，对于临床上有明显包膜挛缩的患者，再次手术带来的手术创伤以及生活质量的下降促使人们寻找其他治疗选择。A型肉毒杆菌毒素在神经疾病治疗以及美容领域治疗瘢痕疙瘩的应用，推动了将同一毒素用于纠正乳腺癌患者包膜挛缩的想法。注射A型肉毒杆菌毒素是一种简单的操作，无需麻醉或住院护理。该治疗副作用很少。此外，注射不会导致感觉丧失或感觉异常。我们描述了一例使用incobotulinumtoxin A纠正包膜挛缩的临床病例。长期淋巴漏后，术后4个月出现IV级包膜挛缩。未进行放疗。根据内部方案，建议患者接受incobotulinumtoxin A治疗而非手术。在第二次注射后1周内，所有症状均有所减轻，特别是重建乳房的整体形状。此外，疼痛综合征消失。
