Botox Touted as Alternative to Breast Lift


Beth Longware Duff, Medical Editor

Beth Longware Duff is an experienced writer and reporter whose work on a wide variety of topics has been published in numerous newspapers and magazines. Her health and medical writing credits include nationally distributed videos for the March of Dimes Birth Defects Foundation, and she is the recipient of numerous awards including an American Cancer Society Media Award and a New England Press Association Award for Health Reporting. She holds a degree in Communications from Ithaca College.

May 19 2008

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You've no doubt heard of Botox® Cosmetic for the wrinkled brow – but Botox for the sagging breast? Possibly, says Kevin Smith, MD, a Canadian dermatologist who started experimenting with the procedure in 2003 and believes it's time to formally test the concept with a double-blind clinical trial.

"We need to sort it out and determine the ideal treatment protocol," he says, adding that a combination of Botox and physical therapy to improve upper body posture could be just the ticket for some women.

Benefits of Botox
Botox is derived from botulinum toxin, a protein produced by a bacterium called Clostridium botulinum that causes botulism food poisoning. There are seven known types of the toxin, but only types A (Botox® Cosmetic) and B (Myobloc®) are used as medical treatments. Myobloc was approved by the U.S. Food and Drug Administration (FDA) in 1989 to treat two eye muscle disorders. Botox Cosmetic was approved in 2002 to temporarily improve the appearance of frown lines between the eyebrows, and in 2004 to treat severe underarm sweating (axillary hyperhidrosis). The Botox breast lift is an off-label (non-FDA-approved) use of Botox Cosmetic.

In its sterile and purified form, Botox is injected into affected muscles and blocks the release of the chemical acetylcholine, which signals the muscle to contract. In effect, it weakens or paralyzes the muscle. In the Botox breast lift, a doctor injects the drug into the pectoralis minor muscles along each side of the chest. Normally, when these muscles contract, they pull the shoulders down and cause the breasts to sag. With the pectoralis minor muscles in a forced state of relaxation, the rhomboid muscles of the back take over to pull the shoulders back, lifting the breasts in the process. In effect, Botox improves the patient's posture by changing the balance between the chest and back muscles. Whatever lift is achieved in the breasts is a result of this improved posture.

Combination Therapy
Dr. Smith, who has written up his observations of the Botox breast lift for a dermatologic surgery textbook, says the ideal protocol might involve treating patients using physical therapy in addition to using Botox. "[The therapy] would be designed to stretch some of the muscles on the anterior chest that are kind of tight and to strengthen the muscles in the back that pull the shoulders back and rotate them outwards," he says.

Women who are intrigued by the concept should know that the Botox effects have been described as "very minor", they're achievable only in small-breasted women (cup size A or B), and they only last about 3 months. There are also potential side effects, including three to four weeks of nipple erection. Other Botox-related risks cited by the FDA are flu-like symptoms, headache, upset stomach, and botulism.

Walter Erhardt, MD, a board-certified plastic surgeon and past president of the American Society of Plastic Surgeons, advises a cautious approach to this and any other procedure that has not undergone conclusive clinical testing.

"This is not anything that's been in any of our peer review journals, and I'm not aware of any clinical data that has been evaluated from that standpoint," he notes. "What we're looking at is some anecdotal cases, and I have real skepticism about it. This is really out there – if not in the stratosphere, close to it."

Dr. Smith agrees with Dr. Erhardt that a "wait and see" approach is best until after clinical trials are conducted. "The worst thing in the world would be for a bunch of hucksters to randomly start doing this to make a bunch of quick money," he points out.