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The botulinum neurotoxin for pain control after breast reconstruction: neural distribution of the pectoralis major muscle
  1. Kyu-Ho Yi1,
  2. Ji-Hyun Lee2,
  3. Hyoung-Moon Kim3 and
  4. Hee-Jin Kim4
  1. 1Division of COVID-19, Wonju Public Health Center, Wonju, Korea
  2. 2Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
  3. 3Maylin Clinic, Goyang, Korea
  4. 4Yonsei University Medical Center, Seodaemun-gu, Korea
  1. Correspondence to Dr Hee-Jin Kim, Yonsei University Medical Center, Seodaemun-gu, Korea (the Republic of); hjk776{at}


Introduction The use of the botulinum neurotoxin injection is a growing area of research and clinical activity, with a focus on its role in facilitating postoperative pain management after reconstructive breast surgery. The study aimed to find out the standard injection points for botulinum neurotoxin injection by revealing the intramuscular nerve arborization of the pectoralis major.

Methods Sihler’s technique was conducted on the pectoralis major muscles (16 cadaveric specimens). The intramuscular nerve arborization was documented relative to the inferior border of the clavicle bone and lateral border of the sternum.

Results After the staining, the pectoralis major was divided into fifths transversely from the inferior border of the clavicle and vertically into fifths from the lateral border of the sternum. Intramuscular nerve arborization of the pectoralis major muscle was the largest in the middle sections of the muscle belly.

Discussion The results indicate that botulinum neurotoxin should be applied to the pectoralis major in certain regions. The regions of major arborization are optimal as the most effective and most reliable points for injecting botulinum neurotoxin.

  • pain management
  • pain
  • postoperative
  • postoperative complications

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  • Correction notice This article has been corrected since it published Online First. The title has been amended.

  • Contributors K-HY was responsible for research concept, study design and writing of the manuscript. J-HL and H-MK helped in research concept and study design. H-JK helped in reviewing/editing a draft of the manuscript and supervised the manuscript.

  • Funding This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIP) (NRF-2019R1C1C1010776).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.