I am in the same boat as you. I saw Dr. Gelabert a year ago but had surgery with one of his former fellows, Niren Angle. Dr. Gelabert gave me an info sheet explaining that the transaxillary procedure was less invasive but had a 10-20% risk of recurrence and possible resurgery like you describe.

I also feel like the Botox is a temporary solution and we are in the process of scheduling supraclavicular full scalenectomy and neurolysis. I don't believe the supraclavicular scalenectomy is more invasive once the rib has already been removed. It should be actually be an easier procedure than either rib resection approach which is why Gelabert and disciples prefer the transaxillary approach even with the potential additional surgery.