Impact of mastectomy for breast cancer on spinal curvature: Considerations when treating patients with scoliosis

Abstract

Objective Mastectomy has been shown to influence body posture in women; however, there are limited data outlining changes in spine curvature after mastectomy in patients with scoliosis. We sought to quantify changes in spine curvature after mastectomy for breast cancer. Methods We conducted a retrospective review of 62 patients with scoliosis who underwent mastectomy for breast cancer at a single institution between 1995 and 2018. Preoperative and postoperative radiographs were used to measure Cobb angles to assess lateral spinal curvature. Changes in Cobb angle were compared using paired two‐tailed t‐tests. The relationship between mass of breast removed and changes in Cobb angle was modeled using a linear regression. Results The median follow‐up after mastectomy was 7.9 years (range 0.9‐21.5). Median age was 62 years (range 30‐85). Of 62 patients, 10 (16%) expressed that their back pain became worse after mastectomy. Nineteen patients had evaluable radiographs before and after mastectomy. In these patients, the average change in Cobb angle was 4.7° (range −0.2‐12.2). Cobb angle significantly increased after mastectomy (P < .0001). Although not statistically significant, average Cobb angle was greater for patients who underwent unilateral compared to bilateral mastectomy (P = .09). Mass of breast removed significantly correlated with the difference in Cobb angle for patients who underwent unilateral mastectomy (P = .0006), but not for bilateral mastectomy (P = .55). Conclusions In this understudied patient population, mastectomy significantly increased the change in spine curvature. Further care should be taken to assess patient‐reported pain and quality of life in patients with spine morbidity who undergo mastectomy for breast cancer.

The Role of Density in Achieving Volume and Weight Symmetry in Breast Reconstruction

“…5 41 42 These changes are particularly relevant in patients with preexisting spine disorders. Gutkin et al 43 investigated 62 patients with scoliosis and found a significant increase of spine curvature after mastectomy. Immediate breast reconstruction significantly reduces the amount of change in spinal alignment after unilateral mastectomy.…”

The effect of breast cancer surgery on spine alignment: Whole-spine radiograph analysis

“…The mass of breast removed significantly correlated with the difference in Cobb angle in nine patients who received unilateral mastectomy. However, laterality of mastectomy was not related to the side of shift in scoliosis curvature [17]. In a study assessing chest radiographs before and after delayed breast reconstruction, the difference was statistically significant and the average change in Cobb angle was 4.3 [16].…”

“…In addition, breast cancer survivors are at elevated risk for spinal abnormalities (e.g., scoliosis) because of post-treatment changes in posture and bone health. Other authors [13][14][15][16][17][18][19] have evaluated the relationship between breast cancer surgery and spine deformity by means of radiological assessment. However, the findings of these studies are inconsistent, and most studies employed chest radiographs or dual energy X-ray absorptiometry to identify only thoracic or lumbar regions of the spine.…”

The Influence of External Breast Prostheses on the Body Postures of Women Who Have Undergone Mastectomies

“…Among the recently discussed breast cancer issues is the postural control assessment in women after mastectomy [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. A review of the above-mentioned publications indicated that the undertaken research was concerned with the impact of mastectomy on body static conditions [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ] and body posture of women who had received mastectomies [ 7 , 10 , 18 , 19 ,…”

“…A review of the above-mentioned publications indicated that the undertaken research was concerned with the impact of mastectomy on body static conditions [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ] and body posture of women who had received mastectomies [ 7 , 10 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ] and also the impact of external breast prostheses on postural control in women after mastectomies [ 11 , 12 , 14 , 32 ]. The results of several scientific reports indicate that mastectomies may cause body posture disorders such as asymmetry in the trunk in the frontal plane [ 18 , 21 , 42 , 43 , 44 , 45 , 46 ,...…”