Abstract 6P
Background
Many patients concern about scoliosis following mastectomy due to the imbalance resulting from breast tissue removal, often justifying immediate-breast reconstruction. However, evidence on the impact of mastectomy or immediate reconstruction on scoliosis is scarce, while previous studies investigated only a small number of patients. Here, we investigated whether mastectomy impacts spine alignment compared to immediate breast reconstruction with large cohorts.
Methods
We retrospectively reviewed the patients who underwent breast cancer surgery between 2004 and 2016 in a single institution. Applying the deep learning-based algorithm (DeepNoid Inc.) on chest posteroanterior x-rays, we collected data on the Cobb's angle for each patient at three time points: pre-operation, postoperative one-year, and five-years.
Results
Totally 62476 patients were included: 3442 (55.1%), 1911 (30.6%), and 893 (14.3%) patients underwent breast-conservation, mastectomy without reconstruction, and immediate-breast reconstruction, respectively. At postoperative five-years, the mastectomy group had a significantly greater change in Cobb's angle compared to both the breast-conservation (p<0.001) and reconstruction (p=0.004) groups, while there was no significant difference between the breast-conservation and reconstruction groups (p=0.347). The results remained consistent after multivariable analysis and 1:1 propensity score matching between each pair of groups. The change in Cobb’s angle was more prominent among patients under 50-years old (p=0.016) and patients who administered hormone treatment (p=0.0009). Lastly, significantly more patients reported lumbar pain after mastectomy (8.4%) than after breast-conservation (6.7%) or immediate reconstruction (4.1%) during the surveillance (p<0.001).
Conclusions
This is the largest study that showed the significant change in thoracic spine alignment after mastectomy compared to breast-conservation and immediate-breast reconstruction. The results would provide the evidence on recommending immediate-breast reconstruction especially for young patients and educating post-mastectomy postural correction.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
K-T Hwang.
Funding
Has not received any funding.
Disclosure
The author has declared no conflicts of interest.