Progressive spinal malalignment: an undervalued sequela in breast cancer survivors

Spinal malalignment and the potential impact on quality of life for breast cancer survivors is currently not screened for. The aim of this study is to examine the effect of mastectomy on thoracolumbar spinal alignment following delayed breast reconstruction. We also sought to assess the relationship between time to delayed reconstruction and the severity of acquired spinal deviation.

A retrospective review of n = 103 patients who underwent mastectomy and subsequent delayed autologous breast reconstruction was performed from 1st July 2020 to 30th June 2023. The degree of lateral spinal deviation was analysed using serial pre- and post-mastectomy spinal imaging. Changes in Cobb angles between the two timepoints were calculated to define the angle of acquired spine curvature and compared between groups.

The mean interval from unilateral mastectomy to delayed DIEAP reconstruction was 1132 days. Patients awaiting a unilateral delayed DIEAP reconstruction demonstrated a mean increase in Cobb angle of 4.45 degrees (95%CI, 3.69–5.2, p < 0.001) versus an average increase of 1 degree (95%CI, 0.347–1.65) in bilateral delayed mastectomy reconstruction. An increase in Cobb angles ranged from 3 to 11 degrees at latest follow-up. Time from unilateral mastectomy to delayed reconstruction was identified as a predictor of increasing Cobb angle. (p = 0.033).

Delays in breast reconstruction following unilateral mastectomy are associated with radiological evidence of spinal malalignment. A prospective clinical study to assess associated musculoskeletal and spinal symptomatology and impact on patient-reported health-related quality of life and to identify factors predictive of this sequela is urgently required.

Level IV, Risk / Prognostic Study.