Original Study Physical Effects of Unilateral Mastectomy on Spine Deformity Savas ¸ Serel, 1 Zeynep Yasavur Tuzlalı, 1 Zehra Akkaya, 2 Ça glar Uzun, 2 Burak Kaya, 1 Sancar Bayar 3 Abstract As mastectomy is known to effect body posture, we evaluated the long-term physical effects of unilateral mastectomy on spine deformity by radiographic examination of 60 women taken before and 12 months after the mastectomy. The results indicated long-term spinal deformation in women with unilateral mastectomy, suggesting informing patients of the possible change in body posture in the long-term. Objective: Mastectomy is known to effect body posture after a change in the center of gravity of women due to a missing breast. Although previous studies on short-term postural changes in mastectomy patients using photo- grammetry or Moiré topography suggested ipsilateral inclination of the trunk, our clinical observations during breast reconstruction surgeries indicated a contralateral shoulder elevation in women with unilateral mastectomy. Because the change in body posture can affect spinal alignment, we aimed to evaluate the long-term physical effects of unilateral mastectomy on spine deformity by radiographic examination. Methods: Posteroanterior chest radiographs of 60 women (mean age 56.3  8.5 years) taken before and 12 months after the mastectomy were evaluated for Cobb angle and the presence or absence of a tilt from the midline in the coronal plane of vertebral body alignment. Results: Cobb angle decreased in 14 and increased in 38 of 60 patients after unilateral mastectomy, and the angular change was found to be independent of the mastectomy side (P < .001). A shift in Cobb angle to the mastectomy side was observed in 11 of 53 patients (P > .05), whereas a statistically significant shift in Cobb angle to the opposite of the mastectomy side was observed in 33 of 53 patients (P < .001). The results of this observational retrospective study indicated long-term spinal deformation in women with unilateral mastectomy. Two patients with idiopathic scoliosis before mastectomy even developed scoliosis. Conclusion: We recommend informing the patients of the possible change in body posture in the long term, which should be supported or limited with physical therapy. Clinical Breast Cancer, Vol. -, No. -, --- ª 2016 Elsevier Inc. All rights reserved. Keywords: Breast cancer, Breast reconstruction, Contralateral shoulder elevation, Lateral deviation of spine, Scoliosis Introduction Breast cancer is the most common cancer in women, and mastectomy is the primary treatment modality. 1,2 Body posture is important for stable balance and to be able to perform important dynamic tasks. 3 The weight of breasts has an effect on the center of gravity of women, causing a change in body posture. 1,3-8 One of the expected outcomes of mastectomy, therefore, is long-term postural changes. There are, indeed, several studies in the litera- ture proving the change in body posture in women after mastec- tomy. 7-12 These reports, however, mostly showed shoulder elevation and ipsilateral inclination of the trunk by using photo- grammetry or Moiré topography. There is only one study in the literature evaluating the change in body posture based on bony structures in women after mastectomy in comparison with im- mediate breast reconstruction using special software analyzing digital images. 12 Our observations during breast reconstruction surgeries over the years indicated a contralateral shoulder elevation in women with unilateral mastectomy to compensate for the weight of the missing breast (Figure 1). We believe that this acquired posture can affect spinal alignment in the long term, because postural changes can cause serious deformity on the spine that leads to scoliosis, which is defined as more than 10  of deviation in structural curves. 6,13,14 Based on our observations, in this retrospective study, we aimed 1 Department of Plastic, Reconstructive and Aesthetic Surgery 2 Department of Radiology 3 Department of Surgical Oncology and General Surgery, Medical Faculty of Ankara University, Ankara, Turkey Submitted: Feb 3, 2016; Revised: Aug 27, 2016; Accepted: Oct 12, 2016 Address for correspondence: Savas ¸ Serel, Professor, Department of Plastic, Recon- structive and Aesthetic Surgery, Medical Faculty of Ankara University, Dikimevi, Ankara 06590, Turkey E-mail contact: savasserel@gmail.com 1526-8209/$ - see frontmatter ª 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.clbc.2016.10.004 Clinical Breast Cancer Month 2016 - 1