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Liu R, Xie H, Wang Y, Wang Q, Xie X, Zhang X. Impact of unilateral mastectomy on body posture: A prospective longitudinal observational study. Asia Pac J Oncol Nurs 2024; 11:100336. [PMID: 38318426 PMCID: PMC10838699 DOI: 10.1016/j.apjon.2023.100336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/06/2023] [Indexed: 02/07/2024] Open
Abstract
Objective Unilateral mastectomy is known to induce postural alterations, yet the temporal development pattern of these changes remains elusive. This study aimed to explore the impact of unilateral mastectomy on body posture. Methods A prospective, longitudinal, observational study with a one-group repeated-measures design was conducted. Patients undergoing unilateral mastectomy were recruited from a university-affiliated hospital in Western China and monitored for 12 months post-surgery. A trained nurse assessed seven postural baseline parameters on the day of suture removal and at 3, 6, and 12 months after unilateral mastectomy. Two parameters were in the sagittal plane (forward head posture and trunk rotation angle), and five were in the coronal plane (neck tilt, shoulder asymmetry, scapular asymmetry, scapular asymmetry relative to the spine, and pelvic tilt). Results The final analysis included 159 patients. Baseline prevalence of most postural abnormalities ranged from 50.94% to 59.75%, with mean deviations between 2.74 and 4.51 mm. At 12 months post-mastectomy, prevalence and mean deviations increased by more than 30% and 3.50 mm, respectively, compared to baseline. Postural abnormalities increased gradually in the first 3 months, notably between the 3rd and 6th months, and slowed between the 6th and 12th months. On the mastectomy side, coronal plane abnormalities significantly increased within 12 months: earlobe to acromion distance (Wald χ2 = 45.283, P < 0.001), depressed shoulder height (Wald χ2 = 42.253, P < 0.001), depressed scapula height (Wald χ2 = 31.587, P < 0.001), scapula to spine distance (Wald χ2 = 45.283, P < 0.001), and elevated pelvic height (Wald χ2 = 48.924, P < 0.001). Conclusions Postural changes are common post-unilateral mastectomy, with prevalence and deviation increasing gradually, particularly between 3 and 6 months post-mastectomy. Early rehabilitation initiation is recommended to mitigate postural changes. Trial registration ChiCTR2000040897.
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Affiliation(s)
- Ruixia Liu
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Hongmei Xie
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Yuehua Wang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qiuzhou Wang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaofeng Xie
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoxia Zhang
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
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Koralewska A, Domagalska-Szopa M, Siwiec J, Szopa A. The Influence of External Breast Prostheses on the Body Postures of Women Who Have Undergone Mastectomies. J Clin Med 2023; 12:2745. [PMID: 37048827 PMCID: PMC10095582 DOI: 10.3390/jcm12072745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 04/08/2023] Open
Abstract
Most women who have had a mastectomy and have not opted for breast reconstruction choose to use an external breast prosthesis. This study aimed to assess the impacts of external breast prostheses on the body postures of women after unilateral mastectomies. An additional aim was to identify whether postural asymmetry depended on the side of mastectomy. This study involved 52 women after unilateral mastectomy and consisted of two parts: (1) anthropometric measurement and (2) assessment of body posture using the moiré topography method. The posturometric indices showed that the body posture of the subjects in the sagittal plane is characterized by forward trunk inclination and a tendency to excessive kyphosis. There were no significant differences between parameters characterizing body posture with and without external breast prosthesis. The lack of external breast prosthesis had a significant effect only on excessive forward trunk inclination. Significant differences were found in the posturometric parameters in the transverse plane between the groups of patients after left- and right-sided mastectomy. The obtained results did not fully confirm the hypothesis that the external breast prosthesis affects the body posture of women after unilateral mastectomy.
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Affiliation(s)
- Anna Koralewska
- Department of Developmental Age Physiotherapy, Medical University of Silesia in Katowice, 40-751 Katowice, Poland
| | - Małgorzata Domagalska-Szopa
- Department of Developmental Age Physiotherapy, Medical University of Silesia in Katowice, 40-751 Katowice, Poland
| | - Jan Siwiec
- John Paul II Pediatric Center in Sosnowiec, 41-218 Sosnowiec, Poland
| | - Andrzej Szopa
- Department of Physiotherapy, Medical University of Silesia in Katowice, 40-751 Katowice, Poland
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3
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ELSHAZLY M, AHMED AA, SARHAN MA. Response of spine alignment to unilateral mastectomy in breast cancer female patients. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.21.05352-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nam KE, Kim I, Park HY, Lee JI. The effect of breast cancer surgery on spine alignment: Whole-spine radiograph analysis. PLoS One 2022; 17:e0276173. [PMID: 36240238 PMCID: PMC9565701 DOI: 10.1371/journal.pone.0276173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/01/2022] [Indexed: 11/16/2022] Open
Abstract
Breast cancer survivors may experience spinal deformity following breast cancer surgery. This study investigated the long-term effects of breast cancer surgery on whole-spine alignment. This retrospective study included 200 patients who underwent breast cancer surgery and ≥2 anteroposterior standing whole-spine X-rays. The curvature of the spine was measured using the Cobb angle; changes in Cobb angle between X-rays were compared among three groups according to breast cancer surgery type. The mean interval between initial and follow-up X-ray was 28.46 ± 13.39 months. The change in Cobb angle was 0.40 ± 1.65 degrees and the absolute value of that change was 1.25 ± 1.15 degrees in all patients with breast cancer. There were no significant differences in angular change among groups according to breast cancer surgery type. Most patients showed minimal changes in spinal alignment after breast cancer surgery. Our findings indicate that breast cancer surgery does not negatively affect spinal alignment.
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Affiliation(s)
- Kyung Eun Nam
- Department of Rehabilitation Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Inah Kim
- Department of Rehabilitation Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hae-Yeon Park
- Department of Rehabilitation Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong In Lee
- Department of Rehabilitation Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
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Koralewska A, Domagalska-Szopa M, Łukowski R, Szopa A. Influence of the external breast prosthesis on the postural control of women who underwent mastectomy: Cross-sectional study. Front Oncol 2022; 12:920211. [PMID: 36106098 PMCID: PMC9465318 DOI: 10.3389/fonc.2022.920211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Women after mastectomy may decide to either have a breast reconstruction or use an external breast prosthesis. Aim: The aim of the presented research was to evaluate the influence of external breast prosthesis on postural stability in women after mastectomy. Methods and Procedures: In the study 52 women after unilateral mastectomy took part. The study consisted of 4 parts: 1) anthropometric measurements; 2) measurements of upper limb circumference; 3) assessment of weight-bearing (WB); and 4) posturographic tests (PT). Outcomes and Results: Differences in the arm circumferences on the amputated (A) and non-amputated (NA) sides did not confirm the occurrence of lymphedema in limb on amputated side. The results of the WB between the A and NA body sides in both tested conditions, i.e., with open and closed eyes, showed no significant differences between the test with and without an external prosthesis. No statistically differences have been observed between posturometric parameters with and without breast prosthesis during both PT. In comparing the posturometric parameters between the PT with open and closed eyes, the sway path of the center of pressure was statistically significantly longer when eyes were closed in both conditions, i.e., with and without breast prosthesis. Conclusion and Implications: The finding show that 1) external breast prosthesis does not have a significant influence on the symmetry of loading on the A and NA body sides and on the postural stability of women after unilateral mastectomy and 2) exclusion visual control during PT increases postural instability in women after unilateral mastectomy.
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Affiliation(s)
- Anna Koralewska
- Department of Developmental Age Physiotherapy, Medical University of Silesia, Katowice, Poland
| | | | | | - Andrzej Szopa
- Department of Physiotherapy, Medical University of Silesia, Katowice, Poland
- Neuromed, Rehabilitation and Medical Center, Katowice, Poland
- *Correspondence: Andrzej Szopa,
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Surmeli M, Cinar Ozdemir O. The effect of upper limb lymphedema in posture of patients after breast cancer surgery. J Back Musculoskelet Rehabil 2022; 35:829-837. [PMID: 34744068 DOI: 10.3233/bmr-210049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Upper limb lymphedema is one of the complications following breast cancer-related surgery. It is a fact that there are alterations in posture of the trunk following surgery, however, there is not much data on whether upper limb lymphedema has any effect on body posture. OBJECTIVES The main purpose of the study was to investigate the effect of upper limb lymphedema in the trunk posture and spine mobility of patients following breast cancer surgery. METHODS Twenty-seven women with lymphedema and 29 women without lymphedema with mastectomy or breast-conserving surgery participated in the study. Posture was evaluated by the New York Posture Rating Chart and spinal stability and thoracic mobility were evaluated by the Spinal Mouse device. RESULTS Posture and spine posture scores were significantly higher in the without lymphedema group (p= 0.004; 0.041; respectively). There was a significant difference between the groups in terms of lateral (p< 0.001) and posterior (p< 0.001) view of shoulders, spine (p= 0.027), upper (p< 0.001) and lower back (p= 0.009), and trunk postures (p= 0.001). CONCLUSIONS Body posture and spine are more affected due to upper limb lymphedema following breast cancer surgery. Alterations of posture mainly occur on shoulders, spine, upper and lower back, and trunk, but not on head and neck postures.
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Affiliation(s)
- Mahmut Surmeli
- Faculty of Health Sciences, Tokat Gaziosmanpasa University, Tokat, Turkey
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Serel S, Sefa Özden N, Aydınlı Y, Akkaya Z, Uzun Ç, Bayar S. Effects of delayed breast reconstruction on the thoracolumbar vertebrae in patients undergoing unilateral mastectomy: A retrospective cohort study. J Plast Reconstr Aesthet Surg 2022; 75:3022-3029. [PMID: 35697605 DOI: 10.1016/j.bjps.2022.04.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 12/08/2021] [Accepted: 04/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Post-mastectomy changes vertebral column alignment. There is limited data assessing spine curvature after breast reconstruction. In this study, the effects of delayed breast reconstruction on the Cobb angle and quality of life indicator (Oswestry disability index [ODI]) were evaluated in patients undergoing unilateral mastectomy. METHODS This study was performed as a retrospective review of 40 patients who had delayed reconstruction for breast cancer at a single center between 2015 and 2018. Patients completed a standardized questionnaire, the ODI, at the beginning and 12 months after the operation. The Cobb angles of the vertebral columns and spinal curve directions were determined using posteroanterior chest radiographs obtained pre- and postoperatively. RESULTS Mean age and body mass index (BMI) were 49.9 ± 9 years and 30.1 kg/m2, respectively. The Cobb angles were found to differ before and after the reconstruction; the difference was statistically significant, and the average change in Cobb angle was 4.3° (p = 0.03). The Cobb angles were also found to be significantly different between patients with implants and those who underwent autologous tissue reconstruction (p = 0.026). Although delayed reconstruction performed with autologous tissue or implant improves post-mastectomy scoliosis, autologous tissue reconstruction yields better outcomes. The mean preoperative ODI score was 21.6%, and 8.8% patients presented no back pain. The mean score was 3.2% at 12 months postoperation. These results are statistically significant (p<0.001). CONCLUSIONS Breast reconstruction positively affects vertebral alignment and leads to better posture, physical function and decreased back pain in breast cancer survivors, significantly improving their quality of life.
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Affiliation(s)
- Savaş Serel
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty of Ankara University, Ankara, Turkey.
| | - Necip Sefa Özden
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty of Ankara University, Ankara, Turkey
| | - Yasemin Aydınlı
- Clinic of Plastic, Reconstructive and Aesthetic Surgery, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey
| | - Zehra Akkaya
- Department of Radiology, Medical Faculty of Ankara University, Ankara, Turkey
| | - Çağlar Uzun
- Department of Radiology, Medical Faculty of Ankara University, Ankara, Turkey
| | - Sancar Bayar
- Department of Surgical Oncology and General Surgery, Medical Faculty of Ankara University, Ankara, Turkey
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Quixadá AP, Miranda JGV, Osypiuk K, Bonato P, Vergara-Diaz G, Ligibel JA, Mehling W, Thompson ET, Wayne PM. Qigong Training Positively Impacts Both Posture and Mood in Breast Cancer Survivors With Persistent Post-surgical Pain: Support for an Embodied Cognition Paradigm. Front Psychol 2022; 13:800727. [PMID: 35265005 PMCID: PMC8900705 DOI: 10.3389/fpsyg.2022.800727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
Theories of embodied cognition hypothesize interdependencies between psychological well-being and physical posture. The purpose of this study was to assess the feasibility of objectively measuring posture, and to explore the relationship between posture and affect and other patient centered outcomes in breast cancer survivors (BCS) with persistent postsurgical pain (PPSP) over a 12-week course of therapeutic Qigong mind-body training. Twenty-one BCS with PPSP attended group Qigong training. Clinical outcomes were pain, fatigue, self-esteem, anxiety, depression, stress and exercise self-efficacy. Posture outcomes were vertical spine and vertical head angles in the sagittal plane, measured with a 3D motion capture system in three conditions: eyes open (EO), eyes open relaxed (EOR) and eyes closed (EC). Assessments were made before and after the Qigong training. The association between categorical variables (angle and mood) was measured by Cramer's V. In the EO condition, most participants who improved in fatigue and anxiety scales also had better vertical head values. For the EOR condition, a moderate correlation was observed between changes in vertical head angle and changes in fatigue scale. In the EC condition, most of the participants who improved in measures of fatigue also improved vertical head angle. Additionally, pain severity decreased while vertical spine angle improved. These preliminary findings support that emotion and other patient centered outcomes should be considered within an embodied framework, and that Qigong may be a promising intervention for addressing biopsychosocially complex interventions such as PPSP in BCSs.
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Affiliation(s)
- Ana Paula Quixadá
- Laboratory of Biosystems, Institute of Physics, Universidade Federal da Bahia, Salvador, Brazil
- *Correspondence: Ana Paula Quixadá,
| | - Jose G. V. Miranda
- Laboratory of Biosystems, Institute of Physics, Universidade Federal da Bahia, Salvador, Brazil
| | - Kamila Osypiuk
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA, United States
| | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Gloria Vergara-Diaz
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Jennifer A. Ligibel
- Zakim Center for Integrative Therapies and Healthy Living, Harvard Medical School, Dana Farber Cancer Institute, Boston, MA, United States
| | - Wolf Mehling
- Department of Family and Community Medicine, Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Evan T. Thompson
- Department of Philosophy, University of British Columbia, Vancouver, BC, Canada
| | - Peter M. Wayne
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA, United States
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Oh JS, Kim H, Jin US. The effect of delayed breast reconstruction after unilateral mastectomy on spine alignment. Gland Surg 2021; 10:2368-2377. [PMID: 34527548 DOI: 10.21037/gs-21-254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/13/2021] [Indexed: 11/06/2022]
Abstract
Background Mastectomy in patients with breast cancer causes spinal deformities. We evaluated the effect of delayed breast reconstruction in post-mastectomy patients on spine alignments. Methods The study included 68 patients who underwent delayed breast reconstruction by three plastic surgeons in a single tertiary hospital. We measured proximal thoracic (PT), main thoracic (MT), and thoracolumbar (TL) Cobb angles and coronal spinal balance from chest or whole spine radiographs. Results The median changes in the PT and MT Cobb angles were -0.33 and -0.34 degrees, respectively. The change in TL Cobb angle and coronal spinal balance were only measured in 29 patients with available spine radiographs. The median change in TL Cobb angle and coronal spinal balance were -0.69 degrees and 3.75 mm, respectively. The median preoperative and postoperative PT Cobb angles were 1.75 and 1.24 degrees. The difference between preoperative and postoperative PT Cobb angles was statistically insignificant (P=0.036). The median preoperative and postoperative MT Cobb angles were 1.32 and 1.09 degrees, respectively. The difference between preoperative and postoperative MT Cobb angles was statistically insignificant (P=0.221). Conclusions Delayed breast reconstruction did not result in clinically significant improvement in mastectomy-induced spinal deformity. This finding should be considered when choosing between immediate and delayed breast reconstruction.
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Affiliation(s)
- Joon Seok Oh
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyoungmin Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ung Sik Jin
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Lee JS, Park E, Lee JH, Lee J, Park HY, Yang JD, Jung TD. Alteration in skeletal posture between breast reconstruction with latissimus dorsi flap and mastectomy: a prospective comparison study. Gland Surg 2021; 10:1587-1597. [PMID: 34164303 DOI: 10.21037/gs-21-31] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The latissimus dorsi (LD) flap is used in cases of immediate breast reconstruction after total or partial mastectomy. However, studies on the effect of unilateral LD flap reconstruction on skeletal posture and comparison with results from mastectomy-only have been sparse. Thus in this prospective, observational study, we compared skeletal posture and functional recovery in patients who underwent a mastectomy-only versus those who underwent breast reconstruction with a LD flap after mastectomy. Methods From January 2018 to February 2020, a total of 54 patients were enrolled. The control group included 23 patients who underwent mastectomy-only and the experimental group included 31 patients who underwent breast reconstruction using a LD flap immediately after mastectomy. We assessed the Cobb's angle in spine X-rays, parameters derived from photometry, computed tomography (CT), and 3D scanning preoperatively (T0), 6 months post-surgery (T1), and 1-year post-surgery (T2). We also evaluated functional outcomes, such as pain intensity, disability of the upper extremities, and quality of life. Results In the control and experimental groups, the average age was 58.7/46.2 years, body mass index (BMI) was 24.9/22.5, and excised mass weight was 386.8/259.1 g, respectively. In the control group, differences in the Cobb's angle were significant between T0 and T2 (P=0.003). There were significant differences in the Cobb's angle and time interaction effects between the two groups (P=0.015). The degree of change in the Cobb's angle between T0 and T1 was positively correlated with change in the vertical distance from the 3D scanner midline to the nipple (P=0.009). Conclusions The experimental group showed improved recovery in skeletal posture compared to the control group. Further, discovering the parameters that can predict the change of skeletal posture through a 3D scanner will have clinical significance. Accordingly, performing breast reconstruction by unilaterally applying the LD muscle is a safe, reliable, and useful method of autologous tissue transfer for breast cancer patients.
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Affiliation(s)
- Joon Seok Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Eunhee Park
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jung Ho Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jeeyeon Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ho Yong Park
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jung Dug Yang
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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Evaluation of Late Postural Complications in Breast Cancer Patients Undergoing Breast-Conserving Therapy in Relation to the Type of Axillary Intervention-Cross-Sectional Study. J Clin Med 2021; 10:jcm10071432. [PMID: 33916060 PMCID: PMC8036801 DOI: 10.3390/jcm10071432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/12/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: The aim of the study was to evaluate posture in patients undergoing breast-conserving therapy (BCT) in relation to the type of surgical intervention to the axilla. Methods: The study was conducted on patients who had undergone breast-conserving surgical treatment for breast cancer 5–6 years earlier. In 54 patients, BCT+ALND (axillary lymph node dissection) was performed, while 63 patients were subjected to BCT+SLND (sentinel lymph node dissection). The control group consisted of 54 females. The study was conducted using digital postural assessment. Results: No statistically significant differences were observed with respect to the parameters between the BCT+SLNB and BCT+ALND groups (p > 0.05). However, the differences were highly significant between the CG (control group) and the studied groups (BCT+ALND, BCT+SLNB) for the following parameters: BETA angle of thoracolumbar spine inclination (p = 0.002), GAMMA angle of thoracic spine inclination (p = 0.0044), TKA (thoracic kyphosis angle) (p < 0.0001) and shoulder level inclination (p = 0.0004). The BCT+ALND patients were characterized by higher dependency of raised shoulder (p = 0.0028) and inferior angle of the scapula (p = 0.00018) on the operated side compared to BCT+SLNB patients. Conclusions: Postural imbalance occurs independent of the type of axillary intervention. Disturbances within the upper torso (abnormal position of shoulders and inferior angles of scapulae) are more pronounced in patients after ALND.
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Ohlendorf D, Sosnov P, Keller J, Wanke EM, Oremek G, Ackermann H, Groneberg DA. Standard reference values of the upper body posture in healthy middle-aged female adults in Germany. Sci Rep 2021; 11:2359. [PMID: 33504851 PMCID: PMC7840933 DOI: 10.1038/s41598-021-81879-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 01/04/2021] [Indexed: 12/25/2022] Open
Abstract
In order to classify and analyze the parameters of upper body posture, a baseline in form of standard values is demanded. To this date, standard values have only been published for healthy young women. Data for female adults between 51 and 60 years are lacking. 101 symptom-free female volunteers aged 51–60 (55.16 ± 2.89) years. The mean height of the volunteers was 1.66 ± 0.62 m, with a mean body weight of 69.3 ± 11.88 kg and an average BMI of 25.02 ± 4.55 kg/m2. By means of video raster stereography, a 3D-scan of the upper back surface was measured in a habitual standing position. The confidence interval, tolerance range and ICCs were calculated for all parameters. The habitual standing position is almost symmetrical in the frontal plane the most prominent deviation being a slightly more ventral position of the left shoulder blade in comparison to the right. The upper body (spine position) is inclined ventrally with a minor tilt to the left. In the sagittal plane, the kyphosis angle of the thoracic spine is greater than the lordosis angle of the lumbar spine. The pelvis is virtually evenly balanced with deviations from an ideal position falling under the measurement error margin of 1 mm/1°. There were also BMI influenced postural variations in the sagittal plane and shoulder distance. The ICCs are calculated from three repeated measurements and all parameters can be classified as "almost perfect". Deflections from an ideally symmetric spinal alignment in women aged 51–60 years are small-scaled, with a minimal frontal-left inclination and accentuated sigmoidal shape of the spine. Postural parameters presented in this survey allow for comparisons with other studies as well as the evaluation of clinical diagnostics and applications.
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Affiliation(s)
- Daniela Ohlendorf
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany.
| | - Polyna Sosnov
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - Julia Keller
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - Eileen M Wanke
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - Gerhard Oremek
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - Hanns Ackermann
- Institute of Biostatistics and Mathematical Modeling, Goethe-University, Frankfurt/Main, Theodor-Stern-Kai 7, Building 11A, 60596, Frankfurt/Main, Germany
| | - David A Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
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Lang AE, Kim SY, Dickerson CR, Milosavljevic S. Measurement of objective shoulder function following breast cancer surgery: a scoping review. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1851439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Angelica E. Lang
- School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Soo Y. Kim
- School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, Canada
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Ahn SY, Bok SK, Song Y, Lee HW, Jung JY, Kim JJ. Dynamic body posture after unilateral mastectomy: a pilot study. Gland Surg 2020; 9:1235-1243. [PMID: 33224798 DOI: 10.21037/gs-20-466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Postural changes after unilateral mastectomy may appear in relation to the dominant hand, postoperative duration, and dynamic conditions. This study aimed to compare the postural changes by inclination angles and muscle activities in the static and dynamic sitting position between women with breast cancer who underwent mastectomy and women who did not have breast cancer. METHODS The observational study design was conducted. We evaluated 17 women who underwent modified radical mastectomy (MRM) more than 1 year prior to the study. They were categorized into the Rt. mastectomy group (n=7) and the Lt. mastectomy group (n=10). An aged-matched cohort of 8 healthy females was also included. The inclination angle in both static and dynamic sitting positions was measured using the balance board system (BBS), and the muscle activities of 8 muscles were measured in the dynamic sitting position. RESULTS There was no significant difference in demographic characteristics between the patients, and all patients were right-handed. The inclination angle of the anterior-posterior axis when leaning forward was significantly increased to the anterior side in the Rt. mastectomy group than in the Lt. mastectomy group. Meanwhile, the inclination angle in the static sitting position and when tilted backward to both directions did not differ among the 3 groups. The inclination angle of the right-left axis was statistically increased to the left side during tilting anterior-left direction in the Rt. Mastectomy group. The muscle activities of the thoracic erector spinae were significantly lower when tilted backward in the Rt. mastectomy group than in the Lt. mastectomy group. CONCLUSIONS Compared with left mastectomy, right unilateral mastectomy yielded more postural changes under dynamic sitting state in right-handed female patients with breast cancer. Thus, to maintain the trunk balance and prevent the postural changes after unilateral mastectomy, the postoperative exercise programs for the para-thoracic muscles will be helpful.
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Affiliation(s)
- So Young Ahn
- Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Soo-Kyung Bok
- Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Youngshin Song
- Chungnam National University College of Nursing, Daejeon, Republic of Korea
| | - Hye-Won Lee
- Daejeon Rehabilitation Hospital, Daejeon, Republic of Korea
| | - Ji-Yong Jung
- Division of Biomedical Engineering, Jeonbuk National University, Jeonju, Republic of Korea
| | - Jung-Ja Kim
- Division of Biomedical Engineering, Jeonbuk National University, Jeonju, Republic of Korea
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Głowacka-Mrotek I, Tarkowska M, Nowikiewicz T, Hagner-Derengowska M, Goch A. Assessment of Postural Balance in Women Treated for Breast Cancer. MEDICINA-LITHUANIA 2020; 56:medicina56100505. [PMID: 32992502 PMCID: PMC7601320 DOI: 10.3390/medicina56100505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 12/04/2022]
Abstract
Background and objectives: Surgery is the primary and most effective treatment of breast cancer. Unilateral mastectomy disrupts the distribution of muscle tension between the right and the left sides of the body. The aim of the study was to evaluate postural balance in patients treated for breast cancer by mastectomy. Materials and methods: A controlled clinical study was conducted on 90 patients who have undergone surgical treatment for breast cancer (mastectomy) 5–6 years prior (Breast Group—BG). The control group (CG) consisted of 74 healthy female volunteers. Analysis of balance was performed using the Alfa stabilography platform. A static test (Romberg’s test) with open and closed eyes was used to assess balance. The following balance parameters were analyzed: path length, statokinesigram area, parameters of deflection and velocity of the foot pressure center. Results: The study demonstrated that patients from BG (5–6 years after surgery) obtained worse results in both tests with open (maximum back deviation, maximum forward deviation, average Y deviation, average Y velocity, path length and path surface area) (p < 0.05) as well as with closed eyes (maximum backward deviation, maximum forward deviation, mean Y deviation and path length) (p < 0.05). Conclusions: Our study demonstrated that women 5–6 years after surgery for breast cancer have impaired balance compared to healthy women, despite physiotherapy.
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Affiliation(s)
- Iwona Głowacka-Mrotek
- Department of Rehabilitation, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 87-100 Toruń, Poland
- Correspondence: ; Tel.: +48-791-225-318; Fax: +48-(52)-585-40-42
| | - Magdalena Tarkowska
- Department of Physiotherapy, Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 87-100 Toruń, Poland; (M.T.); (A.G.)
| | - Tomasz Nowikiewicz
- Department of Surgical Oncology, Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 87-100 Toruń, Poland;
| | | | - Aleksander Goch
- Department of Physiotherapy, Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 87-100 Toruń, Poland; (M.T.); (A.G.)
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Gutkin PM, Kapp DS, von Eyben R, Dirbas FM, Horst KC. Impact of mastectomy for breast cancer on spinal curvature: Considerations when treating patients with scoliosis. Breast J 2020; 26:1973-1979. [PMID: 32841452 DOI: 10.1111/tbj.14018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 01/27/2023]
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.
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Affiliation(s)
- Paulina M Gutkin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Frederick M Dirbas
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Kathleen C Horst
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
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Does the weight of an external breast prosthesis play an important role for women who undergone mastectomy? Rep Pract Oncol Radiother 2020; 25:574-578. [PMID: 32494231 DOI: 10.1016/j.rpor.2020.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/18/2020] [Accepted: 04/20/2020] [Indexed: 01/21/2023] Open
Abstract
Aim The aim of the study was an evaluation of daily functioning and activity in post-mastectomy women who use EBP, with particular focus on the weight of the prosthesis. Background There is a large group of breast cancer patients who need comprehensive care including professional help with EBP. Some researchers have reported the advantages and disadvantages of using EBPs in women who undergo mastectomy. Among the latter, dissatisfaction with the weight, comfort and movement of the prosthesis was identified. Materials and methods The study included 125 women who had undergone unilateral mastectomy. This was a survey with a self-constructed questionnaire which was administered to breast cancer women. In the second part, the author analyzed current objective studies about the implementation of EBP in body motion assessments. Results The analysis of the answers of the women studied showed that they used their first EBP about 6 months after mastectomy, and changed it every two years. The method of choosing EBP had a significant impact on satisfaction with EBP as well as on the prosthesis' weight. Patients who chose EBP themselves were more satisfied with it. There was no statistically significant correlation between the age of the women studied and their satisfaction with the EBP or its weight and size. Conclusion EBP plays an important role in the satisfaction with daily functioning and activity of breast cancer women who have undergone unilateral mastectomy despite the fact that the weight of EBP is not an important factor in an objective analysis of body motions in many studies in this group of patients.
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Puszczalowska-Lizis E, Flak K, Biskup M, Zak M. Physical Activity of Women After Radical Unilateral Mastectomy and Its Impact on Overall Quality of Life. Cancer Control 2020; 27:1073274819900407. [PMID: 32003236 PMCID: PMC7003178 DOI: 10.1177/1073274819900407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Radical unilateral mastectomy is an acknowledged source of traumatic experience for women, adversely affecting their behavioral and emotional paradigm. The present study aimed to assess the quality of life in physically active and inactive postmastectomy women. Population sample involved 100 women, aged 50 to 60 years, having undergone radical unilateral mastectomy, allocated into 2 groups, upon assumption of undertaking physical activity. The abbreviated version of WHOQOL-BREF questionnaire was a research tool of choice. The data were analyzed with the aid of χ2 test, Kruskal-Wallis test, and Mann-Whitney U test. Statistically significant dependence was established between physical activity actually pursued and self-assessment of overall quality of life (P = .014) and overall the self-rated perception of health (P < .001). In the group of physically inactive women, physical health was a variable dependent upon individual level of education (P = .031). The highest scores in this domain were noted in the women boasting secondary education, whereas the lowest in the ones with vocational education. Social domain was the highest rated aspect of quality of life in both the physically active and inactive postmastectomy women, while the physical health domain was rated the lowest. Both in the case of physically active and inactive postmastectomy women, the quality of life in the respective domains, as listed in the WHOQOL-BREF questionnaire, was found independent of the living environment.
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Affiliation(s)
| | - Kinga Flak
- Non-Public Physiotherapy Practice, Jaroslaw, Poland
| | - Malgorzata Biskup
- Department of Rehabilitation, Holycross Cancer Centre, Kielce, Poland.,Faculty of Medicine and Health Sciences, Institute of Physiotherapy, The Jan Kochanowski University, Kielce, Poland
| | - Marek Zak
- Faculty of Medicine and Health Sciences, Institute of Physiotherapy, The Jan Kochanowski University, Kielce, Poland
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Celenay ST, Ucurum SG, Kaya DO. Comparison of Spinal Alignment and Mobility in Women With and Without Post Modified Radical Mastectomy Unilateral Lymphoedema. Clin Breast Cancer 2019; 20:e295-e300. [PMID: 31932238 DOI: 10.1016/j.clbc.2019.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/18/2019] [Accepted: 10/19/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Unilateral lymphoedema and breast resection after modified radical mastectomy might create impairment of spinal alignment and mobility. The aim of this study was to compare spinal alignment and mobility in women with and without post modified radical mastectomy unilateral lymphoedema. MATERIALS AND METHODS Twenty women with post modified radical mastectomy unilateral lymphoedema (lymphoedema group) and 18 healthy women (control group) were included in this study. The sagittal and frontal spinal alignment and mobility were assessed with a Spinal Mouse (Idiag, Fehraltorf, Switzerland). The severity of the lymphoedema was evaluated with circumferential measurements. RESULTS In the lymphoedema group, the volume difference of the arms was 448.31 ± 78.14 mL, known as moderate severity lymphoedema. It was seen that the sagittal thoracic curvature (P = .017) and the frontal inclination angle (P = .048) were higher in the lymphoedema group in comparison with the control group. In the lymphoedema group, the frontal inclination angle changed towards the unaffected side (P < .001). No significant differences were found between groups in the other parameters related to spinal curvature and mobility (P > .05). CONCLUSION The sagittal thoracic curvature and the frontal inclination angle towards the unaffected side increased in women with post modified radical mastectomy unilateral lymphoedema. The sagittal and frontal spinal alignment changes should be taken into consideration for the assessment and the treatment of unilateral lymphoedema.
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Affiliation(s)
- Seyda Toprak Celenay
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Ankara Yildirim Beyazit University, Ankara, Turkey.
| | - Sevtap Gunay Ucurum
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Izmir Katip Celebi University, Izmir, Turkey
| | - Derya Ozer Kaya
- Department of Physiotherapy and Rehabilitation, Health Sciences Faculty, Izmir Katip Celebi University, Izmir, Turkey
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Mangone M, Bernetti A, Agostini F, Paoloni M, De Cicco FA, Capobianco SV, Bai AV, Bonifacino A, Santilli V, Paolucci T. Changes in Spine Alignment and Postural Balance After Breast Cancer Surgery: A Rehabilitative Point of View. Biores Open Access 2019; 8:121-128. [PMID: 31367476 PMCID: PMC6664823 DOI: 10.1089/biores.2018.0045] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Breast cancer is the most common malignant tumor in female patients in developed countries. Recent articles indicate that one-sided mastectomy or minor breast surgery to treat breast cancer can have deleterious effects on posture and the musculoskeletal system. The purpose of this study was to investigate the alterations post-breast cancer surgery of the spine alignment associated to the balance not reported by the noninvasive instrumentation. We enrolled 30 women who had undergone treatment for breast cancer (BG) and were on a waiting-list for rehabilitation treatment and a control group of 30 healthy volunteer women (CG), matched by age and body mass index. The stabilometry was performed using a force platform (Kistler Instruments, Winterthur, Switzerland) test during quiet standing with closed-eyes (EC) and open-eyes (EO), recording the position of the center of pressure (CoP) for 51.2 sec. The stabilogram or the time plot of the two coordinates, X and Y, of the CoP was obtained, which represent anteroposterior and midlateral balance. Spinal posture was measured using the Formetric-4D rasterstereographic system (DIERS, International GmbH, Schlangenbad, Germany), and thoracic kyphotic angle, lumbar lordotic angle, and surface trunk rotation were evaluated. Sixty participants were analyzed (CG:30; BG:30). For the spine rasterstereography a statistically significant difference was shown with regard to anterior-posterior flexion of the trunk major in BG; pelvic inclination and twist of half-pelvis decreased in BG; normalized lumbosacral inversion point decreased in BG; surface rotation major in BG; and lateral deviation major in BG. Compared with the values for the stabilometry test with EO and EC, a statistically significant difference was observed, respectively, for ellipse length (mm; p = 0.04) and ellipse area (mm2; p = 0.04) with EO and in ellipse area (mm2) with EC (p = 0.05), increased in BG for both conditions. No difference was shown for CoP velocity and oscillations between the groups. Breast cancer survivors after prostheses or tissue expanders for mastectomy showed a spine's misalignment present both on the sagittal plane, both on the coronal and frontal plane, increased in BG regard to anterior-posterior flexion of the trunk, surface rotation, and lateral deviation. It is associated with greater energy expenditure for the postural balance control increased in BG with a major ellipse area in EO and EC conditions and major ellipse length in EC condition.
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Affiliation(s)
- Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Andrea Bernetti
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Francesco A De Cicco
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Serena V Capobianco
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Arianna V Bai
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Adriana Bonifacino
- Breast Diagnosis and Treatment Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Valter Santilli
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
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The Effect of Immediate Breast Reconstruction on Thoracic Spine Alignment After Unilateral Mastectomy. Clin Breast Cancer 2018; 18:214-219. [DOI: 10.1016/j.clbc.2017.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 06/19/2017] [Accepted: 06/25/2017] [Indexed: 11/22/2022]
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