Quantitative Orthopaedic Spine Benefits Post Breast Reduction - Preliminary Results
Constantine Papanastasiou, MD, Jean Ouellet, MD, FRCSC, Maryse Fortin, PhD, Lucie Lessard, MD, FRCSC, FRCSC, FACS.
McGill University, Montreal, QC, Canada.
PURPOSE: Breast hypertrophy comes with an array of signs and symptoms that range from mild to debilitating in nature including: headache, neck pain, back pain, breast pain, painful bra strap grooves, hand numbness, and shortness of breath. Breast reduction surgery is one of the most frequently performed plastic surgery procedures that has been shown to have the highest patient satisfaction and improvement in quality of life on specific satisfaction survery questionnaires. The effects of breast reduction surgery on parameters such as sagittal spinal balance, paraspinal muscle function, and physical performance have not been evaluated. The objective of this study is to evaluate the effects of reduction mammaplasty on sagittal spinal balance, paraspinal muscles, and physical function using sophisticated spine surgery imaging modality pre and post breast reduction.
METHODS: This is a prospective, observational cohort study being carried out at the Montreal General Hospital (MGH) of the McGill University Health Centre (MUHC). Twenty-five patients are being prospectively enrolled in this IRB approved study. The following methods are used preoperatively and postoperatively for each patient: EOS X-ray (ultra-low dose radiation) of the spine in standing position*, MRI of the spine, clinical evaluation, patient self-assessment outcomes including Breast-Q (validated questionnaire in French & English).
*EOS: A Nobel Prize winning imaging technology done in the standing position and which exposes the patient to 1/10 the radiation of a traditional X-Ray of the spine. EOS is the proper name for the imaging technology and it is not an acronym.
RESULTS: Postoperative improvement in thoracic kyphosis and lumbar lordosis are documented quantitatively on patients scanned in the standing position. Preoperative and postoperative MRI of the spine demonstrate quantitative changes in cross-sectional area and functional cross-sectional area. Significant postoperative improvement in all Breast-Q categories documented. The measurements will be presented as well as the radiographic evidence.
CONCLUSION: Reduction mammaplasty is not merely an aesthetic procedure but also a procedure with quantitative spine benefits. This may have an impact on health care system and third party payer insurance companies and may beckon the need for better guidelines based on those quantitative findings. This study is also being extended to breast cancer patients with unilateral mastectomy and back pain.
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