The impact of breast size on the vertebral column: a radiologic study

Evaluating the Effects of Sports Bra Design, Body Composition, Metabolic Markers, and Sex Hormones on Kinetic Measures of Postural Control in Full-Busted Women During Physical Activity

Due to inadequate commercial availability of sports bras designed with adequate breast support for full-busted women (cup size D and above), breast discomfort can be a significant barrier to exercise. In this study, postural characteristics during dynamic physical activities were evaluated for 20 full-busted women in 3 different sports bra conditions, 2 of which were bras designed specifically for full-busted women. Participants performed quiet standing, walking, jumping jacks, high knees, and running tasks on a force plate treadmill in each condition to collect postural measures associated with center of pressure (COP). COP measures were also evaluated with respect to body composition, metabolic health markers, and sex hormone profiles. COP measures were larger in high knees and jumping tasks with respect to quiet standing. Across running speeds, conventional bras were associated with the largest COP metrics. Analysis of covariance analysis indicated increased anthropometry measures such as mass and body fat percentage resulted in decreased COP area and favored mediolateral orientation. Luteinizing hormone, estradiol, progesterone, testosterone, and sex hormone-binding globulin were all found to impact statistical models, indicating the importance of incorporating a comprehensive hormone panel when considering the impact subject-level variations have on motor function.

Back pain in patients with macromastia: what a spine surgeon should know?

Large and heavy breasts, termed macromastia, is a common cause of neck and back pain in females that may present as early as puberty. With focus usually elsewhere, macromastia is not usually a primary consideration when a patient initially presents to a spine specialist, particularly a spine surgeon. Axial pain is among the most common indications for breast reduction by plastic surgeons. Breast reduction surgery has been demonstrated to be an effective treatment for many women with back pain from macromastia. Awareness among spine specialists may prevent unneeded spinal intervention prompted by an overestimation of the contribution of vertebral degenerative changes to axial pain in affected women. This review aims to broaden spine providers' understanding of macromastia and its evaluation and treatment, including the role of breast reduction surgery to lessen axial pain.

Investigation of the Relationship of Functional Improvement and Body Mass Index in Breast Reduction Patients

INTRODUCTION

Due to macromastia, center of gravity changes and neck, shoulder, back pain become prominent. Macromastia and obesity separately cause pain and an increase in curves of vertebra. The aim of this study is to compare the functional benefits of reduction mammoplasty between obese and non-obese patients.

MATERIALS AND METHODS

Data of this retrospective study were collected from archives and include preoperative/postoperative thoracic Cobb angles, preoperative/postoperative VAS scores, BMI and resected breast tissue weight of patients who underwent reduction mammaplasty operations between August 2017 and April 2019 in Plastic, Reconstructive and Aesthetic Surgery Department.

RESULTS

This study shows that reduction mammoplasty enables significant decrease both in thoracic kyphosis angles and in neck, shoulder and back VAS scores. However, no significant difference was found in preoperative/postoperative values and mean amount of changes of thoracic kyphosis angles between obese and non-obese patients. Decreases in neck, shoulder and back VAS scores were not found statistically significant between two groups. The breast resection amount was not related to correction of kyphosis, but it enabled only a significant decrease in neck VAS scores.

CONCLUSION

Functional improvement was not related to body mass index in reduction mammoplasty patients. Functional benefits were observed similarly in both obese and non-obese patients. A precise threshold value for body weight, body mass index and amount of breast tissue could not be defined as an indication for functional reduction mammoplasty.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Effect of Breast Size on Spinal Posture

Macromastia can cause various clinical symptoms, such as low back and shoulder pain as well as sacro-iliac disorders. Because of these symptoms, some women consider breast reduction surgery. So far there does not exist a clear correlation between breast size and back pain. Purpose of this study was to evaluate if increasing breast size has a measurable effect on women's posture using radiation free surface topography.A total of 100 women were grouped according to their breast cup size into four groups (Cup Size: A, B, C, D). All female subjects were measured with a surface topography system, and their spinal posture and pelvic position were analysed accordingly.Our results showed that cup size affects kyphotic angle (p = 0.027) and surface rotation (p = 0.039) significantly. Kyphotic angle increased with cup size. Multiple linear regression analysis, however, revealed that the body mass index has the greatest influence on woman's posture, showing significant correlation to kyphotic and lordotic angle (p < 0.01), as to trunk (p < 0.01) and pelvic inclination (p = 0.02).This is the first study that evaluates the influence of increasing breast size on posture using surface topography. The results match with previous studies using different measuring techniques. However, the great influence of BMI on posture is also confirmed. Therefore, in clinical practice these factors should be taken into account and be approached. Surface topography seems to be a promising tool to further investigate the influence of breast size on posture.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Influence of External Breast Prostheses on the Body Postures of Women Who Have Undergone Mastectomies

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.

How much error is associated with calculating breast volume from three-dimensional breast scans obtained when women are standing? Implications for bra design and bra fit

BACKGROUND

A lying prone position is recommended when scanning women's breasts to ensure the entire breast can be visualised. However, several large databases contain three-dimensional scans of women's breasts and torsos that were obtained while the women were standing. This study aimed to establish the error associated with calculating breast volume from three-dimensional breast scans taken when women were standing relative to lying prone.

METHODS

Breast volume was derived for 378 women with Small, Medium, Large and Hypertrophic breast sizes from scans taken while the women were standing and then lying prone.

RESULTS

The magnitude of error associated with breast volume derived from scans obtained while women stood compared to lying prone, ranged from ∼8-22% and increased with increasing breast size.

CONCLUSION

Errors associated with breast volume data derived from breast scans collected while women stand must be accounted for, particularly for women with Medium, Large and Hypertrophic breast sizes. Practitioner summary: This original research provides evidence for bra designers and manufacturers on the degree of error associated when using breast scans obtained while women were standing, such as those scans readily available in large scanning databases. These errors increase with increasing breast size and must be accounted for when sizing and designing bra cups.

Reference Values for Sagittal Clinical Posture Assessment in People Aged 10 to 69 Years

Poor posture is a well-known problem in all age groups and can lead to back pain, which in turn can result in high socio-economic costs. Regular assessment of posture can therefore help to identify postural deficits at an early stage in order to take preventive measures and can therefore be an important tool for promoting public health. We measured the posture of 1127 symptom-free subjects aged 10 to 69 years using stereophotogrammetry and determined the sagittal posture parameters flèche cervicale (FC), flèche lombaire (FL), and kyphosis index (KI) as well as the values standardized to the trunk height (FC%, FL%, KI%). FC, FC%, KI, and KI% showed an increase with age in men but not in women, and a difference between the sexes. FL remained largely constant with age, although FL% had significantly greater values in women than men. Postural parameters correlated only moderately or weakly with body mass index. Reference values were determined for different age groups and for both sexes. Since the parameters analyzed can also be determined by simple and non-instrumental methods in medical office, they are suitable for performing preventive checks in daily medical or therapeutic practice.

Evaluation of the Effect of Reduction Mammoplasty on Body Posture in Patients with Macromastia

BACKGROUND

Breast hypertrophy is a significant health problem with both physiological and psychological impacts on the patients' lives. Patients with macromastia adopt a corrective posture due to the effect of the breast on the center of gravity and possibly in a subconscious effort to conceal their breasts.

OBJECTIVE

This study aimed to evaluate whether the posture of patients with macromastia changed after the reduction of mammoplasty.

MATERIAL AND METHODS

In this prospective study, patients with breast cup sizes C, D, and DD were scheduled for reduction mammoplasty in 3 Shiraz University Hospitals. Age, weight, height, and preoperative cup sizes of the breasts were recorded for every patient, and all patients underwent posture analysis with forceplate before and after reduction mammoplasty. Finally, the preoperative and postoperative data were compared.

RESULTS

Mean age at the time of reduction mammaplasty was 43.57±9.1; the mean pre-operation, such as weight, height, and mean the body mass index (BMI) was 76.57±10 kg, 158.28±6 cm and 30.57±4.1, respectively. The average Anterior-posterior (AP) direction velocity before and after the surgery was 0.85±0.12 cm/s and 0.79±0.098, respectively. These values were 0.83±0.09 and 0.81±0.10 for the mediolateral direction. The Detrended Fluctuation Analysis (DFA) value for the AP direction was 1.63±0.3 and 1.60±0.2 for pre-and post-surgery, respectively, which was not statistically different. The DFA value for maximum likelihood (ML) direction was 1.65±0.2 and 1.48±0.2 in pre-op and post-op, respectively, which was statistically significantly different.

CONCLUSION

Reducing the weight of enlarged breasts can correct disturbed sagittal balance and postural sway.

Effects of Artificially Induced Breast Augmentation on the Electromyographic Activity of Neck and Trunk Muscles during Common Daily Movements

A female breast can be a potential source of musculoskeletal problems, especially if it is disproportionately large. The purpose of the present study was to examine the effect of artificially induced breast volume on the EMG activity of neck and trunk musculature during common everyday movements. The EMG activity of the sternocleidomastoid (SCM), the upper trapezius (UT), and the thoracic and lumbar erector spinae (TES, LES) were recorded during 45° trunk inclination from the upright standing and sitting postures (TIST45°, TISI45°) as well as during stand-to-sit and sit-to-stand (STSI, SIST) in 24 healthy females with minimal and ideal breast volume (M-NBV, I-NBV). All movements were performed before and after increasing M-NBV and I-NBV by 1.5-, 3.0-, 4.5-, and 6-times using silicone-gel implants. Significantly higher EMG activity for TES and LES were found at 6.0- and ≥4.5-times increase the I-NBV, respectively, compared to smaller breast volumes during TIST45°. EMG activity of UT was higher, and TES was lower in M-NBV females compared to I-NBV females in all movements but were significantly different only during SIST. The female breast can affect the activity of neck and trunk muscles only when its volume increases above a certain limit, potentially contributing to muscle dysfunction.

The effect of upper limb lymphedema in posture of patients after breast cancer surgery

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.

IS THERE A DIFFERENCE BETWEEN BREAST CANCER SURVIVOR WOMEN AND HEALTHY WOMEN IN TERMS OF BALANCE FUNCTIONS?

Purpose: Various physical problems and balance disorders are observed after mastectomy surgery in breast cancer survivors (BCSs). The study aimed to compare the balance functions in BCS women who had a mastectomy with healthy women. Methods: Sixty-six individuals, BCSs (study group, n=33) and healthy (control group, n=33) women were included. Subjective balance problems and falling characteristics, static balance (Tandem Romberg Test-TRT) and, dynamic balance (Y Balance Test-YDT and computer-based dynamic balance platform-Technobody) were used in this study as outcome measures to compare the groups. Results: The individuals in the study group (48.48%) experienced more balance problems than the control group (6.06%), but there was no difference between the two groups in terms of falling characteristics. Static balance (TRT) eyes-closed results were lower in the study group than the control group (t=-2.21, p=0.03), but there was no difference between the groups in TRT eyes-open results. There was no difference in any sub-parameter in dynamic balance measurements between the groups. Conclusion: Subjective balance problems and static balance functions are affected more in BCSs than in healthy individuals. It is recommended that balance functions should be evaluated and followed up with appropriate treatment methods in BCS women who had a mastectomy.

Taking the strain: An examination of upper back musculoskeletal tissue sensitivity in relation to upper back pain and breast size. A cross-sectional study

BACKGROUND

The physiological basis for upper back pain experienced by women with large breasts is unclear but could relate to sensitivity of musculoskeletal tissues strained from the postural adaptations to large breasts. The aim of this cross-sectional study was to examine if upper back pain and breast size were associated with greater localised sensitivity of upper back musculoskeletal tissues.

METHODS

119 healthy postmenopausal women (mean age 61 years) had their upper back pain (numerical rating scale), breast size (breast size score), and upper back tissue sensitivity (pressure pain thresholds (digital algometry, kPa)) assessed. The pressure pain thresholds of six skeletal sites (T2, T4, T6, T8, T10 and T12) and six muscular sites (pectoralis major, levator scapulae, sternocleidomastoid, and upper, middle, and lower trapezius muscles) were examined. Linear mixed models with random subject effects were used to evaluate differences in sensitivity at each anatomical site between participants grouped by upper back pain (nil-mild, moderate-severe) and breast size (small, large).

FINDINGS

For most sites, the differences in sensitivity between upper back pain groups were highly significant (P < 0.002) with significantly lower pressure pain thresholds (Mean difference (MD): 74.6 to 151.1 kPa) recorded for participants with moderate-severe upper back pain. There were no differences in sensitivity between breast size groups.

INTERPRETATION

Increased upper back musculoskeletal sensitivity is related to perceived upper back pain but not to breast size. It remains unclear if and how structural or mechanical factors related to breast size contribute to upper back pain in women with large breasts.

Women with larger breasts are less satisfied with their breasts: Implications for quality of life and physical activity participation

Introduction:

Although low breast satisfaction has been associated with a range of potential negative health implications, little is known about key factors that influence breast satisfaction across the lifespan. This study aimed to determine the impacts of age, body mass and breast size on breast satisfaction and how breast satisfaction impacts psychosocial and sexual well-being-related quality of life outcomes and physical activity behaviours.

Methods:

Three hundred and forty-five women (age range: 18.1–83.7 years) had their body mass (kg), standing height (cm) and breast volume (ml) measured. A 13-item questionnaire comprising the Breast-Q and Active Australia Survey was used to assess breast satisfaction, quality of life outcomes and participation in physical activity.

Results:

Breast satisfaction was influenced by breast size, such that women with larger breasts were less satisfied with their breasts compared to their counterparts with smaller breasts. Greater breast satisfaction was associated with improved psychosocial and sexual well-being-related measures of quality of life, and time spent participating in physical activity.

Conclusion:

Interventions to improve breast satisfaction among women across the breast size spectrum should be encouraged in public health initiatives to better engage and encourage positive health behaviours and reduce potential adverse health implications.

Investigating women's chest size, trunk muscle co-contraction and back pain during prolonged standing

BACKGROUND

Chest size is a known factor in the development of back pain for women. However, the neuromuscular mechanisms associated with chest size and back pain are poorly understood.

OBJECTIVE

The purpose of this study was to investigate chest size and its association with back pain development and muscle activity patterns during prolonged standing.

METHODS

Twenty university-aged women were divided into two groups: small chest size (n= 10, ∼A/C cup) and large chest size (n= 10, ∼D/E cup). Participants completed a 2-hr standing protocol, where eight channels of bilateral trunk electromyography were collected. Muscle activity, specifically co-contraction, was compared between chest size groups, pain developers, and time.

RESULTS

The large chest size group reported higher amounts of pain at the upper, middle, and low back. Women in the large chest group sustained higher levels of co-contraction for muscles involving the thoracic and lumbar erector spinae compared to those in the small chest size group during prolonged standing.

CONCLUSIONS

Thoracolumbar co-contraction determined in this study may be a potential mechanism contributing to increased back pain development for women with large chest sizes during prolonged standing. This pain mechanism could be targeted and addressed in future non-invasive musculoskeletal rehabilitation to improve back pain for women.

Frequency of Headaches in Macromastia Patients and Relief After Reduction Mammoplasty

BACKGROUND

Several studies have reported that neck, back, and shoulder pain can be reduced after macromastia. However, only 1 study has specifically investigated the relation between macromastia and headaches.

OBJECTIVES

This study aimed to determine the frequency of headaches in patients with macromastia by examining a sample from our clinic and to determine whether the patients experienced headache relief following breast reduction surgery.

METHODS

One hundred patients, out of 456 patients who met the criteria, were contacted by telephone and administered a questionnaire. Statistical analysis was performed with SPSS version 17.0. Normal distribution of the variables was examined by histograms and Kolmogorov-Smirnov tests. Pearson's chi-square and Fisher's exact tests were used to compare groups. The Mann-Whitney U test was used to evaluate nonparametric variables between the patients who has 1500 grams or less breast tissue removed and the patients more than 1500 grams breast tissue removed.

RESULTS

The incidence of headaches in patients with macromastia was found to be 29%. Among the patients with headaches, 65.52% reported relief after surgery. The relief rate for headaches was found to be associated with the amount of tissue removed.

CONCLUSIONS

The incidence of headaches increased in patients with macromastia compared with the general population, and patients reported headache relief after surgery. In addition, as the amount of tissue removal increased, the relief rate for headaches after surgery also increased. Although additional studies are essential, preoperative headaches should be evaluated in breast reduction patients, and the removal of larger amounts of breast tissue should be considered among patients who report headaches.

LEVEL OF EVIDENCE: 4

Evaluation of Late Postural Complications in Breast Cancer Patients Undergoing Breast-Conserving Therapy in Relation to the Type of Axillary Intervention-Cross-Sectional Study

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.

Breast Biomechanics: What Do We Really Know?

Although half the world's population will develop breasts, there is limited research documenting breast structure or motion. Understanding breast structure and motion, however, is imperative for numerous applications, such as breast reconstruction, breast modeling to better diagnose and treat breast pathologies, and designing effective sports bras. To be impactful, future breast biomechanics research needs to fill gaps in our knowledge, particularly related to breast composition and density, and to improve methods to accurately measure the complexities of three-dimensional breast motion. These methods should then be used to investigate breast biomechanics while individuals, who represent the full spectrum of women in the population, participate in a broad range of activities of daily living and recreation.

A novel multi-study intervention investigating the short and long term effects of a posture bra on whole body and breast kinematics

BACKGROUND

Poor standing posture has been reported in women with larger breasts, increasing the risk of back pain. Whilst breast reduction surgery can improve posture, conservative measures such as special bras may offer short or long-term relief of symptoms without surgical intervention.

RESEARCH QUESTION

This study aimed to utilise a multi-study intervention to investigate the short and long-term kinematic effects of wearing a posture bra.

METHODS

Study one utilised biomechanics and physiotherapy expertise to modify the design of a prototype bra to improve posture and breast kinematics; resulting in a second-generation posture bra. To test this bra, 24 females were randomly assigned to control and intervention groups. The control group wore their everyday bra; the intervention group wore the generation 2 posture bra in place of their everyday bra for three months. Pre and post intervention, posture (spine curvature, scapula position, whole body alignment) and breast kinematics were assessed during sitting, standing and walking. Short-term effects of the posture bra were compared to an everyday bra and no bra (study two), whilst the long-term effects were compared using the no bra condition (study three).

RESULTS

Biomechanical intervention improved posture and breast kinematics in a prototype posture bra resulting in a second-generation prototype. Pre-intervention, the generation 2 posture bra significantly improved scapula retraction by 6° during both sitting and standing, but also increased deviation of whole body alignment compared to everyday bra and no bra conditions. During walking the posture bra reduced breast motion by 17 % compared to the everyday bra. Following the three-month wearer intervention, scapula depression significantly improved in the intervention group.

SIGNIFICANCE

A biomechanically informed posture bra was able to effectively support the breasts and improve scapula position without compromising spinal curvature, reducing the risk of musculoskeletal pain associated with poor posture.

Biomechanics of Breast Support for Active Women

More systematic breast biomechanics research and better translation of the research outcomes are necessary to provide information upon which to design better sports bras and to develop effective evidence-based strategies to alleviate exercise-induced breast pain for women who want to participate in physical activity in comfort.

Is Breast Size Related to Prevalent Thoracic Vertebral Fracture? A Cross-Sectional Study

Large breasts may increase the likelihood of thoracic vertebral fractures by increasing the mechanical loading of the spine. We examined breast size as a factor associated with prevalent thoracic vertebral fractures, also considering its relationship with thoracic kyphosis and upper back extensor muscle endurance. Using a cross-sectional study, the design measurements collected were thoracic vertebral fractures (≥20% loss in vertebral body height on lateral radiograph), breast size (bra size converted to an ordinal breast size score), BMD (g/cm² averaged femoral neck, DXA), upper back extensor muscle endurance (isometric chest raise test), body composition (DXA), thoracic kyphosis (radiograph), and upper back pain (numerical rating scale). Correlations and multivariable logistic regression examined relationships between characteristics and their association with vertebral fracture. Participants were 117 healthy postmenopausal women. The 17 (15%) women with ≥1 thoracic vertebral fracture had larger breast size (mean difference [MD]: 2.2 sizes; 95% CI, 0.6 to 3.8 sizes), less upper back extensor muscle endurance (MD: -38.6 s; 95% CI, -62.9 to -14.3 s), and greater thoracic kyphosis (MD: 7.3°; 95% CI, 1.7° to 12.8°) than those without vertebral fracture. There were no between group differences in age, height, weight, and BMD. Breast size (r = -0.233, p = 0.012) and thoracic kyphosis (r = -0.241, p = 0.009) correlated negatively with upper back extensor muscle endurance. Breast size was unrelated to thoracic kyphosis (r = 0.057, p = 0.542). A (final) multivariable model containing breast size (OR 1.85; 95% CI, 1.10 to 3.10) and thoracic kyphosis (OR 2.04; 95%CI, 1.12 to 3.70) explained 18% of the variance in vertebral fracture. Breast size had a significant, but weak relationship with vertebral fracture (R ² = 0.10), which was independent of BMD and unrelated to thoracic kyphosis. Further work is needed to confirm larger breast size as a risk factor for vertebral fracture. © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

Effect of Chronic Low Back Pain on Lumbar Spine Lordosis During Sit-to-Stand and Stand-to-Sit

OBJECTIVE

This study aimed to evaluate lumbar lordosis during sit-to-stand (STS) and stand-to-sit (SIT) in individuals with and without chronic nonspecific low back pain (CNLBP). The second objective was to investigate sex-related differences in lumbar lordosis.

METHODS

Twenty-six patients with CNLBP and 26 controls were recruited. Controls were matched with cases using a frequency matching method. Reflective markers were placed over the spinous process of T₁₂, L₃, S₂, and the anterior and posterior superior iliac spines. The participants were instructed to stand up at a self-selected pace and maintain their normal upright standing posture for 3 seconds, and then sit down. Kinematic data were recorded at a sampling frequency of 100 Hz using a motion capture system. Lumbar lordosis angle was calculated from the intersection between the line joining T₁₂ and L₃, and the line joining L₃ to S₂.

RESULTS

Lumbar lordosis was decreased in patients with CNLBP during STS and SIT compared with the asymptomatic group (mean difference = 2.68°-9.32°; P ≤ .005). Furthermore, no differences were seen in lumbar lordosis at starting position between CNLBP and asymptomatic groups during STS and SIT (mean difference = 2.68°-3.75°; P ≥ .099). Interestingly, the magnitude of the effect size suggested that the difference in lumbar lordosis values between female and male participants was relatively large (Cohen's d = -1.81 to 0.20).

CONCLUSION

Decreased lumbar lordosis in patients with CNLBP during STS and SIT could be considered as an important point during rehabilitation. Moreover, the present study showed that there is a sex-related difference among women and men in lumbar lordosis during STS and SIT tasks.

A comparison of physical characteristics, functions and quality of life between breast cancer survivor women who had a mastectomy and healthy women

BACKGROUND

The quality of life of breast cancer survivors who had a mastectomy may decrease due to potential physical problems and reduced upper extremity functions.

OBJECTIVE

This study aimed to compare the physical characteristics, upper extremity functions and quality of life of breast cancer survivors and healthy women.

METHODS

A total of 66 women participated in this study: breast cancer survivors (n= 33) and healthy counterparts (n= 33) participated in this study. The Lateral Scapular Dyskinesia Slide Test was used to evaluate scapular dyskinesia, the hand-held dynamometer was used to measure upper extremity muscular strength, the Angle Reproduction Test was used to measure upper extremity position sense, the Disabilities of the Arm, Shoulder and Hand questionnaire was used to assess upper extremity functions, and the Short Form-36 was used to assess the quality of life.

RESULTS

The findings showed that the prevalence of scapular dyskinesia was higher, whereas upper extremity muscle strength, shoulder joint position sense, upper extremity functions and many sub-dimensions of quality of life were reduced in breast cancer survivor women compared to the healthy women (p< 0.05).

CONCLUSIONS

Several physical characteristics, upper extremity functions and quality of life of breast cancer survivor women who had a mastectomy were affected more in comparison to healthy women. Thus, these parameters should be included in physiotherapy assessment and treatment programs.

Effects of obesity on breast size, thoracic spine structure and function, upper torso musculoskeletal pain and physical activity in women

PURPOSE

This study investigated the effects of obesity on breast size, thoracic spine structure and function, upper torso musculoskeletal pain and physical activity participation in women living independently in the community.

METHODS

A total of 378 women were divided into 3 groups (Not Overweight: body mass index (BMI) = 22.5 ± 0.2 kg/m² (mean ± SE); Overweight: BMI = 27.4 ± 0.3 kg/m²; Obese: BMI = 35.4 ± 0.3 kg/m²). Outcome variables of breast volume (mL), thoracic flexion torque (N·m), thoracic kyphosis (degrees), upper torso musculoskeletal pain (score) and time spent in physical activity (min) were calculated and compared among the 3 groups, adjusting for between-group differences in age.

RESULTS

There was a significant main effect of BMI on all outcome variables. Participants classified as Obese displayed significantly larger breasts, had greater thoracic flexion torques and reported less time participating in physical activity relative to the participants who were classified as Not Overweight and Overweight. Participants in the Obese group also displayed significantly more thoracic kyphosis and reported significantly more upper torso musculoskeletal pain compared to their counterparts who were classified as Not Overweight.

CONCLUSION

This study is the first to demonstrate that increased obesity levels were associated with compromised kyphosis and loading of the thoracic spine, as well as increased symptoms of upper torso musculoskeletal pain and reduced time spent in physical activity in women living in the community. We recommend further research to determine whether evidence-based interventions designed to reduce the flexion torque generated on the thoracic spine can improve these symptoms of upper torso musculoskeletal pain and the ability of women with obesity to participate in physical activity.

Effects of sports bra and footwear on vertebral posture during walking and running

Little attention has been given to factors which affects women running, such as proper footwear and breast support and their effects on spine. The objective of study was to analyse the influence of different breast support and footwear on vertebral posture during walking and running. Seventeen women (x¯ = 23.51; SD = 3.70 years) performed a treadmill walking (5 km/h) and running (7 and 10 km/h) with different footwear (barefoot, minimalist and traditional) and breast support (bare breast, everyday bra and sports bra) conditions. Spine movements were analyzed using three cameras in grayscale video mode, positioned behind the participant to register reflective markers fixed in the vertebrae. From the 3D coordinates of the trunk markers we computed, for the whole gait cycle (C) and for the average gait posture (neutral curve-NC) the maximal (M) thoracic (T) kyphosis and lateral flexion, and the maximal lumbar (L) lordosis and lateral flexion. Frontal plane: bare breast presented higher lumbar NC than the everyday bra and sports bra, higher MLC than the sports bra and lower MTC than the everyday bra and sports bra. Barefoot presented higher MTC than minimalist. Sagittal plane: bare breast presented lower MTC than the sports bra. Barefoot presented higher lumbar NC than the minimalist and traditional footwear and higher MLC than the minimalist and traditional ones. The sports bra increased curvatures in the thoracic spine that were rectified during bare breast conditions. In addition, both footwears were able to maintain the natural curvatures of the spine in the lumbar.

Upper back pain in postmenopausal women and associated physical characteristics

The physical characteristics of postmenopausal women that are associated with upper back pain are not well-understood. The aim of this cross-sectional study was to identify the physical characteristics associated with presence and severity of upper back pain in healthy postmenopausal women. Self-reported upper back pain presence (within the previous month) and severity (numerical rating scale) were examined against the physical characteristics: height; weight; body mass index; breast size; breast ptosis; upper back extensor muscle endurance (isometric chest raise test); head, shoulder and upper back posture (photogrammetry); thoracic extension mobility (photogrammetry); bone mineral density (dual-energy x-ray absorptiometry (DXA)); body composition (DXA); and thoracic kyphosis, thoracic osteoarthritis and thoracic vertebral fracture (all radiography). A multivariable logistic regression model, adjusted for age, was built using physical characteristics with a significant univariate association with upper back pain. Censored Tobit regression, adjusted for age, was used to examine each physical characteristic against upper back pain severity. Postmenopausal women (n = 119) with a mean (SD) age of 61.4 (7.0) years participated in the study. After adjusting for age, the physical characteristics independently associated with upper back pain were: height (OR: 0.50, 95% CI: 0.31–0.79); and upper back extensor muscle endurance (OR: 0.46, 95%CI: 0.28–0.75). This model explained 31% of the variance in upper back pain (p<0.001). After adjusting for age, being taller and having better upper back extensor muscle endurance were associated with lower odds for upper back pain. After adjusting for age, differences in upper back pain severity were explained by upper back extensor muscle endurance (p = <0.001) and lean mass (p = 0.01). Conclusion: As a modifiable physical characteristic of postmenopausal women with upper back pain, upper back extensor muscle endurance is worth considering clinically.

Can breast characteristics predict upper torso musculoskeletal pain?

BACKGROUND

Several studies have associated a large breast size with an increased prevalence and severity of musculoskeletal pain, particularly pain in the upper torso. Despite this evidence, no research has explored whether breast size or related characteristics are risk factors for upper torso musculoskeletal pain.

METHODS

A backward multiple regression analysis was performed to identify whether characteristics of the breasts and upper torso, as well as physical factors known to be associated with musculoskeletal pain, could predict musculoskeletal pain among a cohort of 378 Australian women aged 18 years and over who had a wide range of breast sizes.

FINDINGS

The model identified that breast volume, age and nipple-to-nipple distance predicted 23% of the variance in upper torso musculoskeletal pain reported by the participants.

INTERPRETATION

Women with a larger breast volume, lower age and a greater nipple-to-nipple distance were predicted to report a higher upper torso musculoskeletal pain score.

Upper torso pain and musculoskeletal structure and function in women with and without large breasts: A cross sectional study

BACKGROUND

Women with large breasts frequently experience upper torso pain secondary to their breast size. Evidence is lacking on the underlying causes of this pain. This study investigated whether upper torso pain and musculoskeletal structure and function differed between women with large breasts and women with small breasts.

METHODS

A linear regression, adjusting for body mass, compared the upper torso pain, thoracic flexion torque due to breast mass, thoracic kyphosis, shoulder active range-of-motion, and scapular retraction muscle strength of 27 women with large breasts (bilateral breast volume>1200ml, age 45.9y SD 9.9y, BMI 29.0kg/m² SD 3.8kg/m²) and 26 women with small breasts (bilateral breast volume <800ml, age 43.8y SD10.9y, BMI 23.3kg/m² SD 2.9kg/m²).

FINDINGS

Women with large breasts reported a higher upper torso pain score (46.6, 95%CI 33.3-58.0 versus 24.1, 95%CI 12.5-37.8), accompanied by a larger flexion torque (5.9Nm, 95%CI 4.5-5.8Nm versus 0.9Nm, 95%CI 0.8-2.4Nm), greater thoracic kyphosis (34°, 95%CI 31-38° versus 27°, 95% CI 24-31°), decreased shoulder elevation range-of-motion (160°, 95%CI 158-163° versus 169°, 95%CI 166-172°), and decreased scapular retraction endurance-strength (511.4s, 95%CI 362.2-691.3s versus 875.8s, 95%CI 691.5-1028.4s) compared to the women with small breasts.

INTERPRETATION

Differences in the upper torso posture, range-of-motion, and muscle strength of women with large breasts provides insight into underlying causes of their musculoskeletal pain. This information can be used to develop evidence-based assessment and treatment strategies to relieve and prevent symptom progression.

Breast volume is affected by body mass index but not age

BACKGROUND

This study aimed to establish normative breast volume data for women of varying ages, body masses and breast sizes, and to determine the effect of age and body mass index (BMI) on breast volume.

METHODS

The breast volume of 356 women (age range: 18.1-83.7 years; BMI range: 18.4-54.5 kg/m²) was measured using three-dimensional scanning in a prone position.

RESULTS

Breast volumes ranged from 48 to 3100 mL. Although breast volume was not significantly affected by age, it was significantly affected by BMI, with the breast volume of overweight and obese women being two-to-three times greater than women with normal BMI's.

CONCLUSION

It is recommended that bra cups must be designed to support the wide range and increasing magnitude of breast volumes exhibited by women. Practitioner summary: This original research provides evidence for bra designers and manufacturers on the range of breast volumes of women and the significant effect of BMI on breast volume. Bra cups need to be designed to support the wide range and increasing magnitude of breast volumes exhibited by women.

The filling proportion of bone cement affects recollapse of vertebrae after percutaneous vertebral augmentation: A retrospective cohort study

BACKGROUND AND OBJECTIVES

The aim of this study was to determine the relationship between filling proportion of bone cement in the vertical direction and incidence of recollapse in the augmented vertebrae after vertebral augmentation.

METHODS

Fifty-one patients (51 vertebrae) who had operations between January 2014 and July 2016 with a mean age of 78.10 years were included. All patients in our department of spine surgery were advised to have follow-up care every 6 months. Patients characteristics, radiographic outcomes were evaluated.

RESULTS

The recollapse of augmented vertebral body occurred in 10 of 51 vertebrae (20%).

CONCLUSION

Patients with a high proportion rate of bone cement in the middle vertical direction have a low incidence of experiencing recollapse.

The effect of gigantomasty on vertebral degeneration: A computed tomography study

The main reason for waist and back pain in patients with gigantomasty is increased thoracic kyphosis and lumber lordosis. These symptoms and abnormal spinal angulations regress after reduction mammoplasty operations. However, the effect of chronic mechanical stress caused by gigantomasty on the spinal degenerative process is not clear yet. In this study with computed tomography it is shown that degenerative spondylosis is more widespread and severe in patients with large breasts.

Vertebral cross-sectional area: an orphan phenotype with potential implications for female spinal health

A high priority in imaging-based research is the identification of the structural basis that confers greater risk for spinal disorders. New evidence indicates that factors related to sex influence the fetal development of the axial skeleton. Girls are born with smaller vertebral cross-sectional area compared to boys-a sexual dimorphism that is present throughout life and independent of body size. The smaller female vertebra is associated with greater flexibility of the spine that could represent the human adaptation to fetal load. It also likely contributes to the higher prevalence of spinal deformities, such as exaggerated lordosis and progressive scoliosis in adolescent girls when compared to boys, and to the greater susceptibility for spinal osteoporosis and vertebral fractures in elderly women than men.

Three-dimensional scanning in women with large, ptotic breasts: implications for bra cup sizing and design

BACKGROUND

This study aimed to compare breast volume calculated from scanning large, ptotic breasts of women while they were standing upright relative to when lying prone in order to identify the error associated with breast volume calculations.

METHODS

Breast volume and visualisation were compared in 50 women with large breasts (D⁺ bra cup size) while they were scanned in three different positions.

RESULTS

Full visualisation of both breasts occurred in 100% of participants in the prone position and only 5% of participants in either standing position. Breast volume was significantly greater (p < 0.01) in the prone position, with the percentage of underestimation in the standing position increasing as breast volume increased.

CONCLUSION

Breast volume measured by three-dimensional scanning in the standing position will be underestimated by 7-10% in large, ptotic breasts. Consideration of these inaccuracies in breast volume relative to breast size can assist bra manufacturers when designing bras. Practitioner Summary: Errors have been reported when measuring the breast volume of women with large, ptotic breasts using three-dimensional scanning. This original research provides evidence for bra designers and manufacturers on the degree of error associated with this measurement. These errors should be accounted for in future bra designs.

Breast size impacts spine motion and postural muscle activation

BACKGROUND

While it is generally accepted that large breast sizes in females contribute to back pain and poor posture, the effects of breast size on spinal motion and muscle activation characteristics are poorly understood.

OBJECTIVE

This study examined the relationship between breast size, spine motion, and trunk muscle activation.

METHODS

Fifteen university-aged females, free of back pain symptoms, were tested. Breast sizes were calculated, and three-dimensional spine motion and activation from five trunk muscles bilaterally were measured during standing and trunk flexion movements. Correlations between breast size and motion and muscle activation measures were assessed.

RESULTS

Head and trunk angles were strongly, negatively correlated to breast size during upright standing; thoracic angles were moderately, positively correlated to breast size during thoracic flexion movements. Trunk muscles showed positive, moderate-strength relationships with breast size during upright standing and some trunk movements.

CONCLUSIONS

These findings provide a preliminary indication that increasing breast sizes are associated with altered postures and increased muscle activation in a non-clinical population, and constitute a baseline for the study of females with a full range of breast sizes. Further research is required to confirm the generalizability of these findings to other sizes, in order to inform strategies for the prevention or reduction of back pain, as well as diagnosis, treatment, and rehabilitation techniques associated with breast size and back pain.

Body Posture After Mastectomy: Comparison Between Immediate Breast Reconstruction Versus Mastectomy Alone

BACKGROUND

Immediate breast reconstruction has been increasingly incorporated as part of breast cancer treatment, especially for the psychological benefits. Currently, there are many options for breast reconstruction surgery, but the impact of the different techniques on body posture has not been widely studied. One study demonstrated that immediate breast reconstruction with a Beker-25 prosthesis could help to preserve body posture after mastectomy; however, there is no evidence regarding the effect of surgery on the body posture of women after breast reconstruction when using autologous tissue.

PURPOSE

The purpose of this paper is to compare the body postures of women who underwent immediate breast reconstruction using an abdominal flap with those of women who underwent mastectomy alone.

DESIGN

This is a cross-sectional study.

SUBJECTS

Seventy-six women diagnosed with breast cancer underwent mastectomy, between 1 and 5 years after the diagnosis, are the participants of the study. Two groups were defined: women who underwent mastectomy and immediate breast reconstruction (n = 38) and women who underwent mastectomy alone (n = 38).

PROCEDURE

To assess body posture, specific anatomical points for obtaining photographs were located and marked in anterior, posterior and right-side and left-side views. The photographs were analysed using Postural Analysis Software/Software de Análise Postural (PAS/SAPO).

RESULTS

In the left lateral view, there was a significant difference in the vertical alignment of the trunk (4.2 vs 3.1; p = 0.05). There were no significant differences between the two groups for the variables in the anterior, posterior or right-side views.

CONCLUSION

Women who underwent mastectomy alone, compared with women who underwent immediate breast reconstruction with abdominal flaps, showed differences in the vertical alignment of the trunk, with greater asymmetry between the acromion and greater trochanter, which can mean trunk rotation. No significant differences were found between the two groups in the alignment of the head, shoulders, scapula, or pelvis. Copyright © 2015 John Wiley & Sons, Ltd.

Effects of Reduction Mammaplasty Operations on the Spinal Column: Clinical and Radiological Response

BACKGROUND

Women with macromastia suffer from bodily disproportions like increased spinal curvature owing to the mass effect caused by severely large breasts. In such cases, the erector spinae muscles generate an overcompensatory pressure to maintain a normal posture, resulting in neck, back, and lumbar pain. This study aimed to objectively show the improvement of physical symptoms after reduction mammaplasty and evaluate psychological and physical changes of patients.

METHODS

Pre- and postoperative cervical, thoracic, and lumbar bidirectional (anteroposterior and lateral) radiographs were obtained from 40 patients who underwent reduction mammaplasty. Cervical lordosis, thoracic kyphosis, lumbar lordosis, and lumbosacral angles were evaluated. Body mass index, breast tissue volume, and excised tissue amount were recorded for each patient. Visual Analog Scores (VAS) were used to qualify the severity of neck, back, and lumbar pain, the Nottingham Health Profile (NHP) to evaluate quality of life (QoL), and the Beck Depression Inventory (BDI) to evaluate depression severity.

RESULTS

Cervical lordosis, thoracic kyphosis, lumbar lordosis, and lumbosacral angle improved, and patients' neck, back, and lumbar pain decreased. The positive correlation between the excised glandular tissue amount and the decrease in neck, back, and lumbar pain was reflected in the results of VAS, NHP, and BDI tests. After reduction mammaplasty, depression symptoms caused by macromastia decreased. Parameters of QoL, including physical activity, socialization, fatigue, sleeping, and emotional reactions, significantly improved.

CONCLUSION

Patients with macromastia should be considered for reduction mammaplasty before the onset of postmenopausal osteoporosis to improve QoL.

Bra strap orientations and designs to minimise bra strap discomfort and pressure during sport and exercise in women with large breasts

Background

Bra straps are a primary source of discomfort during sport and exercise, particularly for women with large breasts. This study aimed to investigate the effects of altering bra strap orientation and design on bra strap comfort, pressure and breast support in women with large breasts. This is a descriptive laboratory study.

Methods

Bra strap discomfort (visual analogue scale, 0 to 10), pressure (custom-designed 10 mm² calibrated pressure sensor, 0.5 to 24 kPa range, 50 Hz, S2011, Novel GmbH, Munich, Germany, placed under the right bra strap at the crest of each participant’s shoulder), preference ranking and vertical breast displacement (VBD; Optotrak Certus® motion capture system, 200 Hz, Northern Digital, Ontario, Canada) data during dynamic treadmill running and static upright standing (pressure only) were collected for 23 active women with large breasts (D+ cup size) while they wore an encapsulation sports bra with six different bra strap conditions (two bra strap orientations: vertical and cross-back; three bra strap designs: standard width, wide and gel).

Results

Bra strap discomfort was significantly less (p ≤ 0.001) in the vertical compared to the cross-back strap orientation, which was the most preferred orientation despite no significant difference in strap pressure. The wide strap design had the lowest discomfort scores, significantly lower strap pressure compared to the standard width and gel strap designs (p < 0.001), and was equally the most preferred design with the gel straps. There was no significant difference in VBD among the six strap conditions.

Conclusions

Bra straps that are vertically orientated and wide (approximately 4.5 cm in width) are preferable for women with large breasts during sport and exercise to minimise bra strap pressure and discomfort. The addition of gel pads under bra straps may also decrease discomfort and prevent straps slipping off the shoulders, although this notion warrants further investigation.

Effects of transporting an infant on the posture of women during walking and standing still

We investigated the effects on women of carrying an infant in front, focusing on the pelvic and spinal posture and the displacement of the body's center of gravity. For such, we compared mothers to non-mothers not carrying anything or carrying the same load (a doll) and the mothers carrying their infants. Twenty mothers and 44 women who did not have children were analyzed for their movement and posture during walking and standing still with a motion capture system. Walking while carrying a load was slower and with a shorter stride length than while not carrying a load. The mothers' group walked slower and with a shorter stride length than the non-mothers' group. During walking and standing still, the women decreased their angle of pelvic anteversion, increased lumbar lordosis, increased thoracic kyphosis, and increased trunk backward inclination while carrying a load in comparison with not carrying anything. In addition, we observed some small differences in the spinal angles of mothers when carrying their infants compared to when carrying a doll. When standing still, the women carrying a load displaced backwards their vertical projection of the center of gravity to exactly compensate the destabilizing load at the front that resulted in no net change of the body-plus-load center of gravity. In general, these changes are qualitatively similar to the ones observed during pregnancy.

Ethical issues in decision making by hospital health committee members in Turkey

Hospital health committees (HHC) in Turkey review medical reports from clinical practitioners and decide whether or not they are justified. As a rule, each HHC member is expected to observe and examine each patient and then evaluate the report. If the report from the patient's doctor is approved, then the Social Security Administration, a state organisation, will meet all of the patient's expenses covering treatment, medication and operations. Justification of health expenditure is crucial for the state because health resources have to be carefully allocated. Conflicts of obligation also generate ethical issues which have to be resolved as well. However, HHCs are not designed to make ethical decisions. An overall concept of organisational ethics needs to be developed.

Does reduction mammaplasty revert skeletal disturbances in the vertebral column of patients with macromastia? A preliminary study

BACKGROUND

Enlarged breasts are associated with many physical and psychological symptoms. It is important to use objective criteria in documenting physical changes of a patient's body due to enlarged breasts and the benefits of surgery. This preliminary study aimed to determine whether the reduction mammaplasty procedure changes the angles of cervical lordosis, thoracic kyphosis, and lumbar lordosis.

METHODS

The study population consisted of 22 patients who underwent breast reduction surgery. All the patients had lateral cervicothoracolumbar radiographs taken preoperatively and at least 2 months postoperatively. Cervical lordosis, thoracic kyphosis, and lumbar lordosis angles, as well as sagittal balance, were examined. The body mass index (BMI), breast tissue volume, and excised tissue amount of each patient were recorded.

RESULTS

All the patients had increased cervical lordosis and thoracic kyphosis angles preoperatively, and the angles were significantly decreased postoperatively. Of the 22 patients, 7 had decreased and 8 had increased lumbar lordosis angles. All the lordosis angles showed significant improvement at the last examination. Seven patients had disturbed sagittal balance preoperatively, and all had normal sagittal balance postoperatively. Preoperative total breast tissue volume was positively correlated with the differences in cervical lordosis angles, BMI, preoperative cervical lordosis angles, and cervical lordosis angles.

CONCLUSION

Hypertrophic breasts are not only a cosmetic but also a functional problem complicated by pathologic conditions in the vertebral column such as increased cervical lordosis, thoracic kyphosis, and increased or decreased lumbar lordosis. Breast reduction may improve these pathologic angles. Reducing the nonphysiologic weight of enlarged breasts located anterior to the main axis of the body may correct pathologic angulation and disturbed sagittal balance of the vertebral column.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Reduction mammoplasty improves body posture and decreases the perception of pain

Women with hypertrophic breasts often experience body pain and posture problems, which tend to be reduced or even eliminated after reduction mammoplasty. The present study aimed to analyze the effects of reduction mammoplasty on anthropometric variables, body posture and pain in women with breast hypertrophy. Eleven women (mean [± SD] age 31.3±10.4 years) participated in the present study. Anthropometric variables, body posture and pain perception were evaluated pretest, and 60 (post60) and 90 (post90) days after reduction mammoplasty. Commercially available posture analysis software was used to analyze the following variables: acromial horizontal alignment (AHA), angle between acromial and anterior superior iliac spines (A-AAIS), vertical alignment of right (R) and left (L) trunk (VAT), vertical alignment of R and L body (VAB) and horizontal alignment of R and L pelvis (HAP). Descriptive statistics and ANOVA for repeated measures were used, and effect sizes (ES) were measured; the level of significance was set at P<0.05. There were no significant differences in anthropometric variables among the assessments. Only HAP-R showed a significant decrease; however, when analyzed, ES, VAT- L and HAP- L in post60, and VAT-R, VAT-L, HAP-R, HAP-L and VAB-L in post90 showed large ES after mammoplasty (ES>0.70). There were significant reductions in pain at post60 and post90 in the neck, cervical spine, back, shoulder and arm (P<0.05). Following mammoplasty, an improvement in body posture, primarily in the alignment of shoulders, trunk and pelvis, and a decrease in pain in the upper limbs and spine, were observed.

The impact of breast reduction surgery on the vertebral column

BACKGROUND

Although many studies have shown that breast reduction surgery is effective in reducing neck, back, and lumbar pain, most of these studies are subjective evaluations that usually provide data through pain scales. This study was undertaken to objectively evaluate the radiologic effects of breast reduction on the vertebral column.

METHODS

Thirty patients who underwent breast reduction surgery were included in the study. A lateral thoracolumbar radiograph was taken before and 3 months after surgery for each patient. The thoracic kyphosis, lumbar lordosis, and sacral inclination angles were measured for each radiograph. The impact of breast reduction surgery on posture was evaluated according to the comparison of these angles before and after surgery. The effect of age, body mass index, and the total amount of removed tissue was also taken into account, and the relationship between these parameters and their effects on the change in preoperative and postoperative angle measurements were evaluated.

RESULTS

There was a significant decrease in all 3 angles after breast reduction surgery. A significant correlation was determined between body mass index and the total amount of removed tissue on the change in angle measurements, whereas a definite relationship was not observed between the angles and the patient's age.

CONCLUSIONS

This study has shown the objective impact that breast reduction surgery has on the vertebral column. Although the symptomatic relief of breast reduction surgery on the musculoskeletal system is widely accepted, the objective assessment of this relief will be beneficial in persuading health insurance companies and those who think of this surgery as a purely aesthetic procedure.

The effect of reduction mammaplasty on the vertebral column: a radiologic study

Some studies emphasized that anatomic mechanisms of vertebral aberrations could be associated with large breasts. The effect of mammaplasty operation on the vertebral column and body posture seems to be beneficial; in this trial, it was planned to investigate the objective radiologic effect of reduction mammaplasty on the posture of the vertebral column in a group of patients operated due to the large breasts. Thirty-four white women with large breasts were enrolled in this study. The patients were divided into three groups according to their breast cup sizes. Anteroposterior and lateral radiographs of the lumbosacral and thoracic spine were taken at baseline preoperatively, and the same radiographic images were taken in an average of 12 months later than the reduction mammaplasty operation. All were evaluated and compared for thoracic kyphosis angle and lumbar lordosis angle both preoperatively and postoperatively. The mean thoracic kyphosis angle was 40,53 preoperatively and 39,38 postoperatively. However, there was no statistically significant difference between the preoperative and postoperative measurements in all groups (P > 0,05). The mean lumbar lordosis angle was 54,71 preoperatively and 53,18 postoperatively. Regarding the preoperative and postoperative measurements of lumbar lordosis angles, no statistically significant difference was found between the groups (P > 0,05). Although breast size may be an important factor that affects body posture, reduction mammaplasty operations have little or no radiologic effect on the vertebral column.

The effect of breast hypertrophy on patient posture

BACKGROUND

One of the reasons women with macromastia chose to undergo a breast reduction is to relieve their complaints of back, neck, and shoulder pain. We hypothesized that changes in posture after surgery may be the reason for the pain relief and that patient posture may correlate with symptomatic macromastia and may serve as an objective measure for complaints. The purpose of our study was to evaluate the effect of reduction mammaplasty on the posture of women with macromastia.

METHODS

A prospective controlled study at a university medical center. Forty-two patients that underwent breast reduction were studied before surgery and an average of 4.3 years following surgery. Thirty-seven healthy women served as controls. Standardized lateral photos were taken. The inclination angle of the back was measured. Regression analysis was performed for the inclination angle.

RESULTS

Preoperatively, the mean inclination angle was 1.61 degrees ventrally; this diminished postoperatively to 0.72 degrees ventrally. This change was not significant (P-value=0.104). In the control group that angle was 0.28 degrees dorsally. Univariate regression analysis revealed that the inclination was dependent on body mass index (BMI) and having symptomatic macromastia; on multiple regression it was only dependent on BMI.

CONCLUSIONS

The inclination angle of the back in breast reduction candidates is significantly different from that of controls; however, this difference is small and probably does not account for the symptoms associated with macromastia. Back inclination should not be used as a surrogate "objective" measure for symptomatic macromastia.