Spine sequelae after latissimus dorsi harvest for breast reconstruction—A retrospective cohort study

The effects of mastectomy and breast reconstruction on spinal alignment are controversial, with conflicting evidence. The effect of latissimus dorsi (LD) flap harvest is still uncertain, as it has been hypothesized to have deleterious effects on posture. Our aim was to measure the possible effect of post-oncologic breast reconstruction (BR) following mastectomy on spinal alignment, with a special focus on the potential effects of LD harvesting. A retrospective cohort study was performed to assess postoperative spinal changes in patients who underwent mastectomy without reconstruction and those who received BR using an LD flap, a single-stage direct-to-implant (DTI) or a 2-stage reconstruction with expander/implant (EXP/IMP), using chest radiographs to calculate a Cobb angle (CA). Patients were stratified based on spinal divergence (CA ≥ 3°) and scoliosis (CA ≥ 10°). Multiple logistic regression was used to reveal significant predictors for divergence and scoliosis. The study featured 326 patients (440 breasts), among them 43 patients (48 breasts) underwent mastectomy alone while 283 (393 breasts) underwent BR, including LD flap (147 patients, 209 breasts), DTI (73 patients, 98 breasts), and EXP/IMP (63 patients, 86 breasts). Breast reconstruction proved to be protective against spinal divergence (p = 0.043), while chemotherapy and postoperative spinal curvature patterns significantly increased its risk. Scoliosis was associated with higher mastectomy weight (p = 0.005). Logistic regression models showed good accuracy for spinal divergence (AUC = 0.772) and moderate accuracy for scoliosis (AUC = 0.632). These results highlight the impact of reconstructive choices, adjuvant treatments, and spinal curvature on postmastectomy spinal outcomes.