{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T04:58:47Z","timestamp":1785560327751,"version":"3.56.0"},"reference-count":21,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Health and Welfare","award":["RS-2024-00439193"],"award-info":[{"award-number":["RS-2024-00439193"]}]},{"award":["RS-2024-00439193"],"award-info":[{"award-number":["RS-2024-00439193"]}],"id":[{"id":"https:\/\/ror.org\/00vxgjw72","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Breast cancer surgery can induce postural adaptations that influence spinal alignment. Although previous studies have predominantly addressed coronal deformities such as scoliosis, changes in sagittal alignment, particularly thoracic kyphosis, remain poorly characterized. An increased kyphotic angle has been associated with impaired physical function, emphasizing the importance of assessing sagittal spinal changes after surgery. Although thoracic kyphosis is traditionally measured on standing radiographs, it can also be evaluated using supine chest computed tomography (CT), routinely obtained during postoperative follow-up. This study investigated the impact of breast cancer surgery on thoracic kyphotic angle and assessed the correlation between kyphotic angles measured on supine CT and standing X-rays. Methods: This retrospective study included 185 breast cancer patients who underwent multiple chest CT and whole-spine X-rays. The thoracic kyphotic angle was defined as the Cobb angle from T4 to T12 on sagittal images. Changes in kyphotic angle among the three surgical groups were analyzed using linear mixed-effects models adjusted for age, chemotherapy, radiotherapy, and endocrine treatment. The correlation between supine CT and standing X-ray was analyzed using Pearson\u2019s coefficient. Results: The mean follow-up interval was 42.6 \u00b1 6.3 months. The mean angular change was minimal (0.6 \u00b1 2.8\u00b0), and no significant effects of time, surgical group, or their interaction were observed. Kyphotic angles measured on standing X-rays strongly correlated with those obtained from supine CT (r = 0.799, p &lt; 0.001), with standing values approximately 7.4\u00b0 higher. Conclusions: Breast cancer surgery did not significantly alter the thoracic kyphotic angle. Supine CT provides a reliable and practical alternative for the assessment of postoperative kyphosis during follow-up.<\/jats:p>","DOI":"10.3390\/jcm15155951","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:32:13Z","timestamp":1785403933000},"page":"5951","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effects of Breast Cancer Surgery on Thoracic Kyphosis and the Correlation Between Supine CT and Standing X-Rays: A Single-Center Retrospective Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Sejoon","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ho-Geon","family":"Namgung","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ah Yeon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9093-5859","authenticated-orcid":false,"given":"Kyung Hyun","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8844-4807","authenticated-orcid":false,"given":"Jong In","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Seoul St. Mary\u2019s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/bs.pmbts.2017.07.002","article-title":"Breast Cancer Epidemiology, Prevention, and Screening","volume":"151","author":"Winters","year":"2017","journal-title":"Prog. Mol. Biol. Transl. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Izzo, P., Molle, M., Cello, P.D., Meloni, P., Lai, S., Izzo, L., Sibio, S., Messineo, D., and Izzo, S. (2026). Breast Cancer Surgery: Past, Present and Future-A Narrative Review. J. Clin. Med., 15.","DOI":"10.3390\/jcm15103778"},{"key":"ref_3","first-page":"287","article-title":"Body posture in women after mastectomy and its changes as a result of rehabilitation","volume":"51","author":"Rostkowska","year":"2006","journal-title":"Adv. Med. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1007\/s11764-010-0156-4","article-title":"The relation between arm\/shoulder problems and quality of life in breast cancer survivors: A cross-sectional and longitudinal study","volume":"5","author":"Nesvold","year":"2011","journal-title":"J. Cancer Surviv."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"679","DOI":"10.2522\/ptj.20090104","article-title":"Effects of mastectomy on shoulder and spinal kinematics during bilateral upper-limb movement","volume":"90","author":"Crosbie","year":"2010","journal-title":"Phys. Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.clbc.2016.10.004","article-title":"Physical Effects of Unilateral Mastectomy on Spine Deformity","volume":"17","author":"Serel","year":"2017","journal-title":"Clin. Breast Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1973","DOI":"10.1111\/tbj.14018","article-title":"Impact of mastectomy for breast cancer on spinal curvature: Considerations when treating patients with scoliosis","volume":"26","author":"Gutkin","year":"2020","journal-title":"Breast J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.clbc.2017.06.012","article-title":"The Effect of Immediate Breast Reconstruction on Thoracic Spine Alignment After Unilateral Mastectomy","volume":"18","author":"Jeong","year":"2018","journal-title":"Clin. Breast Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Nam, K.E., Kim, I., Park, H.Y., and Lee, J.I. (2022). The effect of breast cancer surgery on spine alignment: Whole-spine radiograph analysis. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0276173"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Koele, M.C., Lems, W.F., and Willems, H.C. (2020). The Clinical Relevance of Hyperkyphosis: A Narrative Review. Front. Endocrinol., 11.","DOI":"10.3389\/fendo.2020.00005"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2298","DOI":"10.1093\/gerona\/glac113","article-title":"The Association Between the Kyphosis Angle and Physical Performance in Community-Dwelling Older Adults","volume":"77","author":"Koele","year":"2022","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"483","DOI":"10.3906\/sag-1912-22","article-title":"Retrospective analysis of the effect of breast surgery on body posture in patients with early-stage breast cancer after cancer treatment (VENUS study) (Breast cancer and body posture)","volume":"51","author":"Tanriverdi","year":"2021","journal-title":"Turk. J. Med. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"270","DOI":"10.12659\/PJR.895949","article-title":"A Comparison of Cobb Angle: Standing Versus Supine Images of Late-Onset Idiopathic Scoliosis","volume":"81","author":"Vavruch","year":"2016","journal-title":"Pol. J. Radiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/1748-7161-9-16","article-title":"Supine to standing Cobb angle change in idiopathic scoliosis: The effect of endplate pre-selection","volume":"9","author":"Keenan","year":"2014","journal-title":"Scoliosis"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"E656","DOI":"10.1097\/BRS.0b013e31828d255d","article-title":"Supine magnetic resonance imaging Cobb measurements for idiopathic scoliosis are linearly related to measurements from standing plain radiographs","volume":"38","author":"Lee","year":"2013","journal-title":"Spine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1097\/BRS.0000000000000927","article-title":"How Does the Supine MRI Correlate With Standing Radiographs of Different Curve Severity in Adolescent Idiopathic Scoliosis?","volume":"40","author":"Shi","year":"2015","journal-title":"Spine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1007\/s00198-021-06136-6","article-title":"The association between hyperkyphosis and fall incidence among community-dwelling older adults","volume":"33","author":"Koele","year":"2022","journal-title":"Osteoporos. Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1359\/JBMR.051201","article-title":"Hyperkyphotic posture and risk of future osteoporotic fractures: The Rancho Bernardo study","volume":"21","author":"Huang","year":"2006","journal-title":"J. Bone Miner. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.bone.2019.06.007","article-title":"Thoracic vertebral fractures and hyperkyphosis in elderly patients with end-stage kidney disease; do these patients have different clinical outcomes?","volume":"127","author":"Goto","year":"2019","journal-title":"Bone"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1016\/j.ctrv.2015.09.003","article-title":"Cancer treatment-induced bone loss (CTIBL): Pathogenesis and clinical implications","volume":"41","author":"Stucci","year":"2015","journal-title":"Cancer Treat. Rev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1007\/s00776-009-1394-z","article-title":"Changes in the sagittal spinal alignment of the elderly without vertebral fractures: A minimum 10-year longitudinal study","volume":"14","author":"Takeda","year":"2009","journal-title":"J. Orthop. Sci."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/5951\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T04:25:55Z","timestamp":1785558355000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/5951"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,30]]},"references-count":21,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15155951"],"URL":"https:\/\/doi.org\/10.3390\/jcm15155951","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,30]]}}}