Purpose of Study
Numerous studies have been published regarding the physical and psychological issues related to breast hypertrophy. The correlation between hypertrophic breasts and chronic pain has been well explored and validated. The purpose of this study was to systematically review the literature on current radiological data regarding the effects of breast reduction mammoplasty on the vertebral column, and examine whether breast reduction leads to significant changes in the cervical, thoracic, lumbar and sacral angles measured using the Cobb method.

Methods
A 1970- 2017 literature search for studies with 10 or more subjects in which lateral radiographs of the spine were compared before and after surgery was undertaken. Studies meeting the following criteria were excluded: 1) articles which collected and analyzed only self-reported data; 2) case reports, abstracts only, letters, comments, and reviews; 3) studies investigating surgical procedures in which Cobb angles were not reported; 4) mixed surgical procedures (ie, augmentation and reduction); 5) breast hypertrophy secondary to pregnancy; and 6) reduction mammoplasty in the setting of breast cancer.

Results
Of the 103 studies identified, only four studies met our inclusion criteria for a total of 126 subjects. All four studies reported a decrease in thoracic kyphosis after surgery, with three reaching statistical significance. Two out of the four included articles measured the cervical lordosis and both found a statistically significant decrease after reduction mammoplasty. There were no significant variations in the sacral region after the surgical procedure, with two of the studies measuring this variable. With regards to the lumbar region, results were inconsistent as two studies reported a significant decrease, while the other two reported no change after surgery. 

Significance
Although surgery has been shown to relieve pain and improve quality of life for woman with breast hypertrophy, insurance companies consider this procedure to be esthetic and most patients are denied coverage. The included studies were the first to investigate possible mechanisms by which surgery may alleviate these symptoms using objective measurements. The results of this systematic review on current radiological data challenges the status quo and hints to significant postural changes that may explain pain relief following breast reduction.

A systematic review of the effects of breast reduction on back pain and the vertebral column