Mastectomy, scoliosis not likely related

Dear Dr. Roach: In 2000 (at age 53), I had a mastectomy with a TRAM flap reconstruction. In 2010, I began experiencing lower back pain. I did physical therapy and have continued those exercises since then, but the back pain worsened last year. I began also doing low-impact aerobics classes and water therapy. X-rays at that time showed 19 degrees of left-leaning scoliosis, compared with 9 degrees back in 2010, but I don’t recall being told about any scoliosis at the time. In fact, I was never diagnosed with scoliosis before 2010.

My question is whether the scoliosis could be a result of the TRAM flap, where the left abdominal muscles are stronger than the right, pulling my spine to the left. My back specialist thought this unlikely. — R.D.

Answer: Scoliosis is a condition where the spine is pulled to one side. The most common form is adolescent scoliosis, which is caused by asymmetrical growth of the spine. In truth, nobody knows what makes this type happen. In contrast, scoliosis that starts in the 50s or later is most commonly degenerative, meaning something is causing the spinal bodies to degenerate. This happens in older people as a result of arthritis or due to weakening of the bone structure (osteoporosis). I agree with your back specialist that the TRAM flap (where a portion of the abdominal muscle is used in the mastectomy and reconstruction to provide a result that looks more natural) is not likely to be providing enough stress on the spine to cause scoliosis. If your breast cancer was estrogen-receptor positive (likely, at age 53), then you probably were put on an antiestrogen drug, which may increase the risk of osteoporosis. I would be sure you have had a recent examination to look at your bone density.